13054-CONTRACT - EBONY.PDF

CONTRACT PURSUANT TO RFP
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This Contract is entered into this 12th day of February, 2014 by and between Maricopa County (“County”), a
political subdivision of the State of Arizona, and Ebony House, Inc., an Arizona corporation (“Contractor”) for the
purchase of Medical and Non-Medical Case Management Services.
1.0 CONTRACT TERM:
1.1 This Contract is for a term of five (5) years, beginning on the 1st day of March, 2014 and ending
the 28th day of February, 2019.
1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this
Contract for additional terms up to a maximum of five (5) one-year renewal terms, (or at the
County’s sole discretion, extend the contract on a month-to-month bases for a maximum of six (6)
months after expiration). The County shall notify the Contractor in writing of its intent to extend
the Contract term at least thirty (30) calendar days prior to the expiration of the original contract
term, or any additional term thereafter.
2.0 PAYMENTS:
2.1 As consideration for performance of the duties described herein, County shall pay Contractor the
sum(s) stated in Exhibit “B”.
2.2 Payment shall be made upon the County’s receipt of a properly completed invoice. Invoices shall
contain the following information: Contract number, purchase order number, item numbers,
description of supplies and/or services, sizes, quantities, unit prices, extended totals and any
applicable sales/use tax.
2.3 INVOICES:
2.3.1 The Contractor shall submit electronically to the Administrative Agent one (1) legible
copy of their detailed monthly invoice before payment(s) can be made.
2.3.2 Contractor will submit the invoice packet for services performed on or before the fifteen
(15th) calendar day following the month in which services were performed.
2.3.3 The invoice must include the requirements as outlined in the Ryan White Part A’s current
policies and procedures manual.
2.3.4 Contractors providing medical services are required to utilize the Health Care Form 1500
(HCF-1500), Uniform Billing 92 (UB-92) or other standardized medical claim forms as
agreed to with the Administrative Agent, and to submit these to the Ryan White Part A
Program in addition to the other required invoice reports and forms.
2.3.5 Problems regarding billing or invoicing shall be directed to the County as listed on the
Purchase Order.
2.3.6 Payment shall be made to the Contractor by Accounts Payable through the Maricopa
County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT)
process. After Contract Award the Contractor shall complete the Vendor Registration

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Form located on the County Department of Finance Vendor Registration Web Site
(www.maricopa.gov/finance/vendors).
2.3.7 EFT payments to the routing and account numbers designated by the Contractor will
include the details on the specific invoices that the payment covers. The Contractor is
required to discuss remittance delivery capabilities with their designated financial
institution for access to those details.
3.0 DUTIES:
3.1 The Contractor shall perform all duties stated in Exhibits “B & C” and the budget’s schedule of
deliverables for that grant year and/or as directed by the current Ryan White Part A policies and
procedures manual or as otherwise directed in writing by the Procurement Officer.
3.2 The Contractor shall perform services at the location(s) and time(s) stated in this application, the
current approved work plan or as otherwise directed in writing, via contract amendment and/or
task order from the Administrative Agent.
3.3 During the Contract term, County shall provide Contractor’s personnel with adequate workspace
for consultants and such other related facilities as may be required by Contractor to carry out its
contractual obligations.
4.0 TERMS and CONDITIONS:
4.1 PRICE ADJUSTMENTS:
4.1.1 Any request for a fee adjustment must be submitted sixty (60) days prior to the current
Contract anniversary date. Requests for adjustment in cost of labor and/or materials must
be supported by appropriate documentation. If County agrees to the adjusted fee, County
shall issue written approval of the change. The reasonableness of the request will be
determined by comparing the request with the AHCCCS fee schedule or by performing a
market survey.
4.2 INDEMNIFICATION:
4.2.1 To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold
harmless County, its agents, representatives, officers, directors, officials, employees and
volunteers from and against all claims, damages, losses and expenses, including, but not
limited to, attorney fees, court costs, expert witness fees, and the cost of appellate
proceedings, relating to, arising out of, or alleged to have resulted from the negligent acts,
errors, omissions, mistakes or malfeasance relating to the performance of this Contract.
Contractor’s duty to defend, indemnify and hold harmless County, its agents,
representatives, officers, directors, officials, employees and volunteers shall arise in
connection with any claim, damage, loss or expense that is caused by any negligent acts,
errors, omissions or mistakes in the performance of this Contract by the Contractor, as
well as any person or entity for whose acts, errors, omissions, mistakes or malfeasance
Contractor may be legally liable.
4.2.2 The amount and type of insurance coverage requirements set forth herein will in no way
be construed as limiting the scope of the indemnity in this paragraph.
4.2.3 The scope of this indemnification does not extend to the sole negligence of County.
4.3 INSURANCE REQUIREMENTS:
4.3.1 The Contractor shall have in effect at all times during the term of this Contract insurance
which is adequate to protect Maricopa County, its officers and employees, participants
and equipment funded under the Contract against such losses as are set forth below. The
Contractor shall provide County with current documentation of insurance coverage by
furnishing a Certificate of Insurance or a certified copy of the insurance policy naming

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Maricopa County as an additional insured.
4.3.2 The following types and amounts of insurance are required as minimums:
4.3.2.1 Worker's Compensation as required by Arizona law; and employer’s liability
insurance with $1,000,000 per accident, $1,000,000 per disease and $1,000,000
per limit disease.
4.3.2.2 Unemployment Insurance as required by Arizona law.
4.3.2.3 Commercial general liability insurance the limits of the policies shall not be less
than $2,000,000 per occurrence, $4,000,000 general aggregate, $2,000,000
products completed operations aggregate.
4.3.3 Automobile and Truck Liability, Bodily Injury and Property Damages:
4.3.3.1 Combined single limit; $1,000,000.
4.3.4 Standard minimum deductible amounts are allowable. Any losses applied against
insurance deductibles are the sole responsibility of the Contractor.
4.3.5 Professional Liability Insurance; $2,000,000 per occurrence or claim and $4,000,000
aggregate.
4.3.6 The Contractor will immediately inform the Director of any cancellation of its insurance
or any decrease in its lines of coverage at least thirty (30) days before such action takes
place.
4.3.7 Certificates of Insurance.
4.3.7.1 Prior to commencing work or services under this Contract, Contractor shall have
insurance in effect as required by the Contract in the form provided by the
County, issued by Contractor’s insurer(s), as evidence that policies providing the
required coverage, conditions and limits required by this Contract are in full
force and effect. Such certificates shall be made available to the County upon
ten (10) business days. BY SIGNING THE AGREEMENT PAGE THE
CONTRACTOR AGREES TO THIS REQUIREMENT AND FAILURE
TO MEET THIS REQUIREMENT WILL RESULT IN CANCELLATION
OF CONTRACT.
4.3.7.1.1 In the event any insurance policy (ies) required by this Contract is
(are) written on a “claims made” basis, coverage shall extend for two
(2) years past completion and acceptance of Contractor’s work or
services and as evidenced by annual Certificates of Insurance.
4.3.7.1.2 If a policy does expire during the life of the Contract, a renewal
certificate must be sent to County fifteen (15) days prior to the
expiration date.
4.3.8 Cancellation and Expiration Notice.
Insurance required herein shall not be permitted to expire, be canceled, or materially
changed without thirty (30) days prior written notice to the County.
4.4 NOTICES:
All notices given pursuant to the terms of this Contract shall be addressed to:
For County:

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Maricopa County
Office of Procurement Services
ATTN: Contract Administration
320 West Lincoln Street
Phoenix, Arizona 85003-2494
For Contractor:
Ebony House, Inc.
ATTN: Mr. William Freeman
6222 S. 13th Street
Phoenix, AZ 85042
4.5 REQUIREMENTS CONTRACT:
4.5.1 Contractor signifies its understanding and agreement by signing this document that this
Contract is a requirements contract. This Contract does not guarantee any purchases will
be made (minimum or maximum). Orders will only be placed when County identifies a
need and issues a purchase order or a written notice to proceed.
4.5.2 County reserves the right to cancel purchase orders or notice to proceed within a
reasonable period of time after issuance. Should a purchase order or notice to proceed be
canceled, the County agrees to reimburse the Contractor for actual and documented costs
incurred by the Contractor. The County will not reimburse the Contractor for any
avoidable costs incurred after receipt of cancellation, or for lost profits, or shipment of
product or performance of services prior to issuance of a purchase order or notice to
proceed.
4.5.3 Contractor agrees to accept written cancellation of purchase orders.
4.6 TERMINATION:
4.6.1 Either party may terminate this Contract at any time with thirty (30) days prior written
notice to the other party. Such notice shall be given by personal delivery or by
Registered or Certified Mail.
4.6.2 This Contract may be terminated by mutual written agreement of the parties specifying
the termination date therein.
4.6.3 County may terminate this Contract upon twenty-four (24) hours notice when County
deems the health or welfare of a patient is endangered or Contractor non-compliance
jeopardizes funding source financial participation. If not terminated by one of the above
methods, this Contract will terminate upon the expiration date of this Contract as stated
on the Cover Page.
4.7 TERMINATION FOR DEFAULT:
County may suspend, modify or terminate this Contract immediately upon written notice to
Contractor in the event of a non-performance of stated objectives or other material breach of
contractual obligations; or upon the happening of any event, which would jeopardize the ability of
the Contractor to perform any of its contractual obligations.
4.8 TERMINATION BY THE COUNTY:
If the Contractor should be adjudged bankrupt or should make a general assignment for the benefit
of its creditors, or if a receiver should be appointed on account of its insolvency, the County may
terminate the Contract. If the Contractor should persistently or repeatedly refuse or should fail,
except in cases for which extension of time is provided, to provide enough properly skilled
workers or proper materials, or persistently disregard laws and ordinances, or not proceed with
work or otherwise be guilty of a substantial violation of any provision of this Contract, then the
County may terminate the Contract. Prior to termination of the Contract, the County shall give the

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Contractor fifteen- (15) calendar day’s written notice. Upon receipt of such termination notice, the
Contractor shall be allowed fifteen (15) calendar days to cure such deficiencies.
4.9 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST:
Notice is given that pursuant to A.R.S. §38-511 the County may cancel this Contract without
penalty or further obligation within three years after execution of the contract, if any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County is at any time while the Contract or any extension of the Contract is in effect,
an employee or agent of any other party to the Contract in any capacity or consultant to any other
party of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to
A.R.S §38-511 the County may recoup any fee or commission paid or due to any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County from any other party to the contract arising as the result of the Contract.
4.10 OFFSET FOR DAMAGES;
In addition to all other remedies at law or equity, the County may offset from any money due to
the Contractor any amounts Contractor owes to the County for damages resulting from breach or
deficiencies in performance under this contract.
4.11 ADDITIONS/DELETIONS OF SERVICE:
4.11.1 The County reserves the right to add and/or delete materials to a Contract. If a service
requirement is deleted, payment to the Contractor will be reduced proportionately, to the
amount of service reduced in accordance with the bid price. If additional materials are
required from a Contract, prices for such additions will be negotiated between the
Contractor and the County.
4.11.2 The County reserves the right of final approval on proposed staff for all Task Orders.
Also, upon request by the County, the Contractor will be required to remove any
employees working on County projects and substitute personnel based on the discretion
of the County within two business days, unless previously approved by the County.
4.12 RELATIONSHIPS:
In the performance of the services described herein, the Contractor shall act solely as an
independent contractor, and nothing herein or implied herein shall at any time be construed as to
create the relationship of employer and employee, partnership, principal and agent, or joint venture
between the District and the Contractor.
4.13 USE OF SUBCONTRACTORS:
4.13.1 The use of subcontractors and/or consultants shall be pre-approved by the County. If the
use of subcontractors is approved by County, the Contractor agrees to use written
subcontract/consultant agreements which conform to Federal and State laws, regulations
and requirements of this Contract appropriate to the service or activity covered by the
subcontract. These provisions apply with equal force to the subcontract as if the
subcontractor were the Contractor referenced herein. The Contractor is responsible for
Contract performance whether or not subcontractors are used. The Contractor shall
submit a copy of each executed subcontract to County within fifteen (15) days of its
effective date.
4.13.2 All subcontract agreements must provide a detailed scope of work, indicating the
provisions of service to be provided by both the Contractor and Subcontractor.
4.13.2.1 All subcontract agreements must include a detailed budget, identifying all
administrative and direct service costs as defined in the Budget, Revenues and
Expenditures section.

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4.13.2.2 All subcontract agreements must document the qualifications and ability to
provide services by the subcontracting agency.
4.13.2.2.1 The Contractor agrees to include in any subcontracts a provision to
the effect that the subcontractor agrees that County shall have access
to the subcontractor’s facilities and the right to examine any books,
documents and records of the subcontractor, involving transactions
related to the subcontract and that such books, documents and
records shall not be disposed of except as provided herein.
4.13.2.2.2 The Contractor shall not enter into a subcontract for any of the work
contemplated under this Agreement except in writing and with prior
written approval of the County. Such approval shall include the
review and acceptance by the County of the proposed sub-contractual
arrangement between the Contractor and the subcontractor.
4.14 AMENDMENTS:
All amendments to this Contract shall be in writing and approved/signed by both parties. Maricopa
County Office of Procurement Services shall be responsible for approving all amendments for
Maricopa County.
4.15 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR
OTHER REVIEW:
4.15.1 In accordance with section MCI 367 of the Maricopa County Procurement Code the
Contractor agrees to retain all books, records, accounts, statements, reports, files, and
other records and back-up documentation relevant to this Contract for six (6) years after
final payment or until after the resolution of any audit questions which could be more
than six (6) years, whichever is latest. The County, Federal or State auditors and any
other persons duly authorized by the Department shall have full access to, and the right to
examine, copy and make use of, any and all said materials.
4.15.2 If the Contractor’s books, records , accounts, statements, reports, files, and other records
and back-up documentation relevant to this Contract are not sufficient to support and
document that requested services were provided, the Contractor shall reimburse Maricopa
County for the services not so adequately supported and documented.
4.16 AUDIT DISALLOWANCES:
4.16.1 The Contractor shall, upon written demand, reimburse Maricopa County for any
payments made under this Contract, which are disallowed, by a Federal, State or
Maricopa County audit in the amount of the disallowance, as well as court costs and
attorney fees which Maricopa County incurs to pursue legal action relating to such a
disallowance.
4.16.2 If at any time it is determined by County that a cost for which payment has been made is
a disallowed cost, County shall notify the Contractor in writing of the disallowance and
the required course of action, which shall be at the option of County either to adjust any
future claim submitted by the Contractor by the amount of the disallowance or to require
repayment of the disallowed amount by the Contractor.
4.16.3 The Contractor shall be responsible for repayment of any and all applicable audit
exceptions, which may be identified by County, State and Federal auditors of their
designated representatives, and reviewed by the Contractor. The Contractor will be billed
by the County for the amount of said audit disallowance and shall promptly repay such
audit disallowance within 60 days of said billing.

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4.17 CONTRACT COMPLIANCE MONITORING:
4.17.1 County shall monitor the Contractor's compliance with, and performance under, the terms
and conditions of this Contract. On-site visits for Contract compliance monitoring may be
made by County and/or its grantor agencies at any time during the Contractor's normal
business hours, announced or unannounced. The Contractor shall make available for
inspection and/or copying by County, all records and accounts relating to the work
performed or the services provided under this Contract, or for similar work and/or service
provided under other grants and contracts.
4.17.2 The Contractor shall have policies and procedures in place that allow the County as the
funding agency prompt and full access to financial, program and management records
and documents as needed for program and fiscal monitoring and oversight.
4.17.3 Contractor shall follow and comply with all related corrective action plans and
requirements of site visits and subsequent audits conducted by County and its
representatives. When monetary penalties are imposed or unallowable costs determined,
the County will define how repayment will be made to the County. This may include
decreasing or withholding the Contractor’s monthly billing or requiring payment to the
County.
4.17.4 The Contractor shall submit reports to County as requested that detail performance and
allow review of budget, cost of services and unit cost methodology.
4.18 AVAILABILITY OF FUNDS:
4.18.1 The provisions of this Contract relating to payment for services shall become effective
when funds assigned for the purpose of compensating the Contractor as herein provided
are actually available to County for disbursement. The Director shall be the sole judge
and authority in determining the availability of funds under this Contract and County
shall keep the Contractor fully informed as to the availability of funds.
4.18.2 If any action is taken by any State Agency, Federal Department or any other agency or
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in
connection with, this Contract, County may amend, suspend, decrease, or terminate its
obligations under, or in connection with, this Contract. In the event of termination,
County shall be liable for payment only for services rendered prior to the effective date of
the termination, provided that such services are performed in accordance with the
provisions of this Contract. County shall give written notice of the effective date of any
suspension, amendment, or termination under this section, at least ten (10) days in
advance.
4.19 RESTRICTIONS ON USE OF FUNDS:
4.19.1 The Contractor shall not utilize funds made available under this Contract to make
payments for any item or service to the extent that payment has been made, or can
reasonably be expected to be made, with respect to that item or service:
4.19.1.1 Under any State compensation program, under any insurance policy, or under
any Federal, State, or county health benefits program; or
4.19.1.2 By an entity that provides health services on a prepaid basis.
4.19.2 Funds shall not be used to purchase or improve (other than minor remodeling) any
building or other facility, or to make cash payments to intended recipients of services as
referenced in the Arizona Revised Statutes (ARS) A.R.S. § 41-2591, R2-7-701 and Code
of Federal Regulations, Chapter 1, Subchapter e., Part 31, and Public Health Service
Grants Policy Statement.
4.19.3 The federal Office of General Counsel and County emphasize that Ryan White Act funds
may only support HIV-related needs of eligible individuals. All activities and

