MPO FY25-1537 GAE 250000002094.PDF
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1/30/25, 7:54 AM MPO List - FY25 - 1537 \iil eenreeiey Manual Purchase Orders SharePoint Main MPO Docs MPO List https://sharepoint.hs.azdhs.gov/Procurement/mpo/Lists/MPO Dev/fd_Item_Display.aspx?List=15e3e237-e41f-4979-9dde-c36f799e3703&ID=1537&We... 1/3 1/30/25, 7:54 AM MPO List - FY25 - 1537 STATE OF ARIZONA BILL TO: (send invoices to invoices@azdhs.gov) Arizona Department of Health Services Manual Purchase Order SHIP TO Procurement Office Arizona Department of Health Services 150 N 18th Avenue, Suite 530 Accounts Payable Phoenix, AZ 85007 150 N 18th Ave, Suite 280 Phoenix, AZ 85007 Purchase Order # FY25 - 1537 Payment Terms NET 30 FOB Destination Change Order No Current Encumbrance Original MPO # Contract Information Requester Name Darla Kunze Location Scope ADHS PREP BIDS S HEPATITIS C Bureau BIDS (Bureau of Infectious Disease and Services) Contract No. IGA2021-051 Supplier Name MARICOPA COUNTY Supplier ID (APP#) or 1v0000002618 Vendor ID (AFIS #) Supplier E-mail CHERYL.BUCALO@MARICOPA.GOV Supplier Address Maricopa County Department of Public Health 301 W Jefferson St 9th Floor Phoenix AZ 85003 Date 1/14/2025 Effective Date 8/1/2024 Termination Date 5/31/2025 Line Items Extended Price is calculated by multiplying Quantity by Unit Price. Line Quantity Unit Description Unit Price (#) Extended Price ($) Totals ($) 1 1 Hepatitis C Testing $186,387.00 $186,387.00 Sub Total $186,387.00 at the Maricopa CountyDepartment of Public Health STI Clinic 2 $0.00 Tax $0.00 3 $0.00 Freight 4 $0.00 Total $186,387.00 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 Encumbrance Distribution No Does this form contain No Encumbrance Distribution is attached Federal Funding? Line BFY Function Dept. Obj Unit PPC Amount (#) CFDA# 1 2025 FEDBID1790 6811 5235 2505 $186,387.00 93.940 2 3 https://sharepoint.hs.azdhs.gov/Procurement/mpo/Lists/MPO Dev/fd_Item_Display.aspx?List=15e3e237-e41f-4979-9dde-c36f799e3703&ID=1537&We... 2/3 1/30/25, 7:54 AM MPO List - FY25 - 1537 4 5 6 Encumbrance Total ($) $186,387.00 GAE # 250000002094 All PDS signed? No Any off-contract MPOs over $10k require Procurement Disclosure Statements (PDS) be attached CFDA Information( if applicable ): Contractor shall comply with the requirements of OMB Circular. For grant restrictions, refer to https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl https://sharepoint.hs.azdhs.gov/Procurement/mpo/Lists/MPO Dev/fd_Item_Display.aspx?List=15e3e237-e41f-4979-9dde-c36f799e3703&ID=1537&We... 3/3