IGA AMENDMENT RE CHRONIC DISEASE HEALTH POLICY WITH ADHS.PDF
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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). 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: 1. 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 175,369 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) $289,000 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. 2.