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expenditures must reflect an explicit connection between any service supported with
Ryan White Act funds and the intended recipient’s HIV status.
4.19.4 Contractor is not authorized to provide services anonymously, unless specifically
approved for the service category in which the Contractor is providing services. All
services must only be provided to documented eligible clients as defined in this contract.
4.19.5 Ryan White funds shall not be used to finance the services of lobbyists, fundraisers or
grant/proposal writers, nor to support lobbying, fundraising activities and/or the writing
of grant/contract proposals. The Contractor shall have personnel policies and an
employee orientation manual that include regulations that forbid using federal funds to
lobby Congress or other Federal personnel.
4.19.6 The Ryan White Act limits the administrative expenses to not more than 10% of the total
grant award. The Act defines allowable “administrative activities” to include:
4.19.6.1 Usual and recognized overhead, including established indirect rates for agencies;
4.19.6.2 Management and oversight of specific programs funded under this title; and
4.19.6.3 Other types of program support such as quality assurance, quality control, and
related activities.”
4.20 CONTINGENCY RELATING TO OTHER CONTRACTS AND GRANTS:
4.20.1 The Contractor shall, during the term of this Contract, immediately inform County in
writing of the award of any other contract or grant where the award of such contract or
grant may affect either the direct or indirect costs being paid/reimbursed under this
Contract. Failure by the Contractor to notify County of such award shall be considered a
material breach of the Contract and County shall have the right to terminate this Contract
without liability.
4.20.2 County may request, and the Contractor shall provide within a reasonable time, a copy of
any other contract or grant, when in the opinion of the Director, the award of the other
contract or grant may affect the costs being paid or reimbursed under this Contract.
4.20.3 If County determines that the award to the Contractor of such other Federal or State
contract or grant has affected the costs being paid or reimbursed under this Contract,
County shall prepare a Contract Amendment effecting a cost adjustment. If the
Contractor protests the proposed cost adjustment, the protest shall be construed as a
dispute within the meaning of the "Disputes" clause contained herein.
4.21 SEVERABILITY:
The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the
validity of any other provision of this Contract.
4.22 ALTERNATIVE DISPUTE RESOLUTION:
4.22.1 After the exhaustion of the administrative remedies provided in the Maricopa County
Procurement Code, any contract dispute in this matter is subject to compulsory
arbitration. Provided the parties participate in the arbitration in good faith, such
arbitration is not binding and the parties are entitled to pursue the matter in state or
federal court sitting in Maricopa County for a de novo determination on the law and facts.
If the parties cannot agree on an arbitrator, each party will designate an arbitrator and
those two arbitrators will agree on a third arbitrator. The three arbitrators will then serve
as a panel to consider the arbitration. The parties will be equally responsible for the
compensation for the arbitrator(s). The hearing, evidence, and procedure will be in
accordance with Rule 74 of the Arizona Rules of Civil Procedure. Within ten (10) days
of the completion of the hearing the arbitrator(s) shall:

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4.22.1.1 Render a decision;
4.22.1.2 Notify the parties that the exhibits are available for retrieval; and
4.22.1.3 Notify the parties of the decision in writing (a letter to the parties or their
counsel shall suffice).
4.22.1.4 Within ten (10) days of the notice of decision, either party may submit to the
arbitrator(s) a proposed form of award or other final disposition, including any
form of award for attorneys’ fees and costs. Within five (5) days of receipt of
the foregoing, the opposing party may file objections. Within ten (10) days of
receipt of any objections, the arbitrator(s) shall pass upon the objections and
prepare a signed award or other final disposition and mail copies to all parties or
their counsel.
4.22.2 Any party which has appeared and participated in good faith in the arbitration
proceedings may appeal from the award or other final disposition by filing an action in
the state or federal court sitting in Maricopa County within twenty (20) days after date of
the award or other final disposition. Unless such action is dismissed for failure to
prosecute, such action will make the award or other final disposition of the arbitrator(s) a
nullity.
4.23 MEDIATION/ARBITRATION:
In the event that a dispute arises under the terms of this agreement, or where the dispute involves
the parties to the agreement, a recipient of services under the terms of this agreement, it is
understood that the parties to the dispute shall meet and confer in an effort to resolve the dispute.
In the event that such efforts to resolve the dispute are not successful, the parties to the dispute
will agree to submit the dispute to non-binding mediation before a mutually agreed upon and
acceptable person who will act as the mediator. In the event that such non-binding mediation
efforts are not able to resolve the dispute, the parties agree to submit the matter to binding
arbitration wherein each party selects their own arbitrator and the two selected arbitrators meet and
mutually agree upon the selection of a third arbitrator. Thereafter, the three arbitrators are to
proceed with arbitration in a manner that is consistent with the provision of A.R.S. 12-1518.
4.24 STRICT COMPLIANCE:
Acceptance by County of performance not in strict compliance with the terms hereof shall not be
deemed to waive the requirement of strict compliance for all future performance obligations. All
changes in performance obligations under this Contract must be in writing.
4.25 NON-LIABILITY:
Maricopa County and its officers and employees shall not be liable for any act or omission by the
Contractor or any subcontractor, employee, officer, agent, or representative of Contractor or
subcontractors occurring in the performance of this Contract, nor shall they be liable for purchases
or Contracts made by the Contractor in anticipation of funding hereunder.
4.26 RIGHT OF PARTIAL CANCELLATION:
If more than one service category is funded by this Contract, Maricopa County reserves the right
to terminate this Contract or any part thereof based upon the Contractor’s failure to perform any
part of this contract without impairing, invalidating or canceling the remaining service category
obligations as stated in the current schedule of deliverables.
4.27 RIGHTS IN DATA:
The County shall own have the use of all data and reports resulting from this Contract without
additional cost or other restriction except as provided by law. Each party shall supply to the other

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party, upon request, any available information that is relevant to this Contract and to the
performance hereunder.
4.28 INTEGRATION:
This Contract represents the entire and integrated agreement between the parties and supersedes
all prior negotiations, proposals, communications, understandings, representations, or agreements,
whether oral or written, express or implied.
4.29 VERIFICATION REGARDING COMPLIANCE WITH ARIZONA REVISED STATUTES §41-
4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS:
4.29.1 By entering into the Contract, the Contractor warrants compliance with the Immigration
and Nationality Act (INA using e-verify) and all other federal immigration laws and
regulations related to the immigration status of its employees and A.R.S. §23-214(A). The
contractor shall obtain statements from its subcontractors certifying compliance and shall
furnish the statements to the Procurement Officer upon request. These warranties shall
remain in effect through the term of the Contract. The Contractor and its subcontractors
shall also maintain Employment Eligibility Verification forms (I-9) as required by the
Immigration Reform and Control Act of 1986, as amended from time to time, for all
employees performing work under the Contract and verify employee compliance using the
E-verify system and shall keep a record of the verification for the duration of the
employee’s employment or at least three years, whichever is longer. I-9 forms are available
for download at USCIS.GOV.
4.29.2 The County retains the legal right to inspect contractor and subcontractor employee
documents performing work under this Contract to verify compliance with paragraph
4.20.1 of this Section. Contractor and subcontractor shall be given reasonable notice of the
County’s intent to inspect and shall make the documents available at the time and date
specified. Should the County suspect or find that the Contractor or any of its subcontractors
are not in compliance, the County will consider this a material breach of the contract and
may pursue any and all remedies allowed by law, including, but not limited to: suspension
of work, termination of the Contract for default, and suspension and/or debarment of the
Contractor. All costs necessary to verify compliance are the responsibility of the
Contractor.
4.30 CONTRACTOR LICENSE REQUIREMENT:
4.30.1 The Respondent shall procure all permits, insurance, licenses and pay the charges and
fees necessary and incidental to the lawful conduct of his/her business, and as necessary
complete any required certification requirements, required by any and all governmental
or non-governmental entities as mandated to maintain compliance with and in good
standing for all permits and/or licenses. The Respondent shall keep fully informed of
existing and future trade or industry requirements, Federal, State and Local laws,
ordinances, and regulations which in any manner affect the fulfillment of a Contract and
shall comply with the same. Contractor shall immediately notify both Office of
Procurement Services and the using agency of any and all changes concerning permits,
insurance or licenses.
4.30.2 Respondents furnishing finished products, materials or articles of merchandise that will
require installation or attachment as part of the Contract, shall possess any licenses
required. A Respondent is not relieved of its obligation to posses the required licenses by
subcontracting of the labor portion of the Contract. Respondents are advised to contact
the Arizona Registrar of Contractors, Chief of Licensing, at (602) 542-1525 to ascertain
licensing requirements for a particular contract. Respondents shall identify which
license(s), if any, the Registrar of Contractors requires for performance of the Contract.

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4.31 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
4.31.1 The undersigned (authorized official signing for the Contractor) certifies to the best of his
or her knowledge and belief, that the Contractor, defined as the primary participant in
accordance with 45 CFR Part 76, and its principals:
4.31.1.1 are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any Federal
Department or agency;
4.31.1.2 have not within 3-year period preceding this Contract been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a
public (Federal, State or local) transaction or contract under a public transaction;
violation of Federal or State antitrust statues or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
4.31.1.3 are not presently indicted or otherwise criminally or civilly charged by a
government entity (Federal, State or local) with commission of any of the
offenses enumerated in paragraph (2) of this certification; and
4.31.1.4 have not within a 3-year period preceding this Contract had one or more public
transaction (Federal, State or local) terminated for cause of default.
4.31.2 Should the Contractor not be able to provide this certification, an explanation as to why
should be attached to the Contract.
4.31.3 The Contractor agrees to include, without modification, this clause in all lower tier
covered transactions (i.e. transactions with subcontractors) and in all solicitations for
lower tier covered transactions related to this Contract.
4.32 INFLUENCE
As prescribed in MC1-1202 of the Maricopa County Procurement Code, any effort to influence an
employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct,
may be grounds for Disbarment or Suspension under MC1-902.
An attempt to influence includes, but is not limited to:
4.32.1 A Person offering or providing a gratuity, gift, tip, present, donation, money,
entertainment or educational passes or tickets, or any type valuable contribution or
subsidy;
4.32.2 That is offered or given with the intent to influence a decision, obtain a contract, garner
favorable treatment, or gain favorable consideration of any kind.
If a Person attempts to influence any employee or agent of Maricopa County, the Chief
Procurement Officer, or his designee, reserves the right to seek any remedy provided by the
Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided
by this contract.
4.33 GOVERNING LAW:
This Contract shall be governed by the laws of the state of Arizona. Venue for any actions or
lawsuits involving this Contract will be in Maricopa County Superior Court or in the United States
District Court for the District of Arizona, sitting in Phoenix, Arizona

SERIAL 13054-RFP
4.34 LAWS, RULES AND REGULATIONS:
The Contractor understands and agrees that this Contract is subject to all State and Federal laws,
rules and regulations that pertain hereto.
4.35 ANTI-KICKBACK REGULATIONS:
4.35.1 If the Contractor is a Medicare/Medicaid provider, it shall maintain a Corporate
Compliance Plan.
4.35.2 The Contractor shall maintain Personnel Policies, Code of Ethics or Standards of
Conduct, Bylaws and Board policies that include ethics standards or business conduct
practices.
4.35.3 The Contractor shall maintain documentation of any employee or Board member
violations of Code of Ethics/Standards of Conduct, and complaints of violations and
resolution.
4.35.4 The Contractor’s Code of Ethics/Standards of Conduct shall include:
• Conflict of interest
• Prohibition on use of provider property, information or position without
approval or advance personal interest
• Fair dealing: Contractor engages in fair and open competition
• Confidentiality
• Protection and use of company assets
• Compliance with laws, rules, regulations
• Timely and truthful disclosure of significant accounting deficiencies and non-
compliance
4.35.5 The Contractor shall have adequate policies and procedures to discourage soliciting cash
or in-kind payments for:
• Awarding contracts
• Referring clients
• Purchasing goods of services
• Submitting fraudulent billings
4.35.6 The Contractor shall have employee policies that discourage:
• Hiring persons with a criminal record
• Hiring persons being investigated by Medicare/Medicaid
• Large signing bonuses
4.36 ORDER OF PRECEDENCE:
In the event of a conflict in the provisions of this Contract and Contractor’s license agreement, if
applicable, the terms of this Contract shall prevail.
4.37 PUBLIC RECORDS:
All Offers submitted and opened are public records and must be retained by the Records Manager
at the Office of Procurement Services. Offers shall be open to public inspection after Contract
award and execution, except for such Offers deemed to be confidential by the Office of
Procurement Services. If an Offeror believes that information in its Offer should remain
confidential, it shall indicate as confidential, the specific information and submit a statement with
its offer detailing the reasons that the information should not be disclosed. Such reasons shall
include the specific harm or prejudice which may arise. The Records Manager of the Office of

SERIAL 13054-RFP
Procurement Services shall determine whether the identified information is confidential pursuant
to the Maricopa County Procurement Code.
4.38 INCORPORATION OF DOCUMENTS:
The following are to be attached to and made part of this Contract:
4.38.1 Exhibit A, Service Provider Application;
4.38.2 Exhibit B, Pricing/RWPA Budget Form including the schedule of deliverables;
4.38.3 Exhibit C, Scope of Work.


SERIAL 13054-RFP
EXHIBIT A
SERVICE PROVIDER APPLICATION

SERIAL 13054-RFP

SERIAL 13054-RFP
EXHIBIT B-1
PRICING & BUDGET FORM
MEDICAL CASE MANAGEMENT
NOTE: The following budget is for fiscal year 2013/2014 the 2014/2015 budgets will be
developed upon issuance of a Task Order, Condition of Award and the new budget pending
grant award and funding allocations.
DATE PREPARED 8/8/13
PREPARED BY: Calicia R. White
NAME OF ORGANIZATION: Ebony House, Inc.
Fed. Employee ID # (FEIN) 86-0287878
DUNS # 139458574
ADDRESS: 39 E Jackson Street
Phoenix, AZ 85004
AUTHORIZED CONTACT William Freeman
TELEPHONE 6022764288 FAX 6022322938
E-MAIL wfreeman@ebonyhouseinc.org
PRIMARY CONTACT
Calicia R. White
TELEPHONE 6022764288 FAX 6022322938
EMAIL cwhite@ebonyhouseinc.org
CONTRACT NUMBER QJ12
SERVICE CATEGORY Medical Case Management-MAI
BUDGET PERIOD: 3/1/2013 2/28/2014
Start Date End Date
CONTRACT AMOUNT $79,000.00
By submission of this budget, the Provider certifies that they have read the List of Unallowable Costs under
the Ryan White Part A Program and agree to follow the HRSA specific standards related to Unallowable Costs.
In addition, the following documents must be submitted with your budget proposal (Check the appropriate boxes)
If applicable, Negotiated Indirect Cost Agreement is attached Cost Allocation Policy is attached (required)

SERIAL 13054-RFP

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SERIAL 13054-RFP
2 Staffing Continuation Sheet ( Page 2 of 2) Provider Entry Auto Calculation Date Prepared: 8/8/2013
Staffing Continuation Sheet ( Page 2 of 2) Ebony House, Inc. Medical Case Management-MAI
Annual Hourly Salary Applied Benefits Applied to Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate to grant per FTE grant per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
9 0.0000 $ - $ - - - $ - $ -
Description
10 0.0000 $ - $ - - - $ - $ -
Description
11 0.0000 $ - $ - - - $ - $ -
Description
12 0.0000 $ - $ - - - $ - $ -
Description
13 0.0000 $ - $ - - - $ - $ -
Description
14 0.0000 $ - $ - - - $ - $ -
Description
15 0.0000 $ - $ - - - $ - $ -
Description
16 0.0000 $ - $ - - - $ - $ -
Description
17 0.0000 $ - $ - - - $ - $ -
Description
Subtotal to Page 1 0.00 $ - $ - - - $ - $ -

SERIAL 13054-RFP
TRAVEL Provider Entry Auto Calculation Date Prepared: 8/8/2013
Travel can be budgeted for the cost of staff mileage and other travel associated with Ryan White Part A.
1 Mileage Mileage will be budgeted utilizing the standard calculation of # of monthly miles for a full time staff person x12 months x the rate per mile
used by your organization x the number of FTE(s) budgeted who will travel to provide services under this grant.
Enter only the FTEs that will travel and provide a Narrative Justification including who will travel and why.
Mileage Ebony House, Inc. Medical Case Management-MAI
Mileage Rate
$0.560
FTE Monthly Miles Annual Miles Total
Budgeted (Per 1 Admin Direct Svc Narrative Justification
FTE)* Applied to Grant Budget
1 Admin 0 $ - $ - $ -
Direct Svc Costs incurred while providing assistance directly to clients and/or attending appointments with
2 1.00 0 0 $ - $ - clients.
TOTAL 0 0 $ - $ - $ - $ -
(Total Miles applied to this grant)
*Note - Budget monthly mileage for 1 FTE. This is a revision to prior year budget templates.
2 Other Allowable Travel ( car rental, parking, fees, etc.)
Ryan White Part A has determined that costs included in this section are Administrative Costs.
Other Allowable Travel Ebony House, Inc. Medical Case Management-MAI
Dates Total Admin Direct Svc Narrative Justification
of Travel Budget
1 Cost $ - $ - 0
Line Item 0
2 Cost $ - $ - 0
Line Item 0
3 Cost $ - $ - 0
Line Item 0
$ - $ - - $ -
Admin Direct Service Total
SUMMARY (Travel) $ - $ - $ -
Travel Budget Instructions B05-TV-1 ( These instructions will not print)
Use this form to budget any travel expenses associated with the services of the Ryan White Part A Grant.
This form consists of two (2) sections - Mileage and Other Allowable Travel
The Travel budget form requires the following entries:
Mileage This section establishes a budget amount, both Administrative and Direct Service, for
mileage reimbursement in conjunction with providing services to the grant.
Maricopa County Ryan White Part A Program has adapted a standard formula to apply all
mileage reimbursements budgets.
Mileage Rate: Enter the current rate used by your organization to reimburse mileage requests
FTE: Enter the number of FTE who will travel, both Administrative and Direct Service, in the corresponding row.
Monthly Miles Enter the monthly miles that are budgeted for one (1) FTE staff person.
Narrative/ Provide a detailed justification for the travel budget requested, including who will travel and why.
Justification:
Other
Allowable
Travel In some cases, other travel may be allowed under the Ryan White Part A Grant.
Each item listed in this section must have a detailed and accurate budget justification attached.
Dates of Travel: Enter the dates that the other travel is expected.
Cost and Enter the estimated cost and name of the expense
Line Item: *this can include car rental, parking fees, etc.
Narrative/ Provide a detailed description and justification of the expense in relation to Ryan White Part A services
Justification: as awarded in this grant.

