RFGA2022-003-007 A3 (1) (003).PDF

Maricopa County — Formal (2024-11-20)

Extracted text (via pymupdf) 6769 characters

GRANT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530
Phoenix, Arizona 85007
GRANT NO.: RFGA2022-003-007
AMENDMENT NO.: Three (3)
Procurement Officer
Lucas Terry

Page 1 of 4
Revised 03.25.2024

Home Visiting Services for The Maternal, Infant, and Early Childhood Home Visiting (MIECHV)

Effective upon signature by both parties, it is mutually agreed that the Grant referenced in this Amendment Three (3) is
amended as follows:

1. Pursuant to the Terms and Conditions, Provision Five (5), Sub-Section 5.1, Amendments, Purchase Orders, And
Change Orders, the Grant is hereby revised with the following:

1.1 The Price Sheet is revised and replaced.

1.2 The Federal Financial Assistance information is added.

ALL CHANGES ARE REFLECTED IN RED

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

Contractor 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)
Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

Maricopa County Department of Public Health
Contractor’s Name
Procurement Officer Signature

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Revised 03.25.2024
Maricopa Co DPH FY25
Cost Reimbursement Line-Item Budget

ACCOUNT CLASSIFICATION
AMOUNT
Personnel *
$951,409.53
ERE *
$338,981.46
Professional & Outside Services *
$38,237.00
Travel Expense (In-State) *
$11,519.00
Out-of-State Travel
$1,407.00
Occupancy
$20,983.83
Operating Expenses/ Other Operating *
$17,586.00
Capital Outlay Expense
$0.00
Indirect (if authorized) (15.79%)
$217,921.55
TOTAL ANNUAL
$1,598,045.37
(*) Indicates line items used to calculate the Indirect Cost.
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.

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Revised 03.25.2024
FEDERAL FINANCIAL ASSISTANCE INFORMATION

Funding Source: FEDCFH1770

PPC: 0925

If Federal Grant Funds are being allocated to fund any part of the service(s) being requested
(ISA/IGA/Contracts/Amendments), the following information must be completed by the
Program Section and attached to the PWO.

1.
GRANT INFORMATION:

a. Grant CFDA Number (or Federal Contract Number if applicable): 93.870
b.
Customer Relationship: Contractor/Vendor X Sub-recipient(s) *
c.
Name of the Federal Financial Assistance (as listed on the Grant): Maternal, Infant,
Early Childhood Home Visiting Program (MIECHV)
Amount of Federal Financial Assistance being allocated to Contractor/Vendor and/or
$ 767,371.47
ADHS Contract Number: # _______________ (To be filled by procurement)

2.
FEDERAL GRANTS COMPLIANCE REQUIREMENTS:

Contractor shall comply with the requirements of OMB Circular A-133.

Insert any specific Restrictions and/or Requirements that apply to the Grant:

NOTE: If volume of information requested exceeds space available on this form, please
reference the applicable Section of the Grant.

* When a sub-recipient relationship exists, the Cash Management Improvement Act of 1990
(CMIA) rules and procedures as noted in the Federal Register, 31 CFR Part 205, must be
followed. In general for the sub-recipient, there must be a receipt and distribution of the cash
within two days unless the cash is used to reimburse for expenditures. The Treasury - State
Agreement (TSA) between the United States Department of the Treasury and the State controls
the funding technique used for the transfer of funds. Any non-compliance with approved
funding techniques or the use of pre-issuance funding will result in an interest liability to the
State or the sub-recipient as applicable.

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Revised 03.25.2024
FEDERAL FINANCIAL ASSISTANCE INFORMATION