PURCHASE ORDER RE STD IPP TESTING WITH ADHS.PDF

)0-120- 3--(C)
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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: HG052195:4
Organizational Reference No.: E0158793
Issued: 03/26/2014
V.1 Vendor Number 000010983 Arizona Department of Health Services
Maricopa County Public Health S Office of Disease Integration and Services
4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 110
Phoenix, AZ 85012 Phoenix, AZ 85007
US
Email: maria.thomas@azdhs.gov
Contract No.: HG052195 (602) 364-3601
Title: STD Program - Marl cope CT/GC Screening 2014
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Office of Disease Integration and Services
150 N. 18th Avenue, Suite 110
Phoenix, AZ 85007
US
Email: maria.thomas@azdhs.gov
(602) 364-3601
Release Instructions
TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order
are incorporated herein by reference and become a part of this order.
Account Code: 14-99405-52300-6811- Payment Terms:
Shipping Terms:
Solicitation (Bid) No,: Delivery Calendar Day(s)A.R.0,: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 952-49
1670.00 EA $ 11.30 $ 18,871,00
0015 - STD Program -Ublization of County Lab: IPP Testing. PO Budget
Period 01/01/2014 through 12/31/2014. CFDA 93.977. Contract#
HG062195. This is 50% of the program total. Additional 50% will be added.
Total amount for the budget period is $37,765.00
TOTAL: $ 1887100 ,
Approved By: Maria Thomas
Phone No.: (602) 364-4761

C-86-10-120-3-10 STD Program IPP Testing
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Ma ricopa County
Date