DI24-002413 CONTRACT AMENDMENT 2.PDF

County No._____________________________ 
Board Approved Date:_____________________________ 
INTERGOVERNMENTAL 
AGREEMENT AMENDMENT 
ARIZONA DEPARTMENT OF 
ECONOMIC SECURITY 
1789 W. Jefferson Street, 
Mail Drop 1541 
Phoenix, Arizona 85007 
(602) 364-0170
10/13/2023 
Intergovernmental Agreement 
Page 1 of 1 
CONTRACTOR (Name and Address): 
Services 
Description: 
Refugee Health Promotion-Community 
Health Practicum 
Maricopa County Department of Public Health 
4041 N. Central Ave. 
Phoenix, AZ. 85012 
Agreement 
Number: 
DI24-002413 
Amendment 
Number: 
Two (2) 
PURSUANT TO THE INTERGOVERNMENTAL AGREEMENT (IGA) SECTION 17, AMENDMENTS, THE PARTIES 
HEREBY AGREE TO AMEND THE AGREEMENT AS FOLLOWS: 
The Itemized Service Budget, Exhibit A, for May 01, 2025 through September 30, 2026 is revised. The total 
allocation remains $99,108.33.  
The revised Itemized Service Budget, Exhibit A, is being replaced and attached. 
EXCEPT AS PROVIDED HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT SHALL REMAIN UNCHANGED AND IN 
FULL FORCE AND EFFECTS.  THE AMENDMENT SHALL BECOME EFFECTIVE ON THE DATE OF LAST SIGNATURE UNLESS 
OTHERWISE SPECIFIED HEREIN.  BY SIGNING THIS AMENDMENT ON BEHALF OF THE CONTRACTOR, THE SIGNATORY CERTIFIES 
HE/SHE HAS THE AUTHORITY TO BIND THE CONTRACTOR TO THIS CONTRACT. 
AGENCY NAME 
NAME OF CONTRACTOR 
Arizona Department of Economic Security 
Maricopa County 
Authorized Signature 
Authorized Signatory 
Type Name 
Type Name 
Title 
Title 
Date 
Date 
IN ACCORDANCE WITH ARS §11-952 THIS CONTRACT AMENDMENT HAS BEEN REVIEWED BY THE UNDERSIGNED WHO HAVE 
DETERMINED THAT THIS CONTRACT AMENDMENT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND AUTHORITY 
GRANTED TO EACH RESPECTIVE PUBLIC BODY. 
ARIZONA ATTORNEY GENERAL'S OFFICE 
PUBLIC AGENCY LEGAL COUNSEL 
ASSISTANT ATTORNEY GENERAL 
Date 
Date 
CLERK OF THE BOARD SIGNATURE AND NAME 
Date

Funding: 
HP
Agency: Maricopa County Department of Health (MCDPH)  
Service:
CRD-RRP-HPR
Contract #: DI24-002413 
Total Allocation:
$99,108.33
Contract Period: 05/01/2025-09/30/2026
Agency UEI#: 
LM85MG1513K5
Voucher (Y/N): N
Client Direct Svcs eligible (Y/N): Y
Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
FTE Level
Position Title
Total Salary for the 
Contract Period per 
FTE
ERE Rate
% Billed to this 
Contract
Personnel 
Subtotal
Employee 
Related 
Expenses 
Subtotal 
Total Cost
$0.00
$0.00
$0.00
   TOTAL PERSONNEL & ERE: 
$0.00
$0.00
$0.00
Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
No
Case Management
1
Other
Subaward
$80,716.67
1
Other
$80,716.67
Yes
Other
1
Other
Practiticum fo CHW 
Students
$13,191.75
1
Other
$13,191.75
$0.00
TOTAL PROFESSIONAL AND OUTSIDE SERVICES:
$93,908.42
Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
$0.00
TOTAL TRAVEL:
$0.00
Exhibit A 
ITEMIZED SERVICE BUDGET
1.  PERSONNEL & ERE
2. PROFESSIONAL AND OUTSIDE SERVICES
3. TRAVEL
Revised  3.26.13

Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
$0.00
TOTAL SPACE:
$0.00
Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
$0.00
TOTAL EQUIPMENT:
$0.00
Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
$0.00
TOTAL MATERIALS AND SUPPLIES:
$0.00
Indirect Cost Eligible 
(dropdown)
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
Yes
Other
1
Other
License
$2,801.00
1
Other
$2,801.00
$0.00
TOTAL OPERATING SERVICES:
$2,801.00
4. SPACE
5. EQUIPMENT
6. MATERIALS AND SUPPLIES
7. OPERATING SERVICES
Revised  3.26.13

Cost Category
eligible for 
Indirects
Indirect %
Total Cost
 
Not Applicable
-
$                   
$0.00
Case Managemen
-
$                   
$0.00
Employment
-
$                   
$0.00
Admin
-
$                   
$0.00
Other
15,992.75
$         
15.00%
$2,398.91
TOTAL INDIRECT COSTS:
$2,398.91
 
Cost Category 
(dropdown)
Total Units
Unit (dropdown)
Unit description
Rate per Unit
Number of 
reoccurrences
Rate of 
reoccurrence 
(dropdown)
Total Cost
$0.00
TOTAL CLIENT DIRECT SERVICES:
$0.00
Personnel
$0.00
ERE
$0.00
Professional & Outside Services
$93,908.42
Travel
$0.00
Space
$0.00
Equipment
$0.00
Materials & Supplies
$0.00
Operating Services
$2,801.00
Indirect Costs
$2,398.91
Client Direct Services/Vouchers
$0.00
TOTAL COSTS:
$99,108.33
Revenue:
Total Cost
ADES Refugee Program
$99,108.33
TOTAL REVENUE:
$99,108.33
Budget Check:
Total Allocation
$99,108.33
Total Revenue ADES Cost
$99,108.33
(Should equal zero)
$0.00
8. INDIRECT COSTS
 9. CLIENT DIRECT SERVICES/VOUCHERS
Revised  3.26.13