DI24-002411 A2 REVISED 12-16-2025 (1).PDF
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ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT AMENDMENT ECONOMIC SECURITY 1789 W. Jefferson Street, Mail Drop 1541 Phoenix, Arizona 85007 (602) 364-0170 CONTRACTOR (Name and Address): Services Description: CRD-RRP-HPR Maricopa County Department of Public Heath 4041 N. Central Ave. Phoenix, AZ. 85012 Agreement Number: DI24-002411 Amendment Number: Two [2] PURSUANT TO THE INTERGOVERNMENTAL AGREEMENT (IGA) SECTION 17 AMENDMENTS, THE PARTIES HEREBY AGREE TO AMEND THE AGREEMENT AS FOLLOWING: Pursuant to the Scope of work, Section 17.0, Amendments, the purpose of this amendment is to add the service reimbursement ceiling for the period of October 1, 2025, through September 30, 2026. The Agreement reimbursement ceiling is $528,800.00. The Itemized Service Budget is attached as part of this amendment. 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 AGMENDMENT 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 Maricopa County Department of Public Health Arizona Department of Economic Security Authorized Signature Authorized Signature Type Name Typed 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 Funding: RCMA Agency: Maricopa County Department of Health (MCDPH) Service: CRD-RRP Contract #: DI24-002411 Total Allocation: $528,800.00 Contract Period: 10/01/2025-09/30/2026 Agency UEI#: Voucher (Y/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 Yes Employment 1 Nurse Practitioner 111,737.60 $ 19.65% 100% $111,737.60 $35,588.44 $147,326.04 Yes Employment 1 Medical Assistant 46,467.20 $ 19.65% 100% $46,467.20 $22,762.80 $69,230.00 Yes Employment 1 Admin Supervisor 71,635.20 $ 19.65% 100% $71,635.20 $27,708.32 $99,343.52 Yes Employment 0.5 Program Supervisor 73,881.60 $ 19.65% 100% $36,940.80 $14,074.87 $51,015.67 Yes Employment 0.14 Senior Epidemologist 84,531.20 $ 19.65% 100% $11,420.17 $4,085.75 $15,505.91 TOTAL PERSONNEL & ERE: $278,200.97 $104,220.17 $382,421.14 (dropdown) (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost $0.00 TOTAL PROFESSIONAL AND OUTSIDE SERVICES: $0.00 (dropdown) (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost $0.00 TOTAL TRAVEL: $0.00 (dropdown) (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost $0.00 TOTAL SPACE: $0.00 (dropdown) (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost $0.00 TOTAL EQUIPMENT: $0.00 4. SPACE 5. EQUIPMENT ATTACHMENT ITEMIZED SERVICE BUDGET 1. PERSONNEL & ERE 2. PROFESSIONAL AND OUTSIDE SERVICES 3. TRAVEL Revised 3.26.13 (dropdown) (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost Yes Admin 1 Other Supplies and Operations $46,065.00 1 Year $46,065.00 TOTAL MATERIALS AND SUPPLIES: $46,065.00 (dropdown) (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost $0.00 TOTAL OPERATING SERVICES: $0.00 Cost Category Indirects Indirect % Total Cost Not Applicable - $ 16.69% $0.00 Case Management - $ 16.69% $0.00 Employment 382,421.14 $ 16.69% $63,826 Admin 46,065.00 $ 16.69% $7,688.25 Other - $ 16.69% $0.00 TOTAL INDIRECT COSTS: $71,514 (dropdown) Total Units Unit (dropdown) Unit description Rate per Unit reoccurrences (dropdown) Total Cost Other 1 Other Completed Screening and Lab $150.00 192 Other $28,800.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CLIENT DIRECT SERVICES: $28,800.00 6. MATERIALS AND SUPPLIES 7. OPERATING SERVICES 8. INDIRECT COSTS If there are no Indirect Costs, please provide an explanation/details in this box 9. CLIENT DIRECT SERVICES/VOUCHERS Revised 3.26.13 Total Cost Personnel $278,200.97 ERE $104,220.17 Professional & Outside Services $0.00 Travel $0.00 Space $0.00 Equipment $0.00 Materials & Supplies $46,065.00 Operating Services $0.00 Indirect Costs $71,514 Client Direct Services/Vouchers $28,800.00 TOTAL COSTS: $528,800 Revenue: Total Cost ADES Refugee Program $528,800 TOTAL REVENUE: $528,800 Budget Check: Total Allocation $528,800 Total Revenue ADES Cost $528,800 (Should equal zero) $0 Revised 3.26.13