CTR046145 DIETETIC INTERNSHIP MARICOPA A4.PDF
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INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR046145 IGA Amendment No: 4 Procurement Officer Diana Landeros Page 1 of 4 Dietetic Internship It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows: 1. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Section 6.1, Amendments, Purchase Orders and Change Orders, the following changes are hereby made under this Amendment Four (4); 1.1. The Price Sheet is hereby revised and replaced; and 1.2. Exhibit A is added; All other provisions of this agreement remain unchanged. MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH Contractor Name: County Authorized Signature 4041 N CENTRAL AVE , SUITE 1400 Address: Print Name PHOENIX ARIZONA 85012 City State Zip Title and Date Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined that this Intergovernmental Agreement is in proper form and is within the powers and authority granted under the laws of Arizona This Intergovernmental Agreement Amendment shall be effective the date indicated. The Public Agency is hereby cautioned not to commence any billable work or provide any material, service or construction under this IGA until the IGA has been executed by an authorized ADHS signatory. State of Arizona Signature Date Signed this day of 2022. Print Name Procurement Officer Contract No.: CTR046145, which is an Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney, who has determined that it is in proper form and is within the powers and authority granted under the laws of the State of Arizona. Signature Date Assistant Attorney General Print Name INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR046145 IGA Amendment No: 4 Procurement Officer Diana Landeros Page 2 of 4 PRICE SHEET October 1, 2022 to September 30, 2023 Agency Name: Maricopa County Department of Public Health Cost Reimbursement Line Item Budget WIC-Track Dietetic Internship Federal Award Date: October 1, 2022 CFDA number and name: 10.557 Special Supplemental Nutrition Program for Women, Infants, and Children WIC Services Account Classification Amount Personnel $99,028.00 Employee Related Expenses $40,075.00 Professional & Outside Services $0.00 Travel Expense $2,250.00 Occupancy Expenses $1,130.00 Other Operating Expenses $10,815.00 Capital Expenditures $0.00 Indirect Cost $26,429.00 Total $179,727.00 Additional Terms and Conditions: With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between funded line items. Transfers of funds are only allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an amendment. Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase Order that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount on the Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of ADHS unless a.) the Purchase Order is modified with an official ADHS Procurement Change Order, and/or b.) an additional Purchase Order is issued for purchase of services under this Contract. ADHS reserves the right to adjust awards given to local agencies depending on federal dollars received. Adjustments will be at the discretion of ADHS. INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR046145 IGA Amendment No: 4 Procurement Officer Diana Landeros Page 3 of 4 Exhibit A- 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 UEI # QMWUG1AMYF65 Federal Award Identification (Grant Number): 216AZ008W1003 Subrecipient name (which must match the name associated with its unique entity identifier): Maricopa County Public Health Subrecipient's unique entity identifier (DUNS #): 602062515 Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): 216AZ008W1003 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: 10/01/2022 Subaward Period of Performance Start and End Date: 10/01/2022-9/30/2023 Subaward Budget Period Start and End Date: 10/01/2022-9/30/2023 Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $179,727.00 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): $179,727.00 Total Amount of the Federal Award committed to the subrecipient by the pass-through entity: $179,727.00 Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA): Arizona local implementation of the WIC Special Supplemental Nutrition Program for Women, Infants, and Children INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR046145 IGA Amendment No: 4 Procurement Officer Diana Landeros Page 4 of 4 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: 10.557 WIC Special Supplemental Nutrition Program for Women, Infants, and Children Identification of whether the award is R&D: Not R&D award Indirect cost rate for the Federal award (including the de minimis rate is charged) per § 200.414: 17.24%