SERIAL 13054-RFP
SUPPLIES Provider Entry Auto Calculation Date Prepared: 8/8/2013
The supplies line item is used to budget funds for supplies used in the operations of the Grant.
This category can include general office supplies and program/medical supplies
1 General Office Supplies: (Apply an FTE Ratio from the Budgeted Personnel Page)
Pens, paper, toner and general supplies that are used to run an office.
General Office Supplies Ebony House, Inc. Medical Case Management-MAI
Annual % Admin % Direct Total Narrative Description/Cost Allocation Methodology
Item Budget 0% 100% 100%
1 $ - $ - $ -
2 $ - $ - $ -
3 $ - $ - $ -
4 $ - $ - $ -
5 $ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
2 Program Supplies
Program/Medical Supplies are budgeted as Direct Service.
Program Supplies Ebony House, Inc. Medical Case Management-MAI
Item Annual Admin Direct Narrative Description/Cost Allocation Methodology
Budget
1 $ - $ -
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY ( Supplies) $ - $ - $ -
Supplies Budget Instructions B05-SP-1 (These instructions will not print)
Use this form to create the general office and program supply budgets for the Ryan White Part A grant.
Section I General Office Supplies
General office supplies include pens, paper, toner and general supplies that are used to run an office.
Maricopa County Ryan White Part A Program has initiated a standard allocation model for general office supplies
to determine the appropriate budget for Administrative and Direct Services.
(Administrative Allocation = Total Budget x Percent of administrative FTE to total FTE)
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.
Section II Program Supplies
This chart can be used to identify and budget for program supplies used in providing services.
Program Supplies include supplies that are specifically related to performance of the direct services; i.e. medical supplies, folders for client files, etc.
Program Supplies have been determined to be Direct Service Costs, however final determination resides with Maricopa County
Ryan White Part A Program, therefore it is important to provide an adequate justification.
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.

SERIAL 13054-RFP
EQUIPMENT Provider Entry Auto Calculation Date Prepared: 8/8/2013
The equipment line item is budgeted for equipment purchased or leased in conjunction with operations of the grant
Refer to your contract terms and conditions for requirements related to equipment purchases
Equipment less than $5,000
Equipment less than $5,000 - includes computers, fax machines, shredders, and other
equipment less than $5,000 to be used in the operations of this grant.
Equipment less than $5,000 Ebony House, Inc. Medical Case Management-MAI
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Service
1 $ -
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ - TOTAL $ -
Equipment $5,000 or greater
Equipment $5,000 or greater Ebony House, Inc. Medical Case Management-MAI
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Amount Amount
1 $ -
2 $ -
3 $ -
4 $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY (Equipment) $ - $ - $ -
Equipment Budget Instructions B05-EQ-1
Use this form to budget for equipment needed to support services under this Part A grant.
The Equipment budget form requires the following entries:
Item Budgeted: Enter the name of the equipment to be purchased or leased
Admin and Direct Amt: Enter the total budgeted amount for Admin and Direct Services.
Narrative/ In the Narrative, describe how the equipment will be used and also the methodology used
Cost Allocation to allocate the total or a portion of the cost to the Ryan White Program. Also
Methodology: describe the methodology used to allocate the cost to Admin and/or Direct Service.
Refer to your contract terms and conditions for requirements related to equipment purchases
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

SERIAL 13054-RFP
Contractual Provider Entry Auto Calculation Date Prepared: 8/8/2013
Use this form to budget for consulting and contract labor (Section 1) and subcontracts ( Section 2) in conjunction with operating this Part A grant.
A copy of the fully executed contract covering the dates of service is required for each subcontract listed in this section.
1. Consulting/Professional Contract Labor/Clerical Support
This budget category includes payments to outside consultants, temporary services, professional contract labor and clerical support.
Indicate the name, licenses/qualifications, hours budgeted, quoted rate, dates of service, and a detailed Narrative/Justification
of activities to be provided.
1. Consulting/Professional Contract Labor/Clerical Support Ebony House, Inc. Medical Case Management-MAI
Dates of Service
Consultant Annual Quoted Total Admin Admin Direct Service
Name Budgeted Hours Rate Budget Budget % Budget Budget
1 $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
2 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
3 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
4 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
5 $ - $ - $ - $ -
Licenses /
qualifications
Narrative
6 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
Consulting/ Prof./ Clerical Sup. Page 1 SUBTOTAL $ - $ - $ -
Consulting/ Prof./ Clerical Sup. From Contractual Continuation Page SUBTOTAL $ - $ - $ -
TOTAL $ - $ - $ -

SERIAL 13054-RFP
2. Subcontracts
Include any payments through subcontracts to provide services under this grant.
Each Subcontractor listed in this section who is a sub recipient (not a vendor) must complete a Budget using the RWPA budget template.
Maricopa County RWPA will enforce the 10% administrative Cost Cap established by HRSA for first-line and second line sub recipient entities receiving Ryan White Part A Funds.
2. Subcontracts Ebony House, Inc. Medical Case Management-MAI
Subcontractor Sub recipient Admin Direct Service Total Admin Dates of Service
Name or Vendor Budget Budget Budget % of Direct
1 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
2 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
3 $ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
TOTAL - - -
Admin Direct Total
SUMMARY Contractual $ - $ - $ -
Contractual B05-CT-1 ( These instructions will not print)
Consulting/Professional Contract Labor/Clerical Support
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Activities,
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided.
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.
Subcontracts
Enter the Subcontractor Name and indicate if the subcontractor is a Vendor or a Subrecipient.
(b) A Subrecipient:
(1) Determines who is eligible to receive what Federal financial assistance;
(2) Has its performance measured against whether the objectives of the Federal program are met;
(3) Has responsibility for programmatic decision making;
(4) Has responsibility for adherence to applicable Federal program compliance requirements; and
(5) Uses the Federal funds to carry out a program of the organization as compared to providing goods or services for a program
of the pass-through entity.
(c) A Vendor:
(1) Provides the goods and services within normal business operations;
(2) Provides similar goods or services to many different purchasers;
(3) Operates in a competitive environment;
(4) Provides goods or services that are ancillary to the operation of the Federal program; and
(5) Is not subject to compliance requirements of the Federal program.
Enter the Admin and Direct Service Subcontract Amounts. These amounts will calculate the Total Budget.
The Administrative percentage ratio will also calculate automatically.
List the services and provide a narrative justification of the services to be provided.
Note: Subcontractors who are sub recipients must also prepare a detailed budget using the RWPA budget template.
Submit the subcontractor budget with your budget submission.

Contractual- Continuation Page Date Prepared: SERIAL 13054-RFP 8/8/2013
The Contractual line item is used for consulting and contracting to be utilized in conjunction with operations of the grant.
Use this page to list Consultant/Contract Labor and Clerical Support if there is insufficient space on the Contractual Page.
Consulting/Professional Contract Labor/Clerical Support
Consulting/Professional Contract Labor/Clerical Support Ebony House, Inc. Medical Case Management-MAI
Dates of Service
Consultant Hours Quoted Total Admin Admin Direct Service
Budgeted Rate Budget Budget % Budget
6 $ - $ - $ -
Licenses /
qualifications
Narrative
7 0 $ - $ - $ -
Licenses /
qualifications
Narrative
8 0 $ - $ - $ -
Licenses /
qualifications
Narrative
9 0 $ - $ - $ -
Licenses /
qualifications
Narrative
10 0 $ - $ - $ -
Licenses /
qualifications
Narrative
11 0 $ - $ - $ -
Licenses /
qualifications
Narrative
12 0 $ - $ - $ -
Licenses /
qualifications
Narrative
13 $ - $ - $ - $ - $ -
Licenses /
qualifications
Narrative
14 0 $ - $ - $ -
Licenses /
qualifications
Narrative
15 0 $ - $ - $ -
Licenses /
qualifications
Narrative
16 0 $ - $ - $ -
Licenses /
qualifications
Narrative
Consulting/ Prof./ Clerical Sup. Subtotal to Page 1 TOTAL - - $ -
Consulting/Professional/Clerical Support-
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Activities,
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.

Other Program Support Provider Entry Auto Calculation Date SERIAL Prepared: 13054-RFP 8/8/2013
Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification
describe how the program support will be used and also the methodology used to allocate the total or a portion of the total cost
to the grant.
1 Communications/Telephone/Internet
Communications/Telephone/Internet Ebony House, Inc. Medical Case Management-MAI
Item Total Narrative/Cost Allocation Methodology
Amount Admin Direct
Budgeted 0% 100%
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
2 Copy/Duplicating
Copy/Duplicating Ebony House, Inc. Medical Case Management-MAI
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
1 Program Brochures
$ - $ -
2 Other Copying/Duplicating
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
3 Postage
Postage Ebony House, Inc. Medical Case Management-MAI
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
4 Utilities
Utilities are 100% administrative. (Ruling 6.6.B05)
Utilities Ebony House, Inc. Medical Case Management-MAI
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL - - TOTAL $ -
4 Other Program Support
Other Program Support Ebony House, Inc. Medical Case Management-MAI
Item Admin Direct Total Narrative/Cost Allocation Methodology
$ 500.00 $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY Program Support $ - $ - $ -
Other Program Support B05-SP-1 ( These instructions will not print)
Section 1-3. These sections apply the FTE ratio for the expenditures including: telephone, postage, copying, and utilities.
Section 4 - Other Program Support allows you to use your own calculation method to allocate costs between Admin and Direct.
Enter the Admin Amount and Direct Amount to calculate the Total Budget and provide adequate justification of the methodology used
to allocate the costs; the methodology must be in line with your agency's cost allocation policy. Final determination resides with the
Maricopa County Ryan White Part A Program.

Other Professional Service Provider Entry Auto Calculation SERIAL 13054-RFP Date Prepared:
Use this form to budget for other professional services; audit/accounting, insurance, rent/space, or other professional services.
1 Audit/Accounting/Finance
Audit/Accounting/Finance Ebony House, Inc. Medical Case Management-MAI
Vendor Hours Quoted Total Dates Admin Direct Service Description of Service
Name Budgeted Price* Price of Service
a $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ -
Cost Method
Used
Budget
Justification
TOTAL - $ -
2 Insurance
Insurance Ebony House, Inc. Medical Case Management-MAI
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Premium To grant Grant of Service
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
3 Rent/Space
Rent is considered 100% administrative
Rent/Space Ebony House, Inc. Medical Case Management-MAI
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Rent to Grant Grant of Service
$ -
a $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
4 Other Professional Service
Other Professional Service Ebony House, Inc. Medical Case Management-MAI
Vendor Hours Quoted Total Admin Admin Direct Service Description of Service
Name Budgeted Price* Price Budget %
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
$ - TOTAL $ - $ - $ -
Admin Direct Total
SUMMARY Other Prof. Svc $ - $ - $ -
Other Professional B05-PF-1 ( These instructions will not print)
For each section, indicated the provider of service(s), the rate, a detailed description of the services provided, the method of calculating the
budget for this Part A grant and a narrative justification describing why is service is needed.
Section 1-3. Auditing, Insurance and Rent have been determined by the Maricopa County Ryan White Program to be Administrative Services.
Section 4 allows providers to indicate the percentage requested as administrative and direct service. Adequate explanation of the methodology
used to allocate costs is required; final determination resides with the Maricopa County Ryan White Part A Program.
If a vendor is not paid based on an hourly rate, enter a 1 for Hours Budgeted and the total cost of the service under Quoted Price.

SERIAL 13054-RFP
Schedule of Deliverables Provider Entry Auto Calculation Date Prepared: 8/8/2013
Organization Name: Ebony House, Inc. Performance Measures:
Service Category Medical Case Management-MAI Number of New Clients 75
Number of Returning Clients 88
Total # of Unduplicated Clients 163
Fee for Service Only
Schedule of Deliverables ( Not Applicable to Cost Reimbursement Contracts)
Service Unit
CAREWare Fee Source (ie
Definition Number of Proposed Fee Total Payment Per
Service Unit Service Description Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb AHCCCS, I H S,
1 unit = Units Per Product/ Objective/Activity
Name/Code Negotiated Rate, etc.)
(i.e. 15 minutes) Proposed Deliverable
Initial and Update
assessments develop
MCM comprehensive care
1 Assessments plan for clients 1 unit = 15 minutes 1,020 85 85 85 85 85 85 85 85 85 85 85 85 $ -
Provides medication
adherence counseling,
facilitate linkage to
primary medical care
and provide education
Medical Case on HIV, medications and
2 Management overall health. 1 unit = 15 minutes 3,780 315 315 315 315 315 315 315 315 315 315 315 315 $ -
3 - $ -
4 - $ -
5 - $ -
6 - $ -
7 - $ -
8 - $ -
9 - $ -
10 - $ -
11 - $ -
12 - $ -
13 - $ -
14 - $ -
15 - $ -
TOTAL 4,800 400 400 400 400 400 400 400 400 400 400 400 400 $ -
Total Budget $ 78,999.98
Over/(Under Budget) $ (78,999.98)
Balance should equal zero
Instructions for Schedule of Deliverables ( These instructions will not print)
Fee for Service Only
Example ( Not Applicable to Cost Reimbursement Contracts)
CAREWare Service Unit Number
Service Unit Service Description Definition 1 of Units Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb Proposed Fee Per Total Payment Per Fee Source (ie AHCCCS, I H
Name/Code unit = (i.e. Proposed Product/ Objective/Activity S, Negotiated Rate, etc.)
Face to face medical 15 minutes) Deliverable
FMCM case management
Assessment assessment. 1 unit = 15 minutes 1,128 94 94 94 94 94 94 94 94 94 94 94 94 $ - $ -
Food boxes Food box 1 unit = 1 food box 3,396 283 283 283 283 283 283 283 283 283 283 283 283 $ - $ -
H0004 Ind Individual counseling
Counseling session 1 unit = 15 minutes 6,900 600 600 600 600 500 600 600 600 600 400 600 600 $ 16.76 $ 115,644.00 AHCCCS Rate
1 Enter the CAREWare Service Name and or/Code; i.e. HCPCS or CPT Codes
2 Service Name Description- Use this cell to provide the full service name or describe the service
3 Service Unit Definition- Enter the DEFINITION of 1 unit. i.e. 15 minutes
The Unit definitions for each service category can be found in the RWPA P&P Manual
4 The TOTAL NUMBER OF UNITS PROPOSED calculates automatically, based on the total number of units
entered in the Schedule of Deliverables.
5 SCHEDULE OF DELIVERABLES: Enter the # of units BY MONTH proposed in the corresponding column and row.
Complete the information in the final 3 columns for Fee for Service Contracts Only
6 Enter the proposed fee for the corresponding activity/unit.
7 The Total Payment for each Activity/Unit calculates based on proposed # of units x proposed fee.
8 The TOTAL PAYMENT for all activity/units must equal the Total Budget from the Budget Summary.
9 In the final column, enter the source of the fee, i.e. AHCCCS, I H S, Negotiated Rate

SERIAL 13054-RFP
EXHIBIT B-2
PRICING & BUDGET FORM
NON- MEDICAL CASE MANAGEMENT
NOTE: The following budget is for fiscal year 2013/2014 the 2014/2015 budgets will be
developed upon issuance of a Task Order, Condition of Award and the new budget pending
grant award and funding allocation.
DATE PREPARED 8/8/13
PREPARED BY: Calicia R. White
NAME OF ORGANIZATION: Ebony House, Inc.
Fed. Employee ID # (FEIN) 86-0287878
DUNS # 139458574
ADDRESS: 39 E Jackson Street
Phoenix, AZ 85004
AUTHORIZED CONTACT William Freeman
TELEPHONE 602-276-4288 FAX 602-232-2938
E-MAIL wfreeman@ebonyhouseinc.org
PRIMARY CONTACT
Calicia R. White
TELEPHONE 602-276-4288 FAX 602-232-2938
EMAIL cwhite@ebonyhouseinc.org
CONTRACT NUMBER Qi94
SERVICE CATEGORY Non-Medical Case Management MAI
BUDGET PERIOD: 3/1/2013 2/28/2014
Start Date End Date
CONTRACT AMOUNT $96,472.00
By submission of this budget, the Provider certifies that they have read the List of Unallowable Costs under
the Ryan White Part A Program and agree to follow the HRSA specific standards related to Unallowable Costs.
In addition, the following documents must be submitted with your budget proposal (Check the appropriate boxes)
If applicable, Negotiated Indirect Cost Agreement is attached Cost Allocation Policy is attached (required)

SERIAL 13054-RFP
Date Prepared: 8/8/2013
(Section I)
Organization Ebony House, Inc.
Service Category Non-Medical Case Management MAI
Budget Period 3/1/2013 Through 2/28/2014
(Section II) Contract Amount $96,472.00
Administrative Total Budget
Operating Expenses Budget Direct Service Budget
FTES 0.00 2.00 2.00
Personnel: Salaries $ - $ 64,688.00 $ 64,688.00
Personnel: Fringe/Benefits - 13,597.42 13,597.42
Subtotal: Personnel/Fringe Benefits - 78,285.42 78,285.42
Other Operating Expenses
Travel - 6,600.00 6,600.00
Supplies - 2,816.40 2,816.40
Equipment - - -
Contractual - - -
Program Support - - -
Other Professional Services - - -
Subtotal: Other Operating Expenses - 9,416.40 9,416.40
Total Operating Expenses - 87,701.82 87,701.82
(Personnel and Other Direct Costs)
Indirect Costs 8,770.18 8,770.18
Enter Indirect Cost Rate 10.00% Providers claiming an indirect cost must submit their most current negotiated indirect
(may not exceed 10% of Direct Costs) costs rate agreement issued by the cognizant federal agency with their budget.
Total Costs of Contract 8,770.18 87,701.82 96,472.00
(Admin-Percent of Direct Costs) 10.00%
Administration may not exceed 10% of Direct Costs
CONTRACT BALANCE (Contract Revenue less Total Costs of Contract) $ 0.00
*The Contract Balance should equal zero.

