PO RE POPULATION HEALTH POLICY WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS12-021145:3
Organizational Reference No.: E0157283
Issued: 03/17/2014
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health S Bureau of Heath Systems Development
4041 N. Central Avenue, #1400 H 150 North 18th Avenue, Room 300
Phoenix, AZ 85012 Phoenix, AZ 85007
US
Email: procure@azdhs,gov
Contract No.: ADHS12-021145 (602) 542-1219
Title: HSD/HAPI/MARICOPA/ 4/1/14-3/31/15
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Bureau of Health Systems Development
150 North 18th Avenue, Room 300
Phoenix, AZ 85007
US
Email: procuregazdhs.gov
(602) 542-1219
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: 14-99409-75020-6811- Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A,R.O.: 0
Item Description 1 Requisition Quantity Unit Unit Price Total
Class-Item 952-44
1 4.00 QTR $ 19,945.00 $ 79,780.00
Procurement - Tobacco Tax 86505-75020-14 $51975.25 CFDA:none; MCH
Block Grant 99409-75020-14 $19945 CFDA: 93.994, Lottery Games 97481-
75020-14 $7859.75 CFDA:none --- PO Period of Performance: 4/1/14-
3/31/15 Contract Expires 3/31/15
Class-Item 952-44
2 4.00 QTR $ 19,945.00 $ 79,780.00
Healthy Community Design - Tobacco Tax 86505-75020-14 $51975,25
CFDA:none; MCH Block Grant 99409-75020-14 $19945 CFDA: 93.994,
Lottery Games 97481-75020-14 $7859.75 CFDA:none
Class-Item 952-44
3 4.00 QTR $ 19,945.00 $ 79,780.00
School Health - Tobacco Tax 86505-75020-14 $51975.25 CFDA:none,
MCH Block Grant 99409-75020-14 $19945 CFDA: 93,994, Lottery Games
97481-75020-14 $7859.75 CFDA:none

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
Class-Item 952-44
4 4,00 QTR $ 19,945 00 $ 79,780.00
VVorksite Wellness - Tobacco Tax 86505-75020-14 $51975.25 CFDA:none:
MCH Block Grant 99409-75020-14 $19945 CFDA: 93,994, Lottery Games
97481-75020-14 87859,75 CFDAzione
Class-Item 952-44
5 4.00 OW $ 19,945.00 $ 79,780,00
Clinical Care - Tobacco Tax 86505-75020-14 $59835 CFDA:none; MChi
Block Grant 99409-75020-14 $11384 CFDA: 93.994, Lottery Games 97481-
75020-14 $8561 CFDA:none
TOTAL: $ 398,900.00
Approved By: Nicki Strattard
Phone No.: (602) 542-1174

C-8642-077-3-02 Population Health Policy Initiative
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 Maricopa County
Date