IGA AMENDMENT RE CHRONIC DISEASE HEALTH POLICY WITH ADHS.PDF

Maricopa County — Formal (2014-06-11)

Extracted text (via pymupdf_layout) 9051 characters

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT
1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS12-015902 Amendment No. 1
Manuel Gonzales
Chronic Disease Health Policy
It is mutually agreed that the Intergovernmental Agreement referenced is amended, effective April 1, 2014, as follows:
1. Price Sheet Page Fifteen (15) is hereby revised and replaced by Price Sheet Page Two (2), of this Amendment
One (1).
2. Scope of Work Page Twelve (12) through Fifteen (15) is hereby revised and replaced with Scope of Work Page
Three (3) through Page Five (5) of this Amendment One (1).
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County Health Department
Contractor Name Contractor Authorized Signature
4041 North Central Avenue, #1400
Address Printed Name
Phoenix Arizona 85012
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney date indicated. The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this ______ day of _______________________ 2014
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. PIGA2012000344, which is an
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General
Printed Name:
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS12-015902 Amendment No. 1
Manuel Gonzales
Price Sheet
Effective April 1, 2014
Budget Amount
Cost Reimbursement Line Items
1. Personnel Services/ERE $91,403
2. Professional & Outside Services 185,369
3. Travel Expenses 6,000
4. Other Operating Expense 2,518
5. Capital Outlay Expense NOT ALLOWED
6. Other (Indirect Costs) 13,710
Total Contract Amount (not to exceed) $299,000
ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS:
1. The Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total Contract amount among the
categorical line items. Transfers of funds are only allowed among funded line items as detailed in the original ISB. Transfers
exceeding ten percent (10%) of the Contracted amount, or to a non-funded line item, shall require a Contract Amendment.
2. Indirect Costs shall not exceed fifteen percent (15%) of the combined total of Personnel Services and Employee Related
Expenses as listed on the ISB. For more detailed information regarding indirect costs, refer to the ADHS Accounting and
Auditing Procedures Manual for Contractors of ADHS Funded Programs. This manual is incorporated into this Contract by
reference herein.
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
1740 W. Adams, Room 303
Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS12-015902 Amendment No. 1
Manuel Gonzales
Chronic Disease Health Policy Contact
Maricopa County Department of Public Health – Year Three SOW
1. Background
1.1 In February 2012 the Arizona Department of Health Services (ADHS) entered into a Contract with the Maricopa
County Department of Public Health (MCDPH) to provide technical assistance on the development and
implementation of evidence-based health policy in Arizona, specifically in relation to the increased coordination
and collaboration on policy, system and environmental change interventions which address the leading causes of
chronic disease morbidity and mortality.
1.2 With the technical assistance and support of the Contractor, during the two years of funding, ADHS successfully
advanced several Chronic Disease Prevention and Health Promotion (CDPHP) objectives including the:
1.2.1 Development of the Arizona Chronic Disease Strategic Plan and Communication Plan,
1.2.2 Implementation of health policy trainings for both State and County health staff and partners,
1.2.3 Development and implementation of a statewide worksite wellness program modeled off the CDC
National Healthy Worksites Program, and
1.2.4 Establishment of the Health in Arizona Policy Initiative, a statewide CDPHP demonstration project which
leverages funding from three bureaus within the ADHS Division of Public Health, Prevention Services.
1.3 During year three (3), ADHS will continue to build upon the successes of years one (1) and two (2) while
continuing to expand the capacity of ADHS to implement health policy, systems and environmental change
throughout Arizona.
2. Purpose/Objective
The purpose of this funding is to continue existing support services and functions of health policy management
including but not limited to development in the areas of health policy and worksite wellness, the implementation of the
Arizona Chronic Disease Strategic Plan, and staff and partnership development.
3. Activities/Tasks
The Contractor shall:
3.1 Assessment, education, and strategic planning on the Healthy Arizona Worksites Program;
3.2 Coordination and synchronization on ADHS efforts to identify and prioritize policy, system and environmental
change initiatives to address public health in Arizona;
3.3 Assistance with implementing the Arizona Chronic Disease Strategic Plan and the CDC’s CDPHP Four Domains;
3.4 Guidance and participation on ADHS’ Prevention Services Collaborative Leadership Team;
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
1740 W. Adams, Room 303
Phoenix, Arizona 85007
SCOPE OF WORK (602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS12-015902 Amendment No. 1
Manuel Gonzales
3.5 Assistance in developing partnerships with healthcare systems to leverage resources and design interventions
that address population health;
3.6 Attendance and participation in ADHS strategic planning efforts related to policy training, development, and
implementation;
3.7 Assistance in disseminating and supporting policy initiatives developed by ADHS and its partners throughout the
state of Arizona such as the Health in Arizona Policy Initiative, diabetes prevention, and initiatives utilizing
evidence-based tools and approaches;
3.8 Attendance at meetings with partners and stakeholders, including regional and/or national meetings / webinars /
teleconferences, ADHS meetings, community meetings, etc. as deemed necessary for completion of Contract
activities; and
3.9 Services onsite at ADHS as a Contractor for no less than twenty (20) hours per week.
4. Deliverables
The Contractor shall provide the following:
4.1 Contractor Expenditure Report / Invoices will be sent to ADHS fifteen (15) days after month end (Attachment A);
and
4.2 A comprehensive quarterly report summarizing findings of all Contractor activities / task identified in Provision
Three (3) shall be due on or before March 1, June 1, September 1 and December 1 of each year.
5 Exhibits
5.1 If applicable, continue to adhere to the Partner Marketing, Media, and Communications Guidelines and
5.2 If applicable, continue to adhere to Evaluation Guidelines.
6. Notices, Correspondence, Reports and Invoices
6.1 Notices, Correspondence, Reports and Invoices from Maricopa County Health Department shall be sent to:
Arizona Department of Health Services
Bureau of Tobacco and Chronic Disease
Attention: Tim Vaske
150 N. 18th Avenue, Suite 310
Phoenix, Arizona 85007
Phone: (602) 360-0841
Fax: (602) 364-0844
E-Mail: tim.vaske@azdhs.gov
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