SERIAL 13054-RFP
Budget Summary B05-SU-1
This form summarizes all of the line items in the submitted budget packet for the award listed in the Cover Page.
If completing this form electronically, the information will automatically populate as the budget packet
is completed:
Section I Summarizes the organizational information provided in the Cover Page.
The information will automatically populate when the Cover Page is completed
Section II This section summarizes the budget information calculated in the submitted budget packet for this grant.
This form is required for all Ryan White Part A awards issued by Maricopa County Ryan White Part A Program
This form reports the summary line item amounts allocated as Administrative Costs, Direct Service Cost, and
total budget for the budget packet for this service award.
1 Direct Services allocations are for service that directly benefits Ryan White HIV clients such as staff, medicine
and drugs clinical supplies, etc.
2 Administrative costs relate to oversight and management of CARE Act funds: The Administrative Costs
Column, including indirect cost, cannot exceed 10% of Direct Costs.
Administrative Costs, defined in Section 2604(f)(3) defines allowable "subcontractor administrative activities to include:
a. Usual and recognized overhead, including establishing indirect rates for agencies. (HRSA has determined
that rent, utilities and facility costs must be categorized as administrative expenses.)
b. Management and oversight of specific programs funded under this title (including program coordination,
clerical, financial and management staff not directly related to patient care; program evaluation; liability insurance;
audits; computer hardware/software not directly related to patient care.)
c. Other types of program support such as quality assurance, quality control, and related activities."
Other Examples include: salaries and expenses of executive officers, personnel administration, contracting, accounting, data recording,
the costs of operating and maintaining facilities, and depreciation or use allowances on building and equipment.
Indirect Costs- Enter the indirect rate you are claiming (not to exceed 10% of direct costs).
** Indirect Cost - Providers claiming an indirect cost must submit their most current negotiated indirect
Cost agreement with their budget. The indirect costs claimed from the Ryan White Part A Program may
not exceed 10% of direct costs nor the amount that would be claimed using their agency's federally
negotiated indirect cost rate and base, whichever is lower. Note: Only United States Health and Human Services (HHS)
negotiated indirect rates will be accepted unless an exception is approved by the HHS.
3 Contract Balance - This cell calculates the amount of the contract less the projected costs. This number should equal 0.
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

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Personnel All staff paid in full or part from this Ryan White Part A grant are to be listed in the following chart. Date Prepared: 8/8/2013
1 Staffing Provider Entry Auto Calculation Fringe Benefit Rate 21.02%
Staffing Ebony House, Inc. Non-Medical Case Management MAI
Benefits
Annual Hourly Salary Applied to Applied to grant Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate grant per FTE per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
Non-Medical
1 Case Manager Pierson 2080 100.00% 1.0000 $15.55 $ 32,344.00 $ 6,798.71 D - - $ 32,344.00 $ 6,798.71
Assist Clients with completing necessary applications and documentation for eligibility. Provide support and aid to clients in Dr visits and other social service visits if requested. Provide referals to necessary healthcare and social
services. Will be providing services to both MAI and Part A clients. Clients are services by both Non-medical Case Managers who allocate hours according to which clients are provided services. Employee benefits are low due to
insufficient funds to cover total costs. List Benefit Categories and %;
( this table w ill not print)
Non-Medical
2 Case Manager Becketts 2080 100.00% 1.0000 $15.55 $ 32,344.00 $ 6,798.71 D - - $ 32,344.00 $ 6,798.71 (R) Benefits
Assist Clients with completing necessary applications and documentation for eligibility. Provide support and aid to clients in Dr visits and other social service visits if requested. Provide referals to necessary healthcare and social
services. Will be providing services to both MAI and Part A clients. Clients are services by both Non-medical Case Managers who allocate hours according to which clients are provided services. Employee benefits are low due to Benefits Name Percent
insufficient funds to cover total costs.
Workers Comp 4.50%
3 0.0000 $ - $ - - - $ - $ - PTO 2.47%
Description
Insurance 6.30%
Unemployment 0.10%
4 0.0000 $ - $ - - - $ - $ - Medicare 1.45%
Description
FICA 6.20%
5 0.0000 $ - $ - - - $ - $ -
Description
TOTAL 21.02%
6 0.0000 $ - $ - - - $ - $ -
Description
7 0.0000 $ - $ - - - $ - $ -
Description
8 0.0000 $ - $ - - - $ - $ -
Description
Subtotal Personnel 2.00 $ 64,688.00 $ 13,597.42 $ - $ - $ 64,688.00 $ 13,597.42
Subtotal from Personnel Continuation Sheet 0.00 $ - $ - $ - $ - $ - $ -
TOTAL Personnel 2.00 $ 64,688.00 $ 13,597.42 $ - $ - $ 64,688.00 $ 13,597.42
(Admin) 0.00 FTE Percent Admin 0%
(Direct Service) 2.00 FTE Percent Direct 100%
Total 2.00 FTE 100%

SERIAL 13054-RFP
Personnel Instructions B05-PE-1 ( These instructions will not print)
Use this form to list ALL persons being paid a salary from the Ryan White Part A grant in this budget packet.
This form calculates the applied annual salary and applied annual benefits per individual position.
The Provider must determine if the position(s) listed are Administrative, Direct Service, or Both
* for Both, the Provider must indicate how much of the time spent on Ryan White Part A activities
are considered administrative.
For example - a Case Management Supervisor may continue with a case load of their own, in this
case, it must be determined how much of their time should be allocated to Administrative duties
and Direct Service support.
If at the time of submission of a service budget one or more of the personnel positions are vacant, contractors must indicat
and provide a date when the positions will be filled, and prorate/apportion personnel and other associated costs to reflect
service. Alternatively, contractors may note the vacancy, with no associated cost, and develop the contract to reflect actual
staffing at the time of budget preparations, amending the budget to reflect ongoing personnel changes as they occur.
The Cells referenced in the form requiring entry are:
Position Title Enter the position title
Last Name Enter the last name of the employee who occupies the position or enter "Vacant"
If you have more than 8 employees/positions who will be paid on this grant, use the
Personnel Continuation Tab in this budget template to list the remaining employees.
The subtotal from the Personnel Continuation will roll over to the main Personnel Page.
Annual Hours Enter Number of Budgeted Hours for this position/employee. Typically, annual hours for full time
staff are 2,080 hours. Adjust hours if position will not be filled for an entire year or if the person
works part time and explain under "Description"
% RWPA Enter the % of time this employee/position is budgeted on the Part A grant
(i.e., A person who spends 1/2 of their work hours on this grant would be 50% )
FTE FTE = Full Time Equivalent. This is a calculated field. ( Annual Hours/2080* % RWPA)
Hourly Rate Enter the employee/budgeted position's hourly rate
Job Status Determine whether an employee's primary responsibilities on this grant will be for Direct Service
activities or Administrative activities by entering A or D.
* For a staff member who has both responsibilities, enter A and D
Percent applied Enter how much of the employee's time is spent on Administrative duties.
as Admin. (i.e., a staff member can spend 90% of their time doing administrative duties and 10% performing
Direct Services.)
Description Provide the Position Number and a Description of Duties. If the employee will not be in the
position for the entire year, enter the start and end dates.
Benefit Table Enter a brief name of each benefit included for staff and the percentage of gross salary
associated with that benefit. (i.e., Social Security- (FICA), Health Insurance, Retirement, etc.)
This data will calculate the total Benefit Rate that will be applied to your budget.
( Note: to maximize space, the benefit table will not print on the printed copy of this page )

SERIAL 13054-RFP
2 Staffing Continuation Sheet ( Page 2 of 2) Provider Entry Auto Calculation Date Prepared: 8/8/2013
Staffing Continuation Sheet ( Page 2 of 2) Ebony House, Inc. Non-Medical Case Management MAI
Annual Hourly Salary Applied Benefits Applied to Job Status % Applied as Gross Admin Gross Admin Direct Service Direct Service
Position Title Last Name Hours % RWPA FTE Rate to grant per FTE grant per FTE A, D or A/D Administrative Salary Benefits Salary Benefits
9 0.0000 $ - $ - - - $ - $ -
Description
10 0.0000 $ - $ - - - $ - $ -
Description
11 0.0000 $ - $ - - - $ - $ -
Description
12 0.0000 $ - $ - - - $ - $ -
Description
13 0.0000 $ - $ - - - $ - $ -
Description
14 0.0000 $ - $ - - - $ - $ -
Description
15 0.0000 $ - $ - - - $ - $ -
Description
16 0.0000 $ - $ - - - $ - $ -
Description
17 0.0000 $ - $ - - - $ - $ -
Description
Subtotal to Page 1 0.00 $ - $ - - - $ - $ -

SERIAL 13054-RFP
TRAVEL Provider Entry Auto Calculation Date Prepared: 8/8/2013
Travel can be budgeted for the cost of staff mileage and other travel associated with Ryan White Part A.
1 Mileage Mileage will be budgeted utilizing the standard calculation of # of monthly miles for a full time staff person x12 months x the rate per mile
used by your organization x the number of FTE(s) budgeted who will travel to provide services under this grant.
Enter only the FTEs that will travel and provide a Narrative Justification including who will travel and why.
Mileage Ebony House, Inc. Non-Medical Case Management MAI
Mileage Rate
$0.550
FTE Monthly Miles Annual Miles Total
Budgeted (Per 1 Admin Direct Svc Narrative Justification
FTE)* Applied to Grant Budget
1 Admin 0 $ - $ - $ -
Direct Svc Costs incurred while providing assistance directly to clients and/or attending appointments with
clients. Pierson and Becketts will travel to take clients to appointments and to perform services
2 2.00 500 12000 $ 6,600.00 $ 6,600.00 on the behalf of and with clients who cannot make it to office appointments.
TOTAL 500 12000 $ 6,600.00 $ - $ 6,600.00 $ 6,600.00
(Total Miles applied to this grant)
*Note - Budget monthly mileage for 1 FTE. This is a revision to prior year budget templates.
2 Other Allowable Travel ( car rental, parking, fees, etc.)
Ryan White Part A has determined that costs included in this section are Administrative Costs.
Other Allowable Travel Ebony House, Inc. Non-Medical Case Management MAI
Dates Total Admin Direct Svc Narrative Justification
of Travel Budget
1 Cost $ - $ - 0
Line Item 0
2 Cost $ - $ - 0
Line Item 0
3 Cost $ - $ - 0
Line Item 0
$ - $ - - $ -
Admin Direct Service Total
SUMMARY (Travel) $ - $ 6,600.00 $ 6,600.00
Travel Budget Instructions B05-TV-1 ( These instructions will not print)
Use this form to budget any travel expenses associated with the services of the Ryan White Part A Grant.
This form consists of two (2) sections - Mileage and Other Allowable Travel
The Travel budget form requires the following entries:
Mileage This section establishes a budget amount, both Administrative and Direct Service, for
mileage reimbursement in conjunction with providing services to the grant.
Maricopa County Ryan White Part A Program has adapted a standard formula to apply all
mileage reimbursements budgets.
Mileage Rate: Enter the current rate used by your organization to reimburse mileage requests
FTE: Enter the number of FTE who will travel, both Administrative and Direct Service, in the corresponding row.
Monthly Miles Enter the monthly miles that are budgeted for one (1) FTE staff person.
Narrative/ Provide a detailed justification for the travel budget requested, including who will travel and why.
Justification:
Other
Allowable
Travel In some cases, other travel may be allowed under the Ryan White Part A Grant.
Each item listed in this section must have a detailed and accurate budget justification attached.
Dates of Travel: Enter the dates that the other travel is expected.
Cost and Enter the estimated cost and name of the expense
Line Item: *this can include car rental, parking fees, etc.
Narrative/ Provide a detailed description and justification of the expense in relation to Ryan White Part A services
Justification: as awarded in this grant.

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SUPPLIES Provider Entry Auto Calculation Date Prepared: 8/8/2013
The supplies line item is used to budget funds for supplies used in the operations of the Grant.
This category can include general office supplies and program/medical supplies
1 General Office Supplies: (Apply an FTE Ratio from the Budgeted Personnel Page)
Pens, paper, toner and general supplies that are used to run an office.
General Office Supplies Ebony House, Inc. Non-Medical Case Management MAI
Annual % Admin % Direct Total Narrative Description/Cost Allocation Methodology
Item Budget 0% 100% 100%
1 $ - $ - $ -
2 $ - $ - $ -
3 $ - $ - $ -
4 $ - $ - $ -
5 $ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
2 Program Supplies
Program/Medical Supplies are budgeted as Direct Service.
Program Supplies Ebony House, Inc. Non-Medical Case Management MAI
Item Annual Admin Direct Narrative Description/Cost Allocation Methodology
Budget
Pens, paper, toner
and general
supplies that are
used to run an Supplies are used to provide information to clients about their care, to create folders and providing
1 office. $ 2,816.40 $ - $ 2,816.40 client's continuum of care providers w ith necessary documentation for continuity of care.
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ 2,816.40 TOTAL $ 2,816.40
Admin Direct Total
SUMMARY ( Supplies) $ - $ 2,816.40 $ 2,816.40
Supplies Budget Instructions B05-SP-1 (These instructions will not print)
Use this form to create the general office and program supply budgets for the Ryan White Part A grant.
Section I General Office Supplies
General office supplies include pens, paper, toner and general supplies that are used to run an office.
Maricopa County Ryan White Part A Program has initiated a standard allocation model for general office supplies
to determine the appropriate budget for Administrative and Direct Services.
(Administrative Allocation = Total Budget x Percent of administrative FTE to total FTE)
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.
Section II Program Supplies
This chart can be used to identify and budget for program supplies used in providing services.
Program Supplies include supplies that are specifically related to performance of the direct services; i.e. medical supplies, folders for client files, etc.
Program Supplies have been determined to be Direct Service Costs, however final determination resides with Maricopa County
Ryan White Part A Program, therefore it is important to provide an adequate justification.
In the Narrative, describe how the supplies will be used and also the methodology used to determine the Annual Budget Amount.
Note: The cost allocation methodology should be based on your organization's cost allocation policy.

