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Page 1 of 2 ARIZONA STATE CONTRACT CONTRACT RELEASE ProcureAZ Purchase Order No.: ADHS13-041805:5 Organizational Reference No.: E0144679 Issued: 01/02/2014 V Vendor Number: 000010983 Arizona Department of Health Services Maricopa County Public Health S Epidemiology and Disease Control Immunization N 4041 N. Central Avenue, #1400 H Program Phoenlx, AZ 85012 150 N. 18th Avenue, Suite 120 Phoenix, AZ 85007 US Email: procure@azdhs.gov T 0 Contract No,: ADFiS13-041805 602 364-3630 Title: Maricopa County Public Health MAIL INVOICE IN DUPLICATE TO: a Arizona Department of Health Services 1 Epidemiology and Disease Control Immunization ' Program L 150 N. 18th Avenue, Suite 120 L Phoenix, AZ 85007 US Email: procure@azdhs.gov CI (602) 364-3630 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: 13-99386-54000-6811- Payment Terms: Net 30 Shipping Terms: Solicitation (Bid) No.: Delivery Calendar Day(s)A.R.O.: 0 Item Description I Requisition Quantity Unit Unit Price Total Class-Item 948-92 Immunization - Contract ADHS13-041805 - Contract End Date - 12/31/2017. PO effective from issue date until 12/31/14. CFDA# 93.268. PO for the delivery of Immunization services and activities as follows; * Salary/Fringe - YEARLY $50,000.00 * Immunization visit for children zero (0) to eighteen (18) years of age - UNIT RATE $50.00 * Immunization Completion for children zero (0) to eighteen (18) years of 1 age - UNIT RATE $100.00 1.00 TOTAL $ 138,430.75 $ 138,430.75 * Perinatal Hepatitis B Case Management - Prenatal - UNIT RATE $300.00 * Perinatal Hepatitis 8 Case Management - Postnatal - UNIT RATE $200.00 * School/Children IDR Management-Preparation and submittal - UNIT RATE $250,00 * Immunization Visit for adults nineteen (19) years of age and older - UNIT RATE $50.00 * Immunization Visit for Flu Vaccine, in children and adults - UNIT RATE $50.00 TOTAL: $ 138,430 75 Approved By: Myra Chavez Phone No.: (602) 364-3649