PO RE WELL WOMAN HEALTH CHECK FROM ADHS 2.PDF

ARIZONA STATE CONTRACT Page 1 of 2
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-029502:4
Organizational Reference No.: E0123156
Issued: 08/16/2013
Vendor Number: 000010983
Maricopa County Public Health Arizona Department of Health Services
501 N. 44th Street, #200 Bureau of Health Systems Development
Phoenix, AZ 85008 H 150 North 18th Avenue, Room 300
Phoenix, AZ 85007
US
Email: procure@azdhs.gov
Contract No.: ADHS13-029502
Title: HSD/VVWHP MARICOPA FY14 W2)542-1219
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
AP Services - Trang Huynh
1740 West Adams #301
Phoenix, AZ 85007
US
Email: INVOICES@azdhs.gov
(602) 542-0781
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.
Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-48
Well Woman Health Check - FEDERAL Personnel, ERE, and Screening As
approved by ADHS and authorized by the Purchase Order Index 99493
PCA 78300 AY: 14 Federal CFDA 93.283 Title: National Cancer Prevention
& Control Program. Period of Performance: 7/1/2013 -6/30/2014. Contract
1 is set to expire 12-31-13. NO EXPENDITURES SHALL BE MADE AFTER 1.00 YR $ 190,000.00 $ 190,000.00
THE ABOVE CONTRACTED DATE UNLESS THE CONTRACT IS
EXTENDED. IF THE CONTRACT IS EXTENDED THE STANDING
PURCHASE ORDER WILL BE VALID THROUGH 6-30-14
LN/FY/Account Code Dollar Amount
1/14/14-99493-78300-6811- $ 190,000.00

ARIZONA STATE CONTRACT Page 2 of 2
CONTRACT RELEASE
Class-Item 948-48
Well Woman Health Check - STATE FUNDS - Personnel, ERE, Screening,
Indirect and Other
2 As approved by ADHS and authorized by the Purchase Order Index: 42060 1.00 YR $ 54,250.00 $ 54,250.00
PCA: 78300 AY: 14
LN/FY/Account Code Dollar Amount
2/14/14-42060-78300-6811- $ 54,250.00
Class-Item 948-48
Well Woman Health Check - ADOT FUNDS - Screening - As approved by
ADHS and authorized by the Purchase Order Index: 91080 PCA: 78300
3 LN/FY/Account Code Dollar Amount 1.00 YR $ 15,000.00 $ 15,000.00
3/14/10-91080-78300-6811- $ 7,089.38
3/14/12-91080-78300-6811- $ 3.84
3/14/13-91080-78300-6811- $ 7,906.78
Class-Item 948-48
Well Woman Health Check - STATE FUNDS - 2nd Quarter - Personnel,
4 ERE, Screening, Indirect and Other As approved by ADHS and authorized 1.00 YR $ 54,250.00 $ 54,250.00
by the Purchase Order Index: 42060 PGA: 78300 AY: 14
LN/FY/Account Code Dollar Amount
4/14/14-42060-78300-6811- $ 54,250.00
TOTAL: $ 313,500.00
Approved By: Nicki Strattard
Phone No.: (602) 542-1174