SERIAL 13054-RFP
EQUIPMENT Provider Entry Auto Calculation Date Prepared: 8/8/2013
The equipment line item is budgeted for equipment purchased or leased in conjunction with operations of the grant
Refer to your contract terms and conditions for requirements related to equipment purchases
Equipment less than $5,000
Equipment less than $5,000 - includes computers, fax machines, shredders, and other
equipment less than $5,000 to be used in the operations of this grant.
Equipment less than $5,000 Ebony House, Inc. Non-Medical Case Management MAI
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Service
1 $ -
2 $ -
3 $ -
4 $ -
5 $ -
$ -
TOTAL $ - $ - TOTAL $ -
Equipment $5,000 or greater
Equipment $5,000 or greater Ebony House, Inc. Non-Medical Case Management MAI
Item Admin Direct Total Narrative Description/Cost Allocation Methodology
Budgeted Amount Amount
1 $ -
2 $ -
3 $ -
4 $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY (Equipment) $ - $ - $ -
Equipment Budget Instructions B05-EQ-1
Use this form to budget for equipment needed to support services under this Part A grant.
The Equipment budget form requires the following entries:
Item Budgeted: Enter the name of the equipment to be purchased or leased
Admin and Direct Amt: Enter the total budgeted amount for Admin and Direct Services.
Narrative/ In the Narrative, describe how the equipment will be used and also the methodology used
Cost Allocation to allocate the total or a portion of the cost to the Ryan White Program. Also
Methodology: describe the methodology used to allocate the cost to Admin and/or Direct Service.
Refer to your contract terms and conditions for requirements related to equipment purchases
The final determination for cost allocations between Administrative Costs and Direct Service Costs
resides with Maricopa County Ryan White Part A Program

SERIAL 13054-RFP
Contractual Provider Entry Auto Calculation Date Prepared: 8/8/2013
Use this form to budget for consulting and contract labor (Section 1) and subcontracts ( Section 2) in conjunction with operating this Part A grant.
A copy of the fully executed contract covering the dates of service is required for each subcontract listed in this section.
1. Consulting/Professional Contract Labor/Clerical Support
This budget category includes payments to outside consultants, temporary services, professional contract labor and clerical support.
Indicate the name, licenses/qualifications, hours budgeted, quoted rate, dates of service, and a detailed Narrative/Justification
of activities to be provided.
1. Consulting/Professional Contract Labor/Clerical Support Ebony House, Inc. Non-Medical Case Management MAI
Dates of Service
Consultant Annual Quoted Total Admin Admin Direct Service
Name Budgeted Hours Rate Budget Budget % Budget Budget
1 $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
2 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
3 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
4 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
5 $ - $ - $ - $ -
Licenses /
qualifications
Narrative
6 $ - $ - $ - $ -
Licenses /
qualifications
Narrative/
Justification
Consulting/ Prof./ Clerical Sup. Page 1 SUBTOTAL $ - $ - $ -
Consulting/ Prof./ Clerical Sup. From Contractual Continuation Page SUBTOTAL $ - $ - $ -
TOTAL $ - $ - $ -

SERIAL 13054-RFP
2. Subcontracts
Include any payments through subcontracts to provide services under this grant.
Each Subcontractor listed in this section who is a sub recipient (not a vendor) must complete a Budget using the RWPA budget template.
Maricopa County RWPA will enforce the 10% administrative Cost Cap established by HRSA for first-line and second line sub recipient entities receiving Ryan White Part A Funds.
2. Subcontracts Ebony House, Inc. Non-Medical Case Management MAI
Subcontractor Sub recipient Admin Direct Service Total Admin Dates of Service
Name or Vendor Budget Budget Budget % of Direct
$ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
$ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
$ - #DIV/0!
Service(s)
Provided
Narrative/
Justification
TOTAL - - -
Admin Direct Total
SUMMARY Contractual $ - $ - $ -
Contractual B05-CT-1 ( These instructions will not print)
Consulting/Professional Contract Labor/Clerical Support
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Activities,
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided.
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.
Subcontracts
Enter the Subcontractor Name and indicate if the subcontractor is a Vendor or a Subrecipient.
(b) A Subrecipient:
(1) Determines who is eligible to receive what Federal financial assistance;
(2) Has its performance measured against whether the objectives of the Federal program are met;
(3) Has responsibility for programmatic decision making;
(4) Has responsibility for adherence to applicable Federal program compliance requirements; and
(5) Uses the Federal funds to carry out a program of the organization as compared to providing goods or services for a program
of the pass-through entity.
(c) A Vendor:
(1) Provides the goods and services within normal business operations;
(2) Provides similar goods or services to many different purchasers;
(3) Operates in a competitive environment;
(4) Provides goods or services that are ancillary to the operation of the Federal program; and
(5) Is not subject to compliance requirements of the Federal program.
Enter the Admin and Direct Service Subcontract Amounts. These amounts will calculate the Total Budget.
The Administrative percentage ratio will also calculate automatically.
List the services and provide a narrative justification of the services to be provided.
Note: Subcontractors who are sub recipients must also prepare a detailed budget using the RWPA budget template.
Submit the subcontractor budget with your budget submission.

SERIAL 13054-RFP
Contractual- Continuation Page Date Prepared: 8/8/2013
The Contractual line item is used for consulting and contracting to be utilized in conjunction with operations of the grant.
Use this page to list Consultant/Contract Labor and Clerical Support if there is insufficient space on the Contractual Page.
Consulting/Professional Contract Labor/Clerical Support
Consulting/Professional Contract Labor/Clerical Support Ebony House, Inc. Non-Medical Case Management MAI
Dates of Service
Consultant Hours Quoted Total Admin Admin Direct Service
Budgeted Rate Budget Budget % Budget
6 $ - $ - $ -
Licenses /
qualifications
Narrative
7 0 $ - $ - $ -
Licenses /
qualifications
Narrative
8 0 $ - $ - $ -
Licenses /
qualifications
Narrative
9 0 $ - $ - $ -
Licenses /
qualifications
Narrative
10 0 $ - $ - $ -
Licenses /
qualifications
Narrative
11 0 $ - $ - $ -
Licenses /
qualifications
Narrative
12 0 $ - $ - $ -
Licenses /
qualifications
Narrative
13 $ - $ - $ - $ - $ -
Licenses /
qualifications
Narrative
14 0 $ - $ - $ -
Licenses /
qualifications
Narrative
15 0 $ - $ - $ -
Licenses /
qualifications
Narrative
16 0 $ - $ - $ -
Licenses /
qualifications
Narrative
Consulting/ Prof./ Clerical Sup. Subtotal to Page 1 TOTAL - - $ -
Consulting/Professional/Clerical Support-
Enter the Consultant/Contractor Name, Annual Budgeted Hours, Quoted Rate, the percent of time that will be spent on Administrative Activities,
Dates of Service, Licenses, Qualifications and Description /Justification of Services to be provided
If there are more than 9 entries, continue on the Contractual Continuation Tab of this budget template. The subtotals from the Contractual
Continuation Page will be carried over to the main Contractual budget page.

SERIAL 13054-RFP
Other Program Support Provider Entry Auto Calculation Date Prepared: 8/8/2013
Use this form to budget for other support necessary to provide services under this grant. In the Narrative Justification
describe how the program support will be used and also the methodology used to allocate the total or a portion of the total cost
to the grant.
1 Communications/Telephone/Internet
Communications/Telephone/Internet Ebony House, Inc. Non-Medical Case Management MAI
Item Total Narrative/Cost Allocation Methodology
Amount Admin Direct
Budgeted 0% 100%
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
2 Copy/Duplicating
Copy/Duplicating Ebony House, Inc. Non-Medical Case Management MAI
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
1 Program Brochures
$ - $ -
2 Other Copying/Duplicating
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
3 Postage
Postage Ebony House, Inc. Non-Medical Case Management MAI
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted 0% 100%
$ - $ - $ -
$ - $ - $ -
TOTAL $ - $ - TOTAL $ -
4 Utilities
Utilities are 100% administrative. (Ruling 6.6.B05)
Utilities Ebony House, Inc. Non-Medical Case Management MAI
Item Amount Admin Direct Total Narrative/Cost Allocation Methodology
Budgeted
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TOTAL - - TOTAL $ -
4 Other Program Support
Other Program Support Ebony House, Inc. Non-Medical Case Management MAI
Item Admin Direct Total Narrative/Cost Allocation Methodology
$ 500.00 $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
$ - $ - $ - $ -
TOTAL $ - $ - TOTAL $ -
Admin Direct Total
SUMMARY Program Support $ - $ - $ -
Other Program Support B05-SP-1 ( These instructions will not print)
Section 1-3. These sections apply the FTE ratio for the expenditures including: telephone, postage, copying, and utilities.
Section 4 - Other Program Support allows you to use your own calculation method to allocate costs between Admin and Direct.
Enter the Admin Amount and Direct Amount to calculate the Total Budget and provide adequate justification of the methodology used
to allocate the costs; the methodology must be in line with your agency's cost allocation policy. Final determination resides with the
Maricopa County Ryan White Part A Program.

SERIAL 13054-RFP
Other Professional Service Provider Entry Auto Calculation Date Prepared:
Use this form to budget for other professional services; audit/accounting, insurance, rent/space, or other professional services.
1 Audit/Accounting/Finance
Audit/Accounting/Finance Ebony House, Inc. Non-Medical Case Management MAI
Vendor Hours Quoted Total Dates Admin Direct Service Description of Service
Name Budgeted Price* Price of Service
a $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ -
Cost Method
Used
Budget
Justification
TOTAL - $ -
2 Insurance
Insurance Ebony House, Inc. Non-Medical Case Management MAI
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Premium To grant Grant of Service
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
3 Rent/Space
Rent is considered 100% administrative
Rent/Space Ebony House, Inc. Non-Medical Case Management MAI
Vendor Annual Percent Total Dates Admin Direct Service Description of Service
Name Rent to Grant Grant of Service
$ -
a $ - $ -
Cost Method
Used
Budget
Justification
TOTAL $ - $ -
4 Other Professional Service
Other Professional Service Ebony House, Inc. Non-Medical Case Management MAI
Vendor Hours Quoted Total Admin Admin Direct Service Description of Service
Name Budgeted Price* Price Budget %
a $ - $ - $ -
Cost Method
Used
Budget
Justification
b $ - $ - $ -
Cost Method
Used
Budget
Justification
c $ - $ - $ -
Cost Method
Used
Budget
Justification
$ - TOTAL $ - $ - $ -
Admin Direct Total
SUMMARY Other Prof. Svc $ - $ - $ -
Other Professional B05-PF-1 ( These instructions will not print)
For each section, indicated the provider of service(s), the rate, a detailed description of the services provided, the method of calculating the
budget for this Part A grant and a narrative justification describing why is service is needed.
Section 1-3. Auditing, Insurance and Rent have been determined by the Maricopa County Ryan White Program to be Administrative Services.
Section 4 allows providers to indicate the percentage requested as administrative and direct service. Adequate explanation of the methodology
used to allocate costs is required; final determination resides with the Maricopa County Ryan White Part A Program.
If a vendor is not paid based on an hourly rate, enter a 1 for Hours Budgeted and the total cost of the service under Quoted Price.

SERIAL 13054-RFP
Schedule of Deliverables Provider Entry Auto Calculation Date Prepared: 8/8/2013
Organization Name: Ebony House, Inc. Performance Measures:
Service Category Non-Medical Case Management MAI Number of New Clients 75
Number of Returning Clients 88
Total # of Unduplicated Clients 163
Fee for Service Only
Schedule of Deliverables ( Not Applicable to Cost Reimbursement Contracts)
Service Unit
CAREWare Fee Source (ie
Definition Number of Proposed Fee Total Payment Per
Service Unit Service Description Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb AHCCCS, I H S,
1 unit = Units Per Product/ Objective/Activity
Name/Code Negotiated Rate, etc.)
(i.e. 15 minutes) Proposed Deliverable
Assessment and Care
NMCM Plan, linkage to primary
1 Assessment medical care 1 unit = 15 minutes 780 65 65 65 65 65 65 65 65 65 65 65 65 $ -
Referrals, assist in
retention to care,
support for community
based services, assist
in decreasing barriers
to care, increase client
health w ith natural and
2 NonMCM community supports. 1 unit = 15 minutes 4,800 400 400 400 400 400 400 400 400 400 400 400 400 $ -
3 - $ -
4 - $ -
5 - $ -
6 - $ -
7 - $ -
8 - $ -
9 - $ -
10 - $ -
11 - $ -
12 - $ -
13 - $ -
14 - $ -
15 - $ -
TOTAL 5,580 465 465 465 465 465 465 465 465 465 465 465 465 $ -
Total Budget $ 96,472.00
Over/(Under Budget) $ (96,472.00)
Balance should equal zero
Instructions for Schedule of Deliverables ( These instructions will not print)
Fee for Service Only
Example ( Not Applicable to Cost Reimbursement Contracts)
CAREWare Service Unit Number
Service Unit Service Description Definition 1 of Units Mar Apr May June July Aug Sep Oct Nov Dec Jan Feb Proposed Fee Per Total Payment Per Fee Source (ie AHCCCS, I H
Name/Code unit = (i.e. Proposed Product/ Objective/Activity S, Negotiated Rate, etc.)
Face to face medical 15 minutes) Deliverable
FMCM case management
Assessment assessment. 1 unit = 15 minutes 1,128 94 94 94 94 94 94 94 94 94 94 94 94 $ - $ -
Food boxes Food box 1 unit = 1 food box 3,396 283 283 283 283 283 283 283 283 283 283 283 283 $ - $ -
H0004 Ind Individual counseling
Counseling session 1 unit = 15 minutes 6,900 600 600 600 600 500 600 600 600 600 400 600 600 $ 16.76 $ 115,644.00 AHCCCS Rate
1 Enter the CAREWare Service Name and or/Code; i.e. HCPCS or CPT Codes
2 Service Name Description- Use this cell to provide the full service name or describe the service
3 Service Unit Definition- Enter the DEFINITION of 1 unit. i.e. 15 minutes
The Unit definitions for each service category can be found in the RWPA P&P Manual
4 The TOTAL NUMBER OF UNITS PROPOSED calculates automatically, based on the total number of units
entered in the Schedule of Deliverables.
5 SCHEDULE OF DELIVERABLES: Enter the # of units BY MONTH proposed in the corresponding column and row.
Complete the information in the final 3 columns for Fee for Service Contracts Only
6 Enter the proposed fee for the corresponding activity/unit.
7 The Total Payment for each Activity/Unit calculates based on proposed # of units x proposed fee.
8 The TOTAL PAYMENT for all activity/units must equal the Total Budget from the Budget Summary.
9 In the final column, enter the source of the fee, i.e. AHCCCS, I H S, Negotiated Rate

SERIAL 13054-RFP
EXHIBIT C
SCOPE OF WORK
1.0 SCOPE OF WORK:
1.1 PURPOSE OF THE PROGRAM, AUTHORITY AND BACKGROUND:
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was first enacted in 1990 and
amended in 1996, 2000, 2006 and 2009. Currently, the Act was reauthorized in 2009 and is called the
Ryan White HIV/AIDS Treatment Extension Act of 2009. The authority for this grant program is the
Public Health Service Act Section 2603, 42 USC 300ff-13. The U.S. Department of Health and Human
Services (DHHS) administers the Part A program through the Health Resources and Services
Administration (HRSA), HIV/AIDS Bureau (HAB), Division of Service System (DSS). The entire
CARE Act may be accessed at http://hab.hrsa.gov/abouthab/legislation.html.
Part A funds provide direct financial assistance to Eligible Metropolitan Area (EMAs) that have been the
most severely affected by the HIV epidemic. Formula and supplemental funding components of the
grant assist EMAs in developing or enhancing access to a comprehensive continuum of high quality,
community-based care for low-income individuals and families with HIV disease. A comprehensive
continuum of care includes primary medical care, HIV-related medications, mental health treatment,
substance abuse treatment, oral health and case management services that assist PLWH/A (People Living
with HIV/AIDS) in accessing treatment of HIV infection that is consistent with Public Health Service
(PHS) Treatment Guidelines (current treatment guidelines are available at www.AIDS info.nih.gov).
Comprehensive HIV/AIDS care beyond these core services also includes access to other health services
(e.g. home health care, nutritional, and rehabilitation service). In addition, this continuum of care may
include supportive services that enable individuals to access and remain in primary medical care (e.g.
outreach, transportation, and food services).
Part A supplemental funds have been awarded since fiscal year (FY) 1999 under the Minority AIDS
Initiative (MAI) to improve the quality of care and health outcomes in communities of color
disproportionately impacted by the HIV epidemic. Funds are to initiate, modify, or expand culturally and
linguistically appropriate HIV care services for disproportionately impacted communities of color.
Following Congressional intent, MAI funds must be used to expand or support new initiatives consistent
with these goals.
MAI funds are subject to special conditions of award, and providers of services funded with MAI funds
must document their use separately from other Part A funds. Progress reports must be provided in a
beginning of year, Mid-Year Progress Report, and end-of-fiscal year Final Progress Report. This
information reported is used to monitor:
1. Compliance with the MAI Condition of Award and related requirements;
2. Progress in meeting planned objectives;
3. Potential grantee technical assistance needs;
4. Type and quantity of services delivered and demographics of clients served, and;
5. Improvements in access and health outcomes being achieved through these services.
In preparing all responses to this Request for Proposal (RFP), applicant should consider how efforts at
the local level are consistent with the Ryan White HIV/AIDS Treatment Extension Act of 2009 which
emphasizes the use of funds to address the service needs of “individuals who know their HIV status and
are not receiving primary medical care services and for informing individuals of and enabling the
individuals to utilize the services, giving particular attention to eliminating disparities in access and
services among affected subpopulations and historically underserved communities” Section 2602
(b)(4)(D)(i).
Additionally, applicants should consider the impact of the epidemic within the Phoenix EMA, which
consists of Maricopa and Pinal counties. Several studies are available for applicants to review including:
1. 2006 Hispanic PLWH/A Needs Assessment
2. 2006 African American PLWH/A Needs Assessment
3. 2006 PLWH/A Out of Care Needs Assessment

SERIAL 13054-RFP
4. 2006 Pinal County Needs Assessment
5. Phoenix EMA 2006-2009 Comprehensive Plan
All reports can be viewed at the Phoenix EMA Ryan White Planning Council's website at:
http://www.ryanwhiteparta.com
Moreover, in developing your application you should consider the HIV/AIDS Bureau (HAB) Guiding
Principles indicated below that have significant implications for HIV/AIDS care services planning.
1. The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach
populations;
1. The quality of emerging HIV/AIDS therapies can make a difference in the lives of people
living with HIV disease;
2. Changes in the economics of health care are affecting HIV/AIDS care network; and
3. Outcomes are a critical component of program performance.
All CARE Act funded projects in any service category must participate in the existing community-based
continuum of care. This concept requires that services in a community must be organized to respond to
the individual’s or family’s changing needs, in order to reduce fragmentation of care. For the Phoenix
EMA to achieve this intent as required by HRSA guidance funded providers will be required to attend
meetings sponsored by the Phoenix EMA Ryan White Planning Council and other management and
technical assistance meetings deemed mandatory by Maricopa County Ryan White Part A Program.
Lastly, Part A funds must be used in a manner consistent with current and future HRSA policies as
developed by the Division of Services Systems, HIV/AIDS Bureau. These policies can be reviewed on
the HAB website at http://hab.hrsa.gov.
1.2 THE PHOENIX EMA RYAN WHITE PLANNING COUNCIL:
The Phoenix EMA Ryan White Planning Council (PC) is a planning body required under the Part A
authorization. The Maricopa County Board of Supervisors serves as the Chief Elected Official for the
Planning Council. Membership of the PC must be reflective of the epidemic within the Phoenix EMA
and includes representatives from a variety of specific groups such as providers of housing and homeless
shelters, HIV prevention services, representatives of individuals who were formerly Federal, State or
local prisoners released from the custody of the penal system and had HIV disease on the date released,
other mandated entities and interested advocates. The PC establishes service priorities, allocates Part A
funds, develops a comprehensive plan, and addresses the efficiency of the grantee’s administrative
mechanism for rapidly contracting out funds to service providers.
The PC establishes Directives for service categories that are additional requirements that must be
incorporated into the program plan along with applicable Standards of Care. These Directives are
discussed under the service category description and should also guide prospective applicants in the
development of goals objectives and a work plan.
1.3 ADMINISTRATIVE AGENT AND QUALITY MANAGEMENT:
Part A funds are awarded to the chief elected official (CEO). The CEO retains ultimate responsibility for
submitting grant applications, ensuring that funds awarded are used appropriately, and complying with
reporting or other requirements. Most CEOs delegate day-to-day responsibility for administering their
Part A award to a health related department within the jurisdiction.
For the purposes of this section, the CEO of the EMA has delegated this responsibility to the Ryan White
Part A Program within Maricopa County.
Administrative activities under the authority of the Administrative Agent include:
Routine grant administration and monitoring activities, including the development of
applications for funds, the receipt, monitoring and disbursal of program funds, the development
and establishment of reimbursement and accounting systems, the preparation of routine
programmatic and financial reports, compliance with grant conditions and audit
requirements/promulgation of policies and procedures and continuous quality improvement
initiatives.

