IGA AMENDMENT RE HIV PREVENTION WITH ADHS.PDF

ARIZONA STATE CONTRACT Page 1 of 1
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS12-016584:6
Organizational Reference No.: E0146886
Issued: 01/15/2014
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Office of Disease Integration and Services
4041 N. Central Avenue, #1400 150 N. 18th Avenue, Suite 110
Phoenix, AZ 85012 Phoenix, AZ 85007
US
Email: maria.thomas@azdhs.gov
Contract No.: ADHS12-016584 (602) 364-3601
Title; HIV Surveillance Maricopa County 2014
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
AP Commodities - Misti Taylor
1740 West Adams, Suite 302
Phoenix, AZ 85007
I,., US
Email: INVOlCES@azdhs.gov
(602) 542-6354
Release Instructions
TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order
are incorporated herein by reference and become a part of this order.
Account Code; 14-98433-52500-6811- Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
ltern Description 1 Requisition Quantity Unit Unit Price Total
Class-Item 952-43
1 1.00 YR $ 14,480.00 $ 14,480.00
OD1S - HIV Surveillance, Contract# ADHS12-016584, PO Budget Period
01/01/14-12/31/14 CFDA 93.944. Contract total amount is $115,808.
Additional funds will be added when becomes available_.
Class-Item 952-43
2 1.00 YR $ 43,583.00 $ 43,583.00
ODIS - HIV Surveillance, Contract# ADHS12-016584. PO Period 1/1/14-
12/31/14. SU - No CFDA number.
TOTAL: $ 58,063.00
Approved By: Maria Thomas
Phone No.: (602) 364-4761

C-86-13-003-3-02 HIV Surveillance
ADHS 12-016584
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date