IGA AMENDMENT RE TOBACCO EDUCATION WITH ADHS.PDF

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ARIZONA DEPARTMENT OF
. ' - INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
aa e• . 1740 W, Adams, Room 303
to Phoenix, Arizona 85007
" (602) 542-1040
(602) 542-1741 Fax
Procurement Specialis
Contract No: HG060018 Amendment No, 5
Manuel Gonzales
Tobacco Education and Prevention Services
It is mutually agreed that the Intergovernmental Agreement referenced is amended, effective January 1, 2014, as follows:
1. Replace Price Sheet, Page Two (2) Amendment Four (4) with Price Sheet Page Two (2) Amendment Five (5)
2. Delete in its entirety Page Eleven (11), Fingerprint and Certification Requirements/Juvenile Services.
3. Delete in its entirety Page Three (3), Amendment (3), Scrutinized Business in accordance with A.R.S. § 35-391 and A.R.S. §
35-393, Contractor certifies that the Contractor does not have scrutinized business operations in Sudan or Iran.
All other provisions of this a • reement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County through the Department of Public
Health
Contractor Name Contractor Authorized Signature
4041 North Central Avenue
Address Printed Name
Phoenix Arizona 86012
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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oosqrk ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
1740 W. Adams, Room 303
I;15112 , • -. - T, Phoenix, Arizona 85007
' N PRICE SHEET (602) 542-1040
(602) 642-1741 Fax
* 9 * Procurement Specialist
Contract No: HG060018 Amendment No. 5 Manuel Gonzales
Effective January, 2014
Cost Reimbursement Line Items Budget Amount
1. Personnel Services/ERE $1,192,198
2. Professional & Outside Services 628,451 I
3. Travel Expenses 29,052
4. Other Operating Expense 523,603
5. Capital Outlay Expense 0
6. Other (Indirect Costs) 178,830
Total Contract Amount (not to exceed) $2,552,134
1. ITEMIZED SERVICE BUDGET (1SB) RESTRICTIONS:
A. 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.
B. Indirect Costs shall not exceed fifteen percent (16%) 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. AUTHORIZATION FOR PROVISION OF SERVICES:
Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a
Purchase Order that is signed by an authorized agent. The Purchase Order will indicate the Contract
number and the dollar amount of funds authorized, The Contractor shall only be authorized to perform
services up to the amount on the Purchase Order. ADHS shall not have any legal obligation to pay for
services in excess of the amount indicated on the Purchase Order. No further obligation for payment shall
exist on behalf of ADHS unless a) the Purchase Order is changed or modified with an official ADHS
Procurement Change Order, and/or b) an additional Purchase Order is issued for purchase of services under
this Contract.
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