SERIAL 13054-RFP
All activities associated with the grantee’s contract award procedures, including the
development of requests for proposals, contract proposal review activities, negotiation and
awarding of contracts, monitoring of contracts through telephone consultation, written
documentation or onsite visits, reporting on contracts, and funding reallocation activities.
The administrative agent will conduct site visits with service providers to monitor program and
fiscal compliance with contracts, and to ensure adherence to the EMA’s Standards of Care as
developed by the PC.
The lead agency (Contractor) agrees to include in any subcontracts a provision to the effect that
the subcontractor agrees that Maricopa County Ryan White Part A Program shall have access to
the subcontractor’s facilities and the right to examine any books, documents, and records of the
subcontractor, involving transactions related to the subcontract. Additionally, client charts,
care/treatment plans, eligibility requirements, etc shall be available for inspection.
The Administrative Agent will also provide technical assistance and training that providers may
be required to attend.
The CARE Act requires the establishment of quality management program and quality service
indicators for all Part A programs to ensure that persons living with HIV disease receive those
services and that the quality of those services meet certain criteria, specifically Standards of
Care and the Public Health Services treatment guidelines.
The Maricopa County Ryan White Part A Program has established a Quality Management Program to
assess all services funded under Ryan White Part A Program and to achieve the goals set forth in the
CARE Act. All funded programs are subject to quality management reviews and technical assistance.
All agencies must be able to demonstrate that health and support services supported by Part A funds are
consistent with PHS treatment guidelines and the Standards of Care as established by the Planning
Council.
All funded providers will be asked to submit quality management plans to reflect how providers are
ensuring quality services.
1.4 CONTRACTOR ELIGIBILITY:
Eligible contractor for awards include public or non-profit health and social services providers, and other
non-profit community organizations, medical care providers, community-based organizations, HIV/AIDS
service organizations, academic entities, and city, county, state, federal governmental units. The CARE
Act Amendments of 1996 provide for contracting with for-profit entities under certain limited
circumstances. Specifically, the amendments allow Part A funds to be used to provide direct financial
assistance through contracts with private for-profit entities if such entities are the only available provider
of quality HIV care in the area (Sec 2604(b) (2) (A); Section 2631(a) (1). Contractors are prohibited
from serving as conduits to pass on their awards to for-profit entities. To better serve Persons Living
with HIV/AIDS (PLWHA) within the EMA, the Maricopa County Ryan White Part A Program
reserves the right, at its discretion, to issue multiple contracts within a service category pursuant to
this Request for Proposal.
All services must be directed to enhance the delivery of services to persons living with HIV, and, in
limited, restricted instances, their families. These funds may not be used for prevention services.
Joint proposals from coalitions of agencies and organizations are allowable. However, if a lead agency
(prime contractor) is proposing to sub-contract with another agency to perform more than 50% of the
deliverables, the proposal must provide sufficient information regarding the qualifications of the sub-
contracting agency.
In all cases, a lead agency (as prime contractor) must be identified. All proposals in response to this RFP
which include the use of subcontractors must be submitted by a lead agency, with the approach to use the
subcontractor(s) clearly outlined in their proposal.

SERIAL 13054-RFP
All providers must have documented evidence to substantiate referral relationships on an ongoing basis.
All officers must submit any written agreements with other organizations/entities that serve the
community of persons living with HIV and are 1) service providers and/or 2) points of entry or access to
HIV services. All officers’ are strongly encouraged to include copies of such agreements, detailing each
agencies/organization’s roles and responsibilities, with each application.
The use of subcontractors and/or consultants must be pre-approved by the Maricopa County Ryan White
Part A Program. If approved, the Contractor agrees to use written agreements which conform to Federal
and State laws, regulations and requirements of this proposal appropriate to the service or activity
defined by this RFP. These provisions apply with equal force to the subcontract as if the subcontractor
were the contractor referenced herein. The Contractor is responsible for the performance of this contract
regardless of whether or not a subcontract is used. The lead agency (Contractor) will submit a copy of
each executed subcontract to the RWPA within fifteen (15) days of its effective date.
All proposals in response to this RFP which include the use of subcontractors must clearly state and
document the details of the subcontract agreement. This will include a scope/intent of work for both the
lead agency and all subcontracts proposed. The scope of the proposal must clearly identify the services
to be provided by all parties for the proposal. Additionally, all subcontract agreements proposed must
include a detailed budget and narrative, identifying all administrative costs, as defined in the
“Administrative Costs” section of this RFP. Subcontracts will be restricted to no more than ten percent
of the budget proposed.
1.5 COMPENSATION:
1.5.1 The County reserves the right to reallocate funding during the contract period so that the
services provided and corresponding contract amount may be decreased or increased, via
contract amendment or Task Order, at the discretion of the County.
1.5.2 County will pay the Contractor on a monthly basis for approved services and expenses and in
accordance with the reimbursement methodology determined by the County’s Administrative
Agent; either fee-for service or cost. The total funds paid to the Contractor will be dependent
upon the approved invoice according to the Administrative Agent. County does not guarantee a
minimum payment to the Contractor. County will not reimburse for fee-for-service activities
when an appointment is canceled either by the client or Contractor.
1.5.3 The Contractor understands and agrees to notify the County of any deviations or changes to any
budget line of the current budget in place for this contract within 30 days of such change.
1.5.4 The Contractor shall be compensated for services provided only by the staff
classifications/positions included/referenced in the current approved budget.
1.5.5 Unless specifically allowed and referenced elsewhere in this contract, all services are to be
provided at approved Contractor sites and/or venues. Services provided at non-authorized
locations or venues will not be reimbursed by the County.
1.5.6 The Contractor shall provide monthly financial and corresponding programmatic reports per the
reporting schedule to the County. If the Contractor is not in compliance due to non-
performance, submission of reports after deadlines, insufficient back-up statements or
improperly completed forms, the Contractor may not be reimbursed or reimbursement may be
delayed until program compliance issues and any other related financial consequences are
resolved. Furthermore, instances of non-compliance with billing and reporting requirements
may result in the County reducing the Contractor’s reimbursement by up to 10% of the
corresponding month’s billing. Billing forms and instructions are included in the current Ryan
White Part A Program Policies and Procedures Manual refer to http://www.ryanwhiteparta.com
1.5.7 The actual amount of consideration to be paid to the Contractor depends upon the actual hours
worked, services provided and related expenses as stated in the current approved budget or as
modified by contract amendment or appropriately executed task order. Any un-obligated
balance of funds at the end of this Agreement period will be returned to the County in
accordance with instruction provided.

SERIAL 13054-RFP
1.6 INVOICES AND PAYMENTS:
1.6.1 The Contractor shall submit electronically to the Administrative Agent one (1) legible copy of
their detailed monthly invoice before payment(s) can be made.
1.6.2 Contractor shall submit the invoice packet for services performed on or before the fifteenth
(15th) calendar day following the month in which services were performed.
1.6.3 The invoice shall include the requirements as outlined in the Ryan White Part A’s current
policies and procedures manual.
1.6.4 Contractors providing medical services are required to utilize the Health Care Form (HCF-1500)
Uniform Billing (UB-92) or other standardized medical claim forms as agreed to with the
Administrative Agent, and to submit these to the Ryan White Part A Program in addition to the
other required invoice reports and forms.
1.7 METHOD OF PAYMENT:
1.7.1 Subject to the availability of funds, County will, within sixty (60) business days from the date of
receipt of the documents enumerated herein, process and remit to the Contractor a warrant for
payment up to the maximum total allowable for services provided or work performed during the
previous month. Payment may be delayed or reduced if invoices are in non-compliance due to
late submission, improperly completed or missing documentation/information or for other
contract non-compliance occurring in the related grant year. Other non-compliance issues that
may delay or reduce payments can be related to any contractual issue, and may not necessarily
be related to the bill itself. Should County make a disallowance in the claim, the claim shall be
processed for the reduced amount. If the Contractor protests the amount or the reason for a
disallowance, the protest shall be construed as a dispute concerning a question of fact within the
meaning of the "Disputes" clause of the Special Provisions of this Contract.
1.7.1.1 The Contractor understands and agrees that County will not honor any claim for
payment submitted 60 calendar days after date of service. The Contractor understands
and agrees that County will not process any claim for payment for services rendered
prior to the end of the contract period which are submitted sixty (60) calendar days
after the end of the contract period without approval of County. For claims that are
subject to AHCCCS Regulation R9-22703.B1, County will not honor any claim for
payment submitted nine months after date of service. Claims submitted 45 calendar
days from the last day of the grant year will not be honored or reimbursed.
1.7.1.2 Payments made by County to the Contractor are conditioned upon the timely receipt of
applicable, accurate and complete invoice reports and forms submitted by the
Contractor. All monthly invoices must be supported by auditable documentation,
which is determined to be sufficient, competent evidential matter defined by the
County.
1.7.1.3 The Contractor understands and agrees that Ryan White Part A Program is the payer of
last resort, and shall maximize and monitor all other revenue streams including self-pay
and all sources of third party reimbursements. The Contractor understands and agrees
that all self-pay and third party payments must be exhausted to offset program costs
before Ryan White funds are used. The Contractor must have policies and procedures
documented and in place to determine and bill these other potential payment sources.
These third party payers include but are not limited to Regional Behavioral Health
Authority (RBHA), Medicaid (Arizona Health Care Cost Containment
Services/AHCCCS), Arizona Long Term Care System (ALTCS), TRICARE, Medicare
and private/commercial or other insurance. The Contractor will determine eligibility of
clients and assist with client enrollment whenever feasible. Payments collected by the
Contractor for Ryan White services must be recorded as Program Income in the
Contractor’s financial management system and deducted from bills issued to the
County. Program income records must be made available to the County for assurance
that such revenues are used to support related services. The Contractor shall have
policies and procedures for handling Ryan White revenue including program income.

SERIAL 13054-RFP
1.7.1.4 The Contractor shall have policies and staff training on the payer of last resort
requirement and how it meets that requirement.
1.7.1.5 Payment shall be made to the Contractor by Accounts Payable through the Maricopa
County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT)
process. After Contract Award the Contractor shall complete the Vendor Registration
Form located on the County Department of Finance Vendor Registration Web Site
(http://www.maricopa.gov/Finance/Vendors.aspx).
1.7.1.6 EFT payments to the routing and account numbers designated by the Contractor will
include the details on the specific invoices that the payment covers. The Contractor is
required to discuss remittance delivery capabilities with their designated financial
institution for access to those details.
1.8 BUDGET, REVENUES AND EXPENDITURES:
1.8.1 The Contractor shall have written fiscal and general policies and procedures that include
compliance with federal and Ryan White programmatic requirements.
1.8.2 The Contractor shall prepare and submit to County a budget using the current Ryan White Part
A Program-approved formats at the beginning of each grant year in accordance with the stated
funds allocated on the most recently issued task order. If the task order is increased or decreased
at any time throughout the duration of the grant year, a revised budget may be required. Failure
to provide a required budget or schedule of deliverables within the designated timeframe may
result in termination of the contract.
1.8.2.1 The total administrative costs budgeted; including any federally approved indirect rate
(inclusive of contractor and subcontractor(s)) cannot exceed 10% of the amount of the
current grant award. Any amount of administrative expenditures in excess of 10% will
not be reimbursed.
1.8.2.2 Contractor agrees that all expenditures are in accordance with the current approved
budget. Any expenditure deemed unallowable by the Administrative Agent is subject
to the Contractor submitting a full reimbursement to the County.
1.8.2.3 Contractor agrees to establish and maintain a “Financial Management System” that is
in accordance with the standards required by Federal OMB Circular A-110, Subpart C.
Such system must also account for both direct and indirect cost transactions, reports on
the results of those transactions, are in compliance with the requirements of OMB
Circular A-21 and generally accepted accounting principles.
1.8.2.4 All expenditures and encumbered funds shall be final and reconciled no later than 45
days after the close of the grant year.
1.8.2.5 Funds collected by the Contractor in the form of fees, charges, and/or donations for the
delivery of the services provided for herein shall be accounted for separately. Such
fees, charges and/or donations must be used for providing additional services or to
defray the costs of providing these services consistent with the Schedule of
Deliverables of this Contract. As applicable, the Contractor agrees to include, in the
underlying budget, the amount of projected revenue from client fees. The amount of
funds collected from client fees shall be reported by Contractor in the Monthly invoice
by discrete service. For audit purposes, the Contractor is responsible for maintaining
necessary documentation to support provision of services.
1.9 AMENDMENTS:
All amendments to this Contract must be in writing and signed by both parties. All amendments shall
clearly state the effective date of the action.

SERIAL 13054-RFP
1.10 TASK ORDERS:
Contractor shall not perform a task other than those found/defined in the contract award document. Task
Orders may be issued by the Administrator of this contract. Task Orders will be communicated via
written document and shall include, but is not limited to: budget amount, reference to special conditions
of award, and any special service and reporting requirements. Amended Task Orders can be issued at
any time during the grant year. Both parties shall sign a new or amended Task Order.
1.11 CHANGES:
1.11.1 The Maricopa County Ryan White Part A Program, with cause, by written order, may make
changes within the general scope of this Contract in any one or more of the following areas
(Also see AMENDMENTS & TASK ORDER SECTIONS):
1.11.1.1 Schedule of deliverables activities reflecting changes in the scope of services, funding
source or County regulations,
1.11.1.2 Administrative requirements such as changes in reporting periods, frequency of
reports, or report formats required by funding source or County regulations, policies or
requirements, and/or,
1.11.1.3 Contractor fee schedules, reimbursement methodologies and/or schedules and/or
program budgets.
Examples of cause would include, but are not limited to: non-compliance, under
performance, service definition changes, reallocations or other directives approved by
the Planning Council, or any other reason deemed necessary by the Administrative
Agent.
1.11.2 Such order will not serve to increase or decrease the maximum reimbursable amount to be paid
to the Contractor. Additionally, such order will not direct substantive changes in services to be
rendered by the Contractor.
1.11.3 Any dispute or disagreement caused by such written order shall constitute a "Dispute" within the
meaning of the Disputes Clause found within this Contract and shall be administered
accordingly.
1.12 AUDIT REQUIREMENTS:
1.12.1 If the Contractor expends $500,000 or more from all contracts administered and/or funded via
County, and/or receives $500,000 or more per year from any federal funding sources, the
Contractor will be subject to Federal audit requirements per P.L. 98-502 "The Single Audit
Act." The Contractor shall comply with OMB Circulars A-128, A-110, and A-133 as
applicable. The audit report shall be submitted to the Maricopa County Internal Audit
Department of Public Health for review within the twelve months following the close of the
fiscal year. The Contractor shall take any necessary corrective action to remedy any material
weaknesses identified in the audit report within six months after the release date of the report or
by a date defined by the Internal Audit Department. Maricopa County may consider sanctions
as described in OMB Circular A-128 for contractors not in compliance with the audit
requirements. All books and records shall be maintained in accordance with Generally
Accepted Accounting Principles (GAAP).
1.12.2 The Contractor shall schedule an annual financial audit to be submitted to County for review
within twelve months following the close of the program’s fiscal year. Contractor understands
that failure to meet this requirement may result in loss of current funding and disqualification
from consideration for future County-administered funding.
1.12.3 The Contractor shall have and make available to County financial policies and procedures that
guide selection of an auditor, based on an Audit Committee for Board of Directors (if
Contractor is a non-profit entity).

