RFGA2020-001-001 MARICOPA COUNTY A3 (002).PDF

Maricopa County — Formal (2022-12-07)

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GRANT 
 AMENDMENT 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
OFFICE OF PROCUREMENT 
150 N 18th Ave., Ste. #530 
Phoenix, Arizona 85007 
GRANT NO.: RFGA2020-001-001 
AMENDMENT NO.: 3 
Procurement Officer 
Brenda Prevost 
 
AZ Health Zone (Snap-Ed) 
 
Effective upon signature by both parties, it is mutually agreed that the Grant referenced in this amendment is amended 
as follows: 
 
1. 
Pursuant to the Terms and Conditions, Provision Three (3) Grant Administration and Operation, Subsection 3.2 
Contract Renewal, the Grant is hereby extended through September 30, 2025.  
 
2. 
Pursuant to the Terms and Conditions, Provision Five (5), Contract Changes, Exhibit Two (2) has been added 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY 
 
Grantee hereby acknowledges receipt and acceptance of 
above amendment and that a signed copy must be filed 
with the Procurement Office before the effective date 
 
 
 
 
 
The above referenced Grant Amendment is hereby 
executed this _____ day of __________ 20______ at 
Phoenix, Arizona 
 
 
 
(To be filled out by ADHS Procurement Office) 
Grantee’s Signature 
 
 
 
Grantee’s Signature Date 
 
 
Authorized Signatory’s Name and Title 
 
Maricopa County 
 
Grantee’s Name 
Procurement Officer Signature

GRANT 
 AMENDMENT 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
OFFICE OF PROCUREMENT 
150 N 18th Ave., Ste. #530 
Phoenix, Arizona 85007 
GRANT NO.: RFGA2020-001-001 
AMENDMENT NO.: 3 
Procurement Officer 
Brenda Prevost 
 
Exhibit - 2 CFR 200.332 
§ 200.332 
Requirements for pass-through entities. 
All pass-through entities must: 
(a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes 
the following information at the time of the subaward and if any of these data elements change, 
include the changes in subsequent subaward modification. When some of this information is not 
available, the pass-through entity must provide the best information available to describe the 
Federal award and subaward. 
Prime Awardee:  
Arizona Department of Health Services 
DUNS # 
804745420 
Federal Award Identification (Grant Number): 
216AZ011Q3903 
Subrecipient name (which must match the name 
associated with its unique entity identifier): 
MARICOPA, COUNTY OF 
Subrecipient's unique entity identifier (DUNS #): 
602062515  
Federal Award Identification Number (FAIN, sometimes 
it’s the same as the Grant Number): 
216AZ011Q3903 
Federal Award Date (see the definition of Federal award 
date in § 200.1 of this part) of award to the recipient by 
the Federal agency; 
10/1/2022 
Subaward Period of Performance Start and End Date; 
10/1/22-9/30/23 
Subaward Budget Period Start and End Date: 
10/1/22-9/30/23 
Amount of Federal Funds Obligated by this action by the 
pass-through entity to the subrecipient (this is normally 
the contract amount): 
$2,205,533.00 
Total Amount of Federal Funds Obligated to the 
subrecipient by the pass-through entity including the 
current financial obligation (how much is available for 
contracts): 
$2,205,533.00

GRANT 
 AMENDMENT 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
OFFICE OF PROCUREMENT 
150 N 18th Ave., Ste. #530 
Phoenix, Arizona 85007 
GRANT NO.: RFGA2020-001-001 
AMENDMENT NO.: 3 
Procurement Officer 
Brenda Prevost 
 
Total Amount of the Federal Award committed to the 
subrecipient by the pass-through entity 
Federal award project description, as required to be 
responsive to the Federal Funding Accountability and 
Transparency Act (FFATA) 
Not available  
Name of Federal awarding agency, pass-through entity, 
and contact information for awarding official of the Pass-
through entity 
United States Department of Agriculture, FNS 
Southwest Regional Office, Food and 
Nutrition Service, 1100 Commerce Street 
Room 522, Dallas, TX 75242-9980, 
Telephone: (214)290-9810 
Assistance Listings number and Title; the pass-through 
entity must identify the dollar amount made available 
under each Federal award and the Assistance Listings 
Number at time of disbursement: 
CFDA 10.561 - State Matching for SNAP 
(SNAP Ed) 
Identification of whether the award is R&D 
N.A 
Indirect cost rate for the Federal award (including if the 
de minimis rate is charged) per § 200.414 
17.24%