IGA AMENDMENT RE INFERTILITY PREVENTION TESTING WITH ADHS.PDF

ARIZONA STATE CONTRACT Page 1 of 1
CONTRACT RELEASE
C 0-12-0 5
ProcureAZ Purchase Order No.: HG052195:3
Organizational Reference No.: E0134883
issued: 10/25/2013
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health S Office of Disease Integration and Services
501 N. 44th Street, #200 H 150 N. 18th Avenue, Suite 110
Phoenix, AZ 85008 1 Phoenix, AZ 85007
P US
Email: maria.thornas@azdhs.gov
Contract No.: HG052195 0
602 364-360
Title: STD Program - Maricopa County 1PP
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Office of Disease Integration and Services
150 N. 18th Avenue, Suite 110
Phoenix, AZ 85007
US
Email: maria.thornas@azdhs.gov
0
(602) 364-3601
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: 13-99305-52310-6811- Payment Terms:
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 952-49
1 STD Program - Utilization of County Lab: 1PP Testing PO budget Perio d 531.00 EA $ 11,30 $ 6,000.30
1/112013-12/3112013 CFDA 93.977. Contract tiHG052195. Initial PO#
E0087547 funding $33,301.10. System didn't alow a Change Order. Total
amount for the budget period is $39,301.40
TOTAL: $ 6,000,30
Approved By: Maria Thomas
Phone No,: (602) 364-4761

C-86-10-120-3-09 Infertility Prevention Project Testing
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MAR ICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date