SERIAL 13054-RFP
1.12.4 The Contractor shall also comply with the following OMB Circulars as applicable to its
organizations business status:
1.12.4.1 A-102 Uniform Administrative Requirements for Grants to State and Local
Government.
1.12.4.2 A-110 Uniform Administrative Requirements for Grants and Agreement with
Institutions of Higher Education, Hospitals and other non-profit organizations.
1.12.4.3 A-122 Cost Principles for Non-Profit Organizations.
1.12.4.4 A-87 Cost Principles for State and Local Governments.
1.12.4.5 A-21 Cost principles for Education Institutions.
1.13 SPECIAL REQUIREMENTS:
1.13.1 The Contractor shall adhere to all applicable requirements of the Ryan White HIV/AIDS
Treatment Extension Act of 2009 and/or current authorized or reauthorized Ryan White
HIV/AIDS Act.
1.13.2 The Contractor shall participate in provider technical assistance meetings and/or teleconference
calls that will be scheduled by the Administrative Agent throughout the year.
1.13.3 The Contractor shall retain the necessary administrative, professional and technical personnel
for operation of the program.
1.13.4 The Contractor agrees to maintain adequate programmatic and fiscal records and files including
source documentation to support program activities and all expenditures made under terms of
this agreement as required.
1.13.5 Contractor agrees to install and utilize the CAREWare client level reporting software system as
described in the current Ryan White Part A Program Policies and Procedures Manual. There
are no licensing costs associated with the use of CAREWare, however, the provider is required
to pay for the cost related to installing and configuring internal firewall devices to gain access to
the CAREWare database. These expenses can be reimbursed by Ryan White if included in the
current approved budget.
1.14 RELEASE OF INFORMATION:
1.14.1 The Contractor agrees to secure from all clients provided services under this contract any and all
releases of information or other authorization requested by County. Each client file documenting
the provision of Part A services must contain a current Administrative Agent authorized release
form signed and dated by the client or client’s legal representative. Failure to secure such
releases from clients may result in disallowance of all claims to County for covered services
provided to eligible individuals. If service to anonymous clients is specifically allowed and
approved by the County according to the current Ryan White Part A policies and procedures
manual or otherwise stated in writing by the Administrative Agent, this provision does not
apply.
1.14.2 The Contractor agrees to comply with ARS §36-662, access to records. In conducting an
investigation of a reportable communicable disease the department of health services and local
health departments may inspect and copy medical or laboratory records in the possession of or
maintained by a health care provider or health care facility which are related to the diagnosis,
treatment and control of the specific communicable disease case reported. Requests for records
shall be made in writing by the appropriate officer of the department of health services or local
health department and shall specify the communicable disease case and the patient under
investigation.
1.15 CERTIFICATION OF CLIENT ELIGIBILITY:
1.15.1 The Contractor agrees to determine and certify eligibility all clients seeking services supported
by Ryan White funds, according to the requirements detailed in of the Eligibility section of the
current Ryan White Part A Program Policies and Procedures Manual.

SERIAL 13054-RFP
1.15.2 The Contractor agrees to have billing, collection, co-pay and sliding fee policies and procedures
that do not deny clients services for non-payment, inability to produce income documentation,
or require full payment prior to service, or include any other barriers to service based on ability
to pay.
1.15.3 If the Contractor charges clients for services, the Contractor agrees to charge and document
client fees collected in accordance with their sliding fee schedule. This fee schedule shall be
consistent with current federal guidelines. This fee schedule must be published and made
available to the public. If charging fees, the Contractor must have a fee discount policy, sliding
fee schedule, and sliding fee eligibility applications. The Contractor must track fees charged and
paid by clients. The Contractor must have a fee discount policy that includes client fee caps,
including:
1.15.3.1 Clear responsibility for annually evaluating clients to establish individual fees and
caps.
1.15.3.2 Tracking of Part A charges or medical expenses inclusive of enrollment fees,
deductibles, and co-payments.
1.15.3.3 A process for alerting the billing system that client has reached cap and no further
charges will be charged for the remainder of the year.
1.15.3.4 Documentation of policies, fees, and implementation, including evidence that staff
understand those policies and procedures.
1.15.3.5 Contractor must have a process for charging, obtaining, and documenting client
charges through a medical practice information system, manual or electronically.
The chart below must be followed when developing the fee schedule.
Fees For Service
Client Income
Less than or equal to 100% of the No fees or charges to be imposed
official poverty line
Greater than 100%, but not exceeding Fees and charges for any calendar year may not
200%, of the official poverty line exceed 5% of the client’s annual gross income
Greater than 200%, but not exceeding Fees and charges for any calendar year may not
300%, of the official poverty line exceed 7% of client’s annual gross income
Greater than 300% of the official Fees and charges for any calendar year may not
poverty line exceed 10% of client’s annual gross income
1.16 QUALITY MANAGEMENT:
1.16.1 The Contractor will participate in the Quality Management program as detailed in the current
Ryan White Part A Program Policies and Procedures Manual.
(http://www.maricopa.gov/publichealth/Services/RyanWhite/publications.aspx) (See Ryan
White Part A Program Policies and Procedures).
1.16.2 The Contractor will utilize and adhere to the most current Standards of Care as developed by the
Phoenix Eligible Metropolitan Area Planning Council.
1.16.3 The Contractor will develop and implement an agency-specific quality management plan for
Ryan White Part A-funded services. The Contractor will conduct Quality Improvement projects
at the agency level utilizing the Plan-Do-Check-Act (PDCA) model.
1.16.4 The Contractor will participate in cross-cutting Quality Improvement projects and report data
per the timeline established with the County. Additionally, the Contractor will report quality
outcome measures established by the County per the reporting schedule.

SERIAL 13054-RFP
1.16.5 The Contractor will participate in the Quality Management activities of the Clinical Quality
Management Committee as requested by the County.
1.16.6 The Contractor will conduct and provide documentation of quality assurance and improvement
activities, including maintenance of client satisfaction surveys and other mechanisms as
designated by the County.
1.16.7 The Contractor will maintain a comprehensive unduplicated client level database of all eligible
clients served as well as demographic and service measures required and submit this
information in the format and frequency as requested by the County. The County will make
available to the Contractor software for the collection of this information (CAREWare).
1.16.8 The Contractor will maintain consent to serve forms signed by the clients to gain permission to
report their data to County, State and Federal authorized entities and to view their records as a
part of site visits and quality management review activities.
1.16.9 The Contractor will participate in Quality Management trainings sponsored by the County
which are deemed mandatory. The Contractor understands that non-participation in these types
of activities may result in non-compliance with the Standards of Care as mandated by the Ryan
White Act. Further, such non-participation in Quality Management trainings could result in
prompting a performance monitoring site visit.
1.17 REPORTING REQUIRMENTS:
1.17.1 The Contractor agrees to submit monthly invoices as defined in the Invoice and Payments
section.
1.17.2 The Contractor agrees to submit any administrative, programmatic, quality and/or fiscal reports
requested and at the due date defined by the Administrative Agent.
1.17.3 The Contractor agrees to comply with and submit annual and semi-annual client-level and
provider-level data as required by HRSA by the due date(s) defined by the Administrative
Agent.
1.17.4 The Contractor agrees to comply with ARS § 36-621, reporting contagious diseases. Any
employee, subcontractor or representative of the Contractor providing services under this
contract shall follow the requirements of this law. Specifically, a person who learns that a
contagious, epidemic or infectious disease exists shall immediately make a written report of the
particulars to the appropriate board of health or health department. The report shall include
names and residences of persons afflicted with the disease. If the person reporting is the
attending physician he shall report on the condition of the person afflicted and the status of the
disease at least twice each week.
1.18 PROGRAM MARKETING INITIATIVES:
1.18.1 When issuing statements, press releases and/or Internet-based or printed documents describing
projects, programs and/or services funded in whole or in part with Ryan White Part A funds, the
Contractor shall clearly reference the funding source as the federal Department of Health and
Human Services, Health Resources and Services Administration, the Ryan White HIV/AIDS
Treatment Extension Act of 2009 (or current authorized or reauthorized name of Act), and
Maricopa County Ryan White Part A Program. Such references to funding source must be of
sufficient size to be clear and legible.
1.18.2 Contractor is responsible for advertising Ryan White Part A-funded services. Such
advertisement is to promote/incorporate the following components: Services available,
venues/locations, and hours of operation. The content of any and all advertising for these
services must be in a format allowed by Local, State and Federal regulations and shall contain
the funding language referenced in this contract section.
1.18.3 Contractor is responsible to ensure that all appropriate program descriptions, including hours
and locations, and any changes related to these services are disseminated to the community and
other Ryan White providers to ensure that clients have access to care. The Contractor shall be

SERIAL 13054-RFP
able to document and explain this communication process to the Administrative Agent upon
request.
1.19 OTHER REQUIREMENTS:
1.19.1 Contractor shall comply with all policies and procedures as defined in the current Ryan White
Part A Policies and Procedures Manual.
1.19.2 Contractor will maintain discrete client files for all individuals served and will secure the
necessary releases of information to allow for review of all pertinent client information by
employees of County and/or their designated representatives.
1.19.3 Contractor shall respond to all requests for information and documentation solicited by County
when they are submitted in writing no later than 72 hours of receipt of request.
1.19.4 Contractor shall participate with a standardized anonymous Consumer Satisfaction Survey
issued to all program participants, at least once during the contract year. The survey and
procedure is included in the Ryan White Part A Program Policies and Procedures Manual.
Refer to http://www.maricopa.gov/publichealth/Services/RyanWhite/providers.aspx
1.19.5 Contractor’s service locations shall be accessible by public transportation. If service locations
are not accessible by public transportation, the Contractor shall have policies and procedures in
place that describe how it will provide transportation assistance to clients.
1.19.6 Contractors providing Medicaid eligible services shall be certified to receive Medicaid
payments, or receive a waiver from the U.S. Secretary of Health and Human Services. The
Contractor shall document efforts to receive certification or waiver, and when certified,
maintain proof of certification and file of contracts with Medicaid insurance companies.
1.20 SAFEGUARDING OF CLIENT INFORMATION:
The use or disclosure by any party of any information concerning an eligible individual served under this
Contract is directly limited to the performance of this Contract.
1.21 NON-DISCRIMINATION:
The Contractor, in connection with any service or other activity under this Contract, shall not in any way
discriminate against any patient on the grounds of race, color, religion, sex, national origin, age, or
handicap. The Contractor shall include a clause to this effect in all Subcontracts inuring to the benefit of
the Contractor or County.
1.22 EQUAL EMPLOYMENT OPPORTUNITY:
1.22.1 The Contractor will not discriminate against any employee or applicant for employment because
of race, age, handicap, color, religion, sex, or national origin. The Contractor will take
affirmative action to insure that applicants are employed and that employees are treated during
employment without regard to their race, age, handicap, color, religion, sex, or national origin.
Such action shall include, but not be limited to the following: employment, upgrading,
demotion or transfer, recruitment or recruitment advertising, lay-off or termination, rates of pay
or other forms of compensation, and selection for training, including apprenticeship. The
Contractor shall to the extent such provisions apply, comply with Title VI and VII of the Federal
Civil Rights Act; the Federal Rehabilitation Act; the Age Discrimination in Employment Act;
the Immigration Reform and Control Act of 1986 (IRCA) and Arizona Executive Order 99.-4
which mandates that all persons shall have equal access to employment opportunities. The
Contractor shall also comply with all applicable provisions of the Americans with Disabilities
Act of 1990.
1.22.2 The Contractor will operate under this agreement so that no person otherwise qualified is denied
employment or other benefits on the grounds of race, color, sex, religion, national origin,
ancestry, age physical or mental disability or sexual orientation except where a particular
occupation or position reasonably requires consideration of these attributes as an essential
qualification for the position.

SERIAL 13054-RFP
1.23 CULTURAL COMPETENCY:
1.23.1 The Contractor shall meet and comply with applicable standards of the federal Culturally and
Linguistically Appropriate Services (CLAS) standards The Contractor shall develop and
implement organizational policies that comply with these standards.
1.23.2 The Contractor shall recognize linguistic subgroups and provide assistance in overcoming
language barriers by the appropriate inclusion of American Sign Language and languages of
clients accessing care.
1.24 RYAN WHITE CAREWARE DATA BASE:
1.24.1 RWPA requires the installation and utilization of HRSA-supplied Ryan White CAREWare
software. CAREWare is used for client level data reporting and monthly billing reports,
demographic reports, and various custom reporting. The Contractor agrees to install, collect,
and report all data requested by the RWPA via RYAN WHITE CAREWare within 60 days of
request by the RWPA. The Contractor agrees to participate in technical assistance training
and/or informational presentations for CAREWare at various times scheduled during the
contract year.
1.24.2 The Contractor is responsible for coordinating the installation of the CAREWare software with
their internal information technology staff. CAREWare software is developed by HRSA and
requires no licensing fees. The Contractor will be responsible for the cost of Virtual Provider
Network (VPN) cards for each user within their organization.
1.24.3 The Ryan White Part A office will provide technical assistance to eligible applicants for the
implementation, configuration and end user support for the CAREWare database. In addition,
technical assistance is made available to eligible applicants to integrate CAREWare with
proprietary in-house billing systems on an as needed basis to minimize data entry efforts needed
to report client level demographic and service related data.
1.25 IMPROPRIETIES AND FRAUD:
1.25.1 The contractor shall notify the Ryan White Part A Program in writing of any actual or suspected
incidences of improprieties involving the expenditure of CARE Act funds or delivery of
services. This will include when potential or current clients receive services, or attempt to
receive services, for which they are ineligible. Notification is also required whenever acts of
indiscretion are committed by employees that may be unlawful or in violation of this contract.
Notification to the Ryan White Part A Program shall occur in writing within 24 hours of
detection.
1.25.2 The Federal Department of HHS Inspector General maintains a toll-free hotline for receiving
information concerning fraud, waste, or abuse under grants and cooperative agreements. Such
reports are kept confidential and callers may decline to give their names if they choose to
remain anonymous.
Office of Inspector General
TIPS HOTLINE
P. O. Box 23489
Washington, D. C. 20026
Telephone: 1-800-447-8477 (1-880-HHS-TIPS)
1.25.3 The Contractor shall be responsible for any loss of funds due to mismanagement, misuse, and/or
theft of such funds by agents, servants and/or employees of the Contractor.
1.26 ADHERENCE TO RYAN WHITE PART A POLICIES:
1.26.1 Contractor shall adhere to all Ryan White Part A Program Policies. Such policies are referenced
in the Ryan White Part A Program Policies and Procedures Manual (See
http://www.maricopa.gov/publichealth/Services/RyanWhite/providers.aspx

SERIAL 13054-RFP
1.27 REFERRAL RELATIONSHIPS:
1.27.1 Contractors must have documented evidence to substantiate referral relationships on an ongoing
basis consistent with HRSA guidance regarding “Maintaining Appropriate Referral
Relationships” available from the RWPA upon request.
1.27.2 The Contractor shall have letters of agreement and Memorandums of Understanding (MOUs) to
document referral relationships with key points of entry. Key points of entry include:
• Emergency rooms
• Substance abuse and mental health treatment programs
• Detox(ification) centers
• Detention facilities
• Sexually Transmitted Disease (STD) Clinics
• Homeless shelters
• HIV counseling and testing sites
Additional points of entry:
• Public health departments
• Health care points of entry specified by eligible areas
• Federally Qualified Healthcare Centers (FQHCs)
• Entities such as Ryan White Part C and D grantees
1.28 POLICY ON CONFIDENTIALITY:
1.28.1 The Contractor understands and agrees that this Contract is subject to all State and Federal laws
protecting client confidentiality of medical, behavioral health and drug treatment information.
1.28.2 The Contractor shall establish and maintain written procedures and controls that ensure the
confidentiality of client medical information and records.
1.28.3 The Contractor shall maintain and document employee and direct service provider training on
their organization’s policies and procedures related to client confidentiality.
1.28.4 In accordance with Section 318 (e)(5) of the Public Health Service Act [42 U.S.C. 247c(e)(5)],
no information obtained in connection with the examination, care or services provided to any
individual under any program which is being carried out with Federal monies shall, without
such individual’s consent, be disclosed except as may be necessary to provide services to such
individual or as may be required by laws of the State of Arizona or its political subdivisions.
Information derived from any such program may be disclosed (a) in summary, statistical, or
other form, or (b) for clinical research purposes, but only if the identity of the individuals
diagnosed or provided care under such program is not disclosed. The Contractor shall comply
with the provisions of A.R.S. § 36-663 concerning HIV-related testing; restrictions; exceptions
and A.R.S. § 36-664 concerning confidentiality; exceptions, in providing services under this
Contract.
1.28.5 Confidential communicable disease related information may only be disclosed as permitted by
law, and only consistent with the current Ryan White Part A Program Policies and Procedures
Manual (See http://www.ryanwhiteparta.com
1.29 EQUIPMENT:
1.29.1 All equipment and products purchased with grant funds should be American-made.
1.29.2 The title to any and all equipment acquired through the expenditure of funds received from
County shall remain that of the Department of Health and Human Services, Health Resources
and Services Administration. County must specifically authorize the acquisition of any such
equipment in advance. Upon termination of this Contract, County may determine the
disposition of all such equipment.

SERIAL 13054-RFP
1.29.3 The Contractor agrees to exercise reasonable control over all equipment purchased with capital
outlay expense Contract funds. All equipment lost, stolen, rendered un-usable, or no longer
required for program operation must be reported immediately to County for disposition
instructions. The Contractor shall report the physical inventory of all equipment purchased with
contract funds within sixty (60) days of receipt of such equipment.

