SIG' BLOCK CTR043100 HIV SURVEILLANCE MARICOPA A3 FOR SIGNATURE.PDF

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES  
OFFICE OF PROCUREMENT 
150 N. 18th Ave Suite 530 
Phoenix, Arizona 85007 
Contract No.: CTR043100 
IGA Amendment No.: 3 
Procurement Officer 
Anthony Beckum 
 
Page 1 of 2 
 
HIV Surveillance Capacity Expansion Program 
 
Effective upon signatures of both parties, it is mutually agreed that the Intergovernmental Agreement referenced is amended 
as follows: 
 
1. Pursuant to the 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 Three (3): 
 
1.1 
The Price Sheet is revised and replaced. 
 
 
ALL CHANGES ARE IDENTIFIED BELOW IN RED. 
 
 
All other provisions of this Agreement remain unchanged. 
 
 
 
Contractor Name:    MARICOPA COUNTY DEPARTMENT OF PUBLIC 
HEALTH 
 
Authorized Signature 
 
 
 
Address: 4041 N. CENTERAL AVE., SUITE 1400  
 
Print Name 
PHOENIX 
ARIZONA 
85012 
 
 
City 
State 
Zip 
 
Title 
 
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                                  20___. 
 
 
Print Name 
 
Procurement Officer 
 
 
Contract No.: CTR043100, 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 
 
 
Bill Gates, Chairman, Board of Supervisor
Anne Longo
ATTEST:
__________________________
Clerk of the Board                Date

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES  
OFFICE OF PROCUREMENT 
150 N. 18th Ave Suite 530 
Phoenix, Arizona 85007 
Contract No.: CTR043100 
IGA Amendment No.: 3 
Procurement Officer 
Anthony Beckum 
 
Page 2 of 2 
 
                                                               
 
                                                                PRICE SHEET 
 
 
 
Cost Reimbursement Line Items 
Budget Amount 
Personnel 
$118,436.10 
Employee Related Expenses 
$50,508.27 
Other/Indirect 
$35,619.00 
Total Amount (Not to Exceed) 
$204,563.37 
 
Note: With prior approval from the ADHS Program Manager, the Contractor is authorized to transfer up to a maximum of 
thirty-five percent (35%) of the total budget between line items. Transfers of funds are only allowed between funded line 
items. Transfer exceeding thirty-five percent (35%) or to a non-funded line item shall require a written Contract Amendment. 
 
Authorization for Provision of Services: 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 changed or modified with an official ADHS Procurement Change Order, and/or an additional Purchase Order is 
issued for purchase of services under this contract. 
 
Any staff changes, including salary, must be pre-approved in writing by the ADHS Program Manager.