C-86-22-124-X-07 MPO20260200 .PDF
Extracted text (via pymupdf)
2445 characters
150 N. 18th Avenue, Phoenix, AZ 85007 BILL TO: (send invoices to invoices@azdhs.gov) SHIP TO Arizona Department of Health Services Accounts Payable 150 N 18th Ave, Suite 530 Phoenix, AZ 85007 Manual Purchase Order Type: Service(s) MPO #: Is this a change order?: Y Current Encumbrance: Original MPO #: MPO20260200 MPO Change Order Action: Increase Change Amount (if applicable): $1,127,430.76 Request Basic Information: Requestor Email: peggy.peixoto@azdhs.gov Location Scope (Site) ADHS PREV BWCH S Childrens Health Bureau WCHCH Contract No. RFGA2022-003-007 Supplier Name Maricopa County Department of Public Health Supplier ID IV0000029389 Supplier Email raquel.bales@maricopa.gov Supplier Address 4041 N Central Ave. Ste. 1400, Phoenix, AZ 85012 Date 2/17/2026 Effective Date 10/1/2025 Termination Date 9/30/2026 Line Items: Line Quantity Description Unit Price (#) Extended Price ($) 1 Encumber additional FY26 funding per contract price sheet $1,127,430.76 $1,127,430.76 Totals ($) Sub Total $1,127,430.76 Tax $0.00 Freight $0.00 Total $1,127,430.76 Encumbrance Distribution: PPC or BFY Function Dept. Object Unit Funding Amount CFDA# 2709 FEDCFH1770 6811-Aid to Counties 4340 $1,127,430.76 93.870 Encumbrance Total ($) $1,127,430.76 GAE # 260000001547 CFDA Information (if applicable): Contractor shall comply with requirements of OMB Circular. For grant restrictions, refer to https://www.ecfr.gov/cgi-bin/text-idx? tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl Federal Funding Accountability and Transparency Act If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form. This form and the instructions and the instructions can be downloaded below and must be returned to the ADHS by the 15th of the month following that in which the award was received. The form shall be completed electronically, and submitted using the steps outlined in the Grant Reporting Certification Form Instructions and emailed to us. All required fields must be filled including Top Employee Compensation, if applicable. Completing the Grant Reporting Certification Form is required for compliance with the Office of Management and Budget (OMB). Failure to timely submit the Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during the term of the Award.