SERIAL 13054-RFP
NARRATIVE
Ebony House, Inc. is seeking funding under Bid #13054-RFP – Ryan White Part A Services –Medical and Non-Medical
Case Management Services as a minority provider. We qualify on the basis of the composition of our Board of Directors
(88% African American) and staff (90% African American and Latino), our history service population and agency Mission
Statement. Ebony House, Inc. proposes to provide medical and non-medical case management services for adults, 18
years of age and above. We are requesting funding for Medical Case Management services and for Non-Medical Case
Management services. Services and schedule of deliverables shall be in accordance with the approved fiscal year budget.
For the provision of services targeting the African American community, Ebony House is licensed by the State of Arizona
and is a provider agency for the Regional Behavioral Health Authority managed care system (Magellan of Arizona) and is
a current Ryan White Part A provider of Medical and Non-Medical Case Management services.
Ebony House, Inc. is a Community-Based Organization with an extensive history of delivering HIV/AIDS services in
Maricopa and Pinal Counties. For more than 40 years, Ebony House, Inc. has been a provider of essential and critical
services to African Americans and other ethnic populations who live with multiple challenges of mental health, substance
use and HIV/AIDS; providing education, prevention and treatment in both residential and outpatient venues to meet the
client’s individualized needs. Ebony House was established to provide effective substance abuse treatment in a safe
environment for African American men in recovery and their families. Our organization remains the only agency to
specifically target the African American community for residential substance abuse and HIV/AIDS Case Management and
treatment, which has resulted in amassing considerable data and experience, along with achieving substantial knowledge of
treating and preventing substance use and HIV/AIDS in Arizona. Although our scope of services has increased to include
women, children, families and all ethnic groups, the tradition of care for the African American community has not lessened
over the years.
Ebony House, Inc. has been a provider agency of HIV/AIDS and other STIs in the Eligible Metropolitan Area (EMA) since
1997 with services funded through the Center for Disease Control (CDC) where we provided Health Education/Risk
Reduction interventions to African Americans and other ethnic communities to prevent and reduce HIV/STD infections.
As a result of successful implementation and service provision of HE/RR intervention we embarked upon another HIV
inspired venture in 1999 with an award from Substance Abuse Mental Health Services Administration (SAMHSA)
utilizing the tracking tools under the Government Performance and Results Act (GPRA). This program conducted
outreach, HIV testing and substance abuse intervention for African Americans in high risk behaviors and areas in an effort
to prevent and reduce HIV/STI transmissions. In 2000, Ebony House ventured on to provide services in collaboration with
the State of Arizona Department of Health Services in the Syphilis Reduction Services HO-042 proposal which led to
Ebony House single handedly causing the eradication of Syphilis in targeted zip codes including 85040, 85041, 85003,
85007, and 85009. For approximately seven (7) years Ebony House has provided Sisters Informing Sisters on Topics
about AIDS (SISTA) a group setting that provides empowerment to African American women in safer sex negotiations and
proper prophylactic use. In 2008, Ebony House became a recipient Maricopa County Ryan White Part A providing Non-
Medical Case Management and Outreach services targeting African Americans in the EMA. As our program continued to
grow, Ebony House was able to contact 20,000 people and connect over 100 of them to primary medical care.
Ebony House has existing alliances and collaborations with Maricopa County Ryan White Part A, Magellan of Arizona,
Inc., St. Mary’s Westside Food Bank, HIV Care Directions, Phoenix Shanti Group, Southwest Center for HIV, Chicanos
Por La Causa, People of Color Network, Arizona Opportunities Industrial Coalition, Black AIDS Task Force, Black
Treatment Advocacy Network, National Minority AIDS Council and others who can provide services not included in our
service area. Members of our staff serve on the Race and Equity Workgroup of the Regional Behavioral Health Authority
Magellan Health Services of Arizona, and is a voting member of the Ryan White Planning Council. Ebony House has an
extensive history of partnering with and participating in collaborations. Historic collaborations include Community
Epidemiology Workshop on Substance Abuse (local chapter), Arizona Mental Health Advocates Association and The
Alliance (a coalition of agencies servicing minority clients in Maricopa County). We will offer referrals to our clients for
services that we do not provide based upon the client’s needs assessment and care plan.
The Ebony House, Inc. mission, “In a spirit of gratitude and service, the Ebony House, Inc. model is dedicated to
increasing awareness of the worth, dignity, individuality and divine nature of each consumer that comes through our doors;
with the mission of providing an environment appropriate for change through instruction, unconditional love, honor and
community;” embodies the spirit of this RFP. Ebony House continues its mission with the belief that it is a priority to
identify HIV-infected persons within the African American community. Our goal has always been to link them to primary
medical care, community based social resources and provide treatment education and adherence for reduction and
prevention of HIV/AIDS transmission. Our HIV Outreach department strives to ensure complete and competent adherence

SERIAL 13054-RFP
to all National and Local HIV/AIDS Strategies, including, National AIDS Strategy, Ryan White HIV/AIDS Treatment Act
of 2009, HIV/AIDS Statewide Coordinated Statement for Arizona, Health Resources Services Administration, HIV AIDS
Bureau (HAB), and the local EMA Ryan White Planning Council, to name a few.
In the 2012-2014 HIV/AIDS Statewide Coordinated Statement of Need published by the Arizona Department of Health
Services Office of Disease Integration and Services states, “…African Americans in Arizona are nearly four (4) times more
likely than any other race-ethnicity group to become infected with HIV, and they are more likely to be diagnosed with
AIDS at first diagnosis.” The report further states, “Although African Americans are just over 3% of the Arizona
population, they currently represent over 11% of reported HIV prevalence,” (azdhs.gov). African Americans continue to
produce staggering statistics in transmission and infection rates in the Eligible Metropolitan Area of Maricopa and Pinal
Counties. State wide African Americans represent the highest population that is underserved for HIV care, “9.3% of
clients, 8.1% of total Rx costs, and 7.7% of prescriptions provided,” (azdhs.gov). These numbers represent an ever
increasing disparity in service delivery in a group where HIV transmission is the highest in the State. The disparities
within the African American community include diminished access to testing and treatment, education, treatment
adherence counseling and maintenance of care for those who have been identified as HIV positive. “African Americans
have greater difficulty accessing the healthcare system in Arizona, and access it later for HIV primary care than other
groups. This results in poor outcomes for African Americans living with HIV. More effective delivery of coordination of
care, and Partner Services through case management through providers that work predominantly among African Americans
will improve HIV primary care outcomes,”(azdhs.gov).
African Americans, in the State of Arizona are one of the smallest populations according to www.census.gov, being 4.5%
of the total population. The report continues to say that African Americans comprise 5.4% of Maricopa County and 5% of
Pinal County populace. The Census Bureau continues to report, by city or township, the African American populace;
Glendale – 6%, Phoenix – 6.5%, Tempe – 5.9%, Avondale – 9.3%, Goodyear – 6.7%, El Mirage – 6.6%Chandler –
4.8%and Buckeye – 7.1%. The report provides Pinal County cities, townships and Census Designated Place (CDP)
populations as; Eloy – 10.1%, Coolidge – 7.8%, Casa Grande – 4.6%, Florence – 6.3% and San Tan Valley 5%. These
heavily populated areas are at high risk of HIV/AIDS infection according to Arizona Health Matters who inform that
Maricopa County African Americans has the highest HIV/AIDS incidence rate of “33 cases/100,000,” and that Pinal
County African American HIV/AIDS incidence rate is the second highest only to the Latino community of, “24.4
cases/100,000.” Consistently, African Americans have been a major part of the epidemiology in the State of Arizona and
EMA. In relation to the overall populace, African Americans remain the community most widespread affected by
HIV/AIDS infection, transmission, late detection and disproportionate healthcare access.
Ryan White Part A funds will continue to be used solely for service delivery for people living with HIV/AIDS who do not
meet the financial criteria of AHCCCS eligibility or any other eligibility driven related health services. Ebony House
understands that Ryan White Part A Services is the payer of last resort and will maximize and monitor all other revenue
strings to offset program costs before Ryan White Part A funds are used. All services will continue to target individuals
who are HIV positive and are aware of their status. Ebony House will maximize all Ryan White Part A funding by
providing timely and comprehensive services to each of our clients. Staff will provide culturally competent and
linguistically appropriate Case Management services to eligible clients within the EMA. Ebony House adheres to The
National Culturally and Linguistically Appropriate Services (CLAS) standards by providing each individual client services
based on their individual needs and request. We ensure CLAS standards are adhered to by providing linguistic and written
information to clients based on their cultural preference. Ebony House employs staff members that have been tested and
approved as interpreters in Spanish. Further, we readily maintain relationships with interpreting agencies for other
prominent languages, to include American Sign Language, within the EMA. Ebony House, Inc. adheres to all standards,
policies and procedures established by Ryan White Care Act its respective amendments and current enactment of
HIV/AIDS Treatment Extension Act, Health Resources and Services Administration, The HIV/AIDS Bureau, National
HIV Strategy, Arizona State HIV Strategy, The State of Arizona (Board of Behavioral Health Licensure), Maricopa
County, Ryan White Planning Council and all federal and local regulations. Ebony House will adhere to all terms and
conditions outlined in the proposal and subsequent contract.
In order to address these disparities within the African American community, Ebony House, Inc. proposes to provide both
medical and non-medical case management services targeting, African Americans in Maricopa and Pinal Counties, but
inclusive of all ethnicities. Ebony House proposes to increase our annual client intake to 200 per year, up from 110.
Medical Case Managers will be Registered Nurses and hold a current license with the Arizona State Board of Nursing with
a minimum of two (2) years’ experience. Medical Case Managers hired are expected to be experienced in the evaluation
and assessment of clients, and able to meet their psychosocial, physical needs and social needs. Medical Case Managers
will serve as the centralized point of contact for the clinical care team, and will coordinate all efforts of the clinical care
team in a collaborative effort to increase the health and overall wellbeing of each client. The Medical Case Managers will
not only perform the initial assessment and care plan, but will utilize this evaluation as a triage for service delivery for the

SERIAL 13054-RFP
benefit of the client. They are expected to ensure that each client receives medication adherence counseling and treatment
compliance motivation, according their individual care plan. Medical Case Managers will also provide instruction to Non-
Medical Case Managers for social and community based referrals and services.
The Non-Medical Case Managers will serve as the social representatives for the clients. Non-Medical Case Managers will
ensure that clients are properly screened for eligibility of community resources such as the Arizona Health Care Cost
Containment System, AIDS Drug Assistance Program and any other community based support programming. The Non-
Medical Case Managers are expected to provide clients with emotional support, while encouraging treatment compliance
according to the recommendations and directions of the Medical Case Manager. Non-Medical Case Managers will serve as
the initial point of contact for clients and provide assistance where needed. They will assist new clients to schedule
assessment appointments and support existing clients in renewing Central Eligibility and other required renewals necessary
for the client to receive care. Non-Medical Case Managers will also provide reassessment and care plan updates for clients
triaged by Medical Case Managers and determined to require a lower level of care.
In an effort to close the disparity gap in services, Ebony House, Inc. proposes to provide timely responses to referrals,
service requests and HIV related health and social care by maintaining a Medical Case Management staff of three (3)
Registered Nurses. They will provide the following Medical Case Management services, including completing an initial
assessment of service needs and conducting a complete assessment that evaluates each client’s primary social and medical
needs; gives referrals based upon the needs of each client; and provides health education about comorbid diseases. Each
client will be offers facts on medication side effects and interactions; and provided information on medication adherence
and counseling. We ensure that a comprehensive, individualized care plan will be developed in partnership with the client
that creates a working plan of action for workable HIV/AIDS care; and treatment that will ensure the likelihood of
following the care plan.
Below is a chart to reflect our staff and employee composition when confirmation of the grant is received.
POSITION NAME CREDENTIALS DUTIES
Program Director Calicia R. White Masters of Public Oversight of Program activities and
Administration Health services, track client outcomes,
Services Administration supervise staff, and conduct client
satisfaction surveys.
Accountant CDL Accounting Certified Professional Track funding sources and conduct
Accountant allocations.
Medical Case Manager Elizabeth Erikson Licensed RN-RN097488 Conduct all services as Medical
Case Manager, provide initial
assessment and care plan creation,
provide medication and treatment
adherence.
Medical Case Manager TBD Licensed RN- License must Conduct all services as Medical
be current and applicant Case Manager, provide initial
must have a minimum of 2 assessment and care plan creation,
years’ experience in direct provide medication and treatment
service provision. adherence.
Medical Case Manager TBD Licensed RN- License must Conduct all services as Medical
be current and applicant Case Manager, provide initial
must have a minimum of 2 assessment and care plan creation,
years’ experience in direct provide medication and treatment
service provision. adherence.
Non-Medical Case William Becketts 14 years Non-Medical Case Assists with community social
Manager Management experience. services and applications, provides
Direct service provision to support to clients, conducts
PLWHA, peer service reassessments and care plans
provider (when directed by MCM), provides
advice and referral to clients.
Non-Medical Case Benjamin Pierson 5 years Non-Medical Case Assists with community social
Manager Management experience. services and applications, provides
Direct service provision to support to clients, conducts
PLWHA, peer service reassessments and care plans
provider (when directed by MCM), provides

SERIAL 13054-RFP
advice and referral to clients.
Non-Medical Case TBD Minimum 3 years Non- Assists with community social
Manager Medical Case Management services and applications, provides
experience. Direct service support to clients, conducts
provision to PLWHA reassessments and care plans
(when directed by MCM), provides
advice and referral to clients.
Non-Medical Case TBD Minimum 3 years Non- Assists with community social
Manager Medical Case Management services and applications, provides
experience. Direct service support to clients, conducts
provision to PLWHA reassessments and care plans
(when directed by MCM), provides
advice and referral to clients.
Ebony House, Inc. will meet the needs of people living with HIV/AIDS by the use of Medical Case Managers that will
coordinate all services required to assess and implement the care plan, attend doctor appointment with clients, provide all
referrals for other necessary services, i.e., dental care and comorbid disease physicians; and provide insight and
documentation to the external clinical team members. They will provide continuous client monitoring to assess the efficacy
of the individual’s care plan through a written review that documents the execution of any care plan referrals, and
achievements of plan goals and milestones, and update care plan goals that are achieved. A continuous review of viral load
and CD-4 counts will be completed to assess and monitor individual client health outcomes; and counseling to ensure
adherence and readiness for complex HIV/AIDS treatment compliance. Medical Case Managers will look for any barriers
to a client achieving their goals, and will adjust the plans accordingly. Care plans will be re-evaluated and adapted every
six (6) months; and the medical case managers will coordinate with non-medical case management to ensure basic life
sustaining social needs are met and advise non-medical case managers of necessary referrals.
Non-Medical Case Managers will assist and educate eligible clients on benefits/entitlement counseling and referral
activities to obtain access to public and private programs for which they may be eligible. They will assist clients with
applications such as, Arizona Health Care Cost Containment System (AHCCCS), AIDS Drug Assistance Program
(ADAP), housing opportunities (HOPWA), Department of Economic Security (DES) and the Healthcare Market Place, if
applicable. Using all types of case management encounters and communications (face-to-face, telephone contact, other),
Non-Medical Case Managers will conduct updated assessments and care plans every six(6) months; provide support for
clients who request assistance with or attendance to HIV related medical appointments, and provide support for client in
disclosure techniques.
Non-Medical Case Managers will provide transitional case management for incarcerated person as they prepare to exit the
correctional system by accepting and following up on referrals submitted by the correctional system. They will attempt to
connect with the potential client by calling all numbers listed, going out to any last known address, and utilize any known
contact information in an effort to engage and support the client. Non-Medical Case Managers will help clients connect
with Central Eligibility and go with clients to their eligibility appointments, supporting them to ensure all documentation is
brought to the appointment. Non-Medical Case Managers will offer advice on implementation of primary medical care,
case management services and other client eligible social services; and offer referrals to any supplementary services.
Ebony House, Inc. plans to meet the needs of the PLWHA by providing clients with services to educate and empower
about current and effective treatments, medication adherence and primary life needs.
To ensure the quality of staff and employees working at Ebony House, Inc. and the safety of our clients, all applicants must
complete an employment application on forms provided by the agency. Ebony House also requires a resume' and letters of
reference depending on the position being applied for. Resumes are specific to the position classification and are reviewed
and updated as needed. Ebony House, Inc. will conduct employment reference checks and criminal background
investigations on all candidates for employment prior to making a final offer of employment, and may use a third party to
conduct these background checks. Background checks typically include criminal records checks, education verification
checks, and employment verification checks.
Information may be gathered online, through public or educational records, and/or through interviews with employers, or
referenced associates who may have information about the employee or potential employee. Ebony House, Inc. will
conduct background checks in compliance with the Americans with Disabilities Act (ADA), and all other applicable local,
state, and federal laws and regulations. Information may also be sought out at other times during employment, such as
during reassignment or promotional periods, and following safety infractions or other incidents. Although a reported

SERIAL 13054-RFP
criminal offense conviction will not necessarily disqualify a candidate from employment. The nature and seriousness of the
offense, the date of the offense, the surrounding circumstances, rehabilitation, the relevance of the offense to the specific
position(s), and whether hiring, transferring or promoting the applicant would pose an unreasonable risk to Ebony House,
Inc. or its clients may be considered before a final decision is reached.
Following an acceptance of an offer of employment, all new employees will be given a start date and location to report for
an orientation session. Orientation is paid. During the orientation, the new employees will be given workplace rules,
policies and other information about their positions. Authorization forms and policies must be signed prior to actual work
is performed and before they are sent for a meeting with their new department manager. Conditional offers of employment
to those candidates selected during the interview process depend on the candidate's agreeing to acknowledge company
policies in writing, consenting and passing all necessary drug, background and reference checks and any other condition
that should be met before the applicant may consider themselves an employee.
Ebony House, Inc. takes pride in service provision to our community. We strive to ensure the efficacy, continuum of care,
coordination and delivery of services is culturally based on each individual’s needs. Ebony House is an advocate for a
client when they feel they have no voice and a support for the client when they need that extra ground to stand on. We
have been an effective service provider within the EMA for over 16 years rendering substance abuse, general mental health
and HIV/AIDS services to our constituents. Ebony House is dedicated to increasing the awareness of worth, dignity,
individuality and divine nature of each of our clients by providing sound instruction and advice with genuine respect, honor
and love.

SERIAL 13054-RFP
ORGANIZATIONAL CHART
Legend:
Blue= Members of the Executive Management Team Green= Fiscal Management Staff Light Green:
General Administrative Staff
Orange=Direct Services and/or Support Staff Yellow=Volunteers