AMENDMENT RE NURSE FAMILY PARTNERSHIP WITH ADHS .PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer:
Contract No: ADHS12-023419 Amendment No 2
Tracey Thomas
Nurse Family Partnership
Effective January 30, 2014, it is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1 The Price Sheet of the Agreement is replaced with the revised Price Sheet of this Amendment Two (2) The
Contract Item Pricing shall be revised in ProcureAZ to align with available funding upon execution of this
Amendment Two (2) The Agreement line item pricing total increased from $1,233,545.39 to $1,594,246.13 to
support_the_expansion of_Nurse_Family__Partnership-Home-Visiting -Services -to- Central -and- East-Mesa- Region -of -
Maricopa County based on the line item changes outlined on Page Two (2) of this Amendment
All other provisions of this Agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 N. Central Ave. Frances Delgado
Address Printed Name
Phoenix 85012 Grants/Contract Administrator Supervisor
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A R S § 11-952, the undersigned public agency attorney date indicated The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this 1GA until the 1GA has been executed by an authorized ADHS
the State of Arizona signatory
State of Arizona
Signed this day of 2014
Signature Date
Printed Name Procurement Officer
Attorney General Contract No P0012012000033, which is an RESERVED FOR USE BY THE SECRETARY OF STATE
Agreement between public agencies, has been reviewed pursuant to
A R S § 11-952 by the undersigned Assistant Attorney General, who Under House Bill 2011, A.R.S. § 11-952
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona was amended to remove the requirement
that Intergovernmental Agreements be filed
with the Secretary of State.
Signature Date
Attorney General Office:

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740W Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-023419 Amendment No 2 Tracey Thomas
Price Sheet changes breakdown and summary:
1 1 Personnel increased by $219,526 80 for a total of $640,097.40 Additional Staff is required for the expansion
1.2 ERE increased by $71,522.84 for a total of $212,322.76. Additional staff requires 1926% increase at a fixed
cost of $8,904 per the 10 FTEs
1 3 Professional and Outside Services increased by $7,209.53 for a total of $492,815.00. Four (4) Nurse
Family Partnership Nurse Educators added at a-cost of $7 720953.
1.4 Travel increased by $3,487 50 for a total of $21,900.00. The expansion of service area has increased for NFP
nurses at a cost of estimate of 10 miles per trip 445 per mile
1.5 Occupancy Expense increased by $3,974 79 for a total of $10,599.58; additional office space is required for
additional staff
1 6 Other Operating Expenses increased by $25,038 00 for a total of $60,388.00; additional telephones, office
supplies, printing, copying, and program materials for additional staff .
1.7 Indirect (if authorized) increased by $49,941.28 for a total of $156,123.39 to support the expansion of the
Nurse Family Partnership Home Visiting Services
2

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740W HEALTH Adams. SERVICES Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS12-023419 Amendment No 2 Procurement Officer
Tracey Thomas
Cost reimbursement line item budget effective January 30, 2014
ACCOUNT CLASSIFICATION AMOUNT
Personnel $640,097.40
•ERE $212,32216
Professional & Outside Services $492,81500
Travel Expense $21,900.00
Other Operating Expense $60,388 00
Occupancy Expense $10,599.58
Indirect Cost $156,123,39
TOTAL $1,594,246.13
With prior written approval from the Program manager, the Contractor is authorized to transfer up to
a maximum of 10% of the total budget amount between line items Transfers of funds are only
allowed between funded line items Transfers exceeding 10% or to a non-funded line item shall
require an amendment
AUTHORIZATION FOR PROVISION OF SERVICES. Authorization for purchase of services under
this contract shall be made only upon ADHS issuance of a Purchase Order that is signed by an
authorized agent The Purchase Order will indicate the contract number and the dollar amount of
funds authorized The Contractor shall only be authorized to perform services up to the amount on
the Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the
amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of
ADHS unless: a) the Purchase Order is changed or modified with an official ADHS Procurement
Change Order, and/or b) an additional Purchase Order is issued for purchase of services under this
contract