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INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18 th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: ADHS18-177694 IGA Amendment No: 4 Arizona Procurement Portal Amendment No.: 3 Procurement Officer Nicole Marquez 1 IMMUNIZATION SERVICES It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows: 1. Pursuant to Terms and Conditions, Page Seven (7), Provision Six (6), Contract Changes; the Intergovernmental Agreement is amended to revise the following: 1.1 Scope of Work, Page Nineteen (19), Provision 4.12, VPD Outbreak and Pandemic Preparedness added items 4.12.3 and 4.12.4 that are hereby revised in this Amendment Four (4) to read: 4.12.3 Improve vaccine cold storage capacity to include purchase of storage units (refrigerator, freezer [NOT ultra-cold freezer]), generators, portable refrigeration units. These efforts are intended to help keep vaccines viable during the COVID-19 pandemic. 4.12.4 Increase capacity for data entry and reminder recall activities, to include but not limited to additional staffing, or purchase of hardware and software equipment to accomplish this task. These efforts are intended to help track immunization data during the COVID-19 pandemic. Continued on next page All other provisions of this agreement remain unchanged. MARICOPA COUNTY DEPARTMENT of PUBLIC HEALTH Contractor Name: Authorized Signature 4041 N. CENTRAL AVENUE, SUITE 1400 Address: 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 2020. Print Name Procurement Officer Contract No.: ADHS18-177694, 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 C-86-18-018-3-09 Clint Hickman Chariman, Board of Supervisors Anne Longo, Attorney for County ATTEST: _________________________________________ County Clerk of the Board Date INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18 th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: ADHS18-177694 IGA Amendment No: 4 Arizona Procurement Portal Amendment No.: 3 Procurement Officer Nicole Marquez 2 1.2 The Price Sheet is revised and replaced with the Price Sheet of this Amendment Four (4); Price Sheet Activity Frequency Unit Rate Unit of Measure Total Immunization Visit for children zero (0) to eighteen (18) years of age who meet VFC eligibility requirements. Do not include visits for insured children. Quarterly $50.00 Per Visit As approved by ADHS and authorized by purchase order Immunization Visit for adults nineteen (19) years of age and older who meet VFA eligibility requirements. Do not include visits for insured adults Quarterly, when specific VFA funds are available $50.00 Per Visit Immunization Completion report for children zero (0) to twenty-four (24) months of age for the 4:3:1:3:3:1:4 series Quarterly $100.00 Per Series Completion Perinatal Hepatitis B Case Management – Prenatal Quarterly $300.00 Per Case Perinatal Hepatitis B Case Management – Postnatal Quarterly $200.00 Per Case Immunization Visit for Flu Vaccine, in children and adults who meet VFC and VFA eligibility requirements. Do not include visits for insured children or adults. When specific pan flu vaccine funds are available $50.00 Per Visit IDR Submission – Preparation and Submittal of School/Child Care IDR by CHD nurse or in cooperation with school/child care personnel Optional $250.00 Each/per grade level IDR IDR Validation – On-site visit to schools/child care facilities to validate IDR submission data Optional $50.00 Each/per grade level validation Supplemental flu vaccination activities. As needed by June 30, 2021 N/A Total Not to exceed allocation=$1,005,000 Improve vaccine cold storage capacity; increase capacity for data entry and reminder recall activities As needed by June 30, 2021 N/A Total Not to exceed allocation=$125,000 INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18 th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: ADHS18-177694 IGA Amendment No: 4 Arizona Procurement Portal Amendment No.: 3 Procurement Officer Nicole Marquez 3 1.3 Exhibit Three (3) has been added; EXHIBIT THREE 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): 6 NH23IP922599-02-01 Subrecipient name (which must match the name associated with its unique entity identifier): Maricopa County Subrecipient's unique entity identifier (DUNS #): Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NH23IP922599 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; 09/23/2020 Subaward Period of Performance Start and End Date; 07/01/2019 - 06/30/2024 Subaward Budget Period Start and End Date: 07/01/2020 - 06/30/2021 Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $125,000.00 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): $8,992,059.00 INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18 th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: ADHS18-177694 IGA Amendment No: 4 Arizona Procurement Portal Amendment No.: 3 Procurement Officer Nicole Marquez 4 Total Amount of the Federal Award committed to the subrecipient by the pass-through entity $12,181,923.00 Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) CDC-RFA-IP19-1901 Immunization and Vaccines for Children Name of Federal awarding agency, pass- through entity, and contact information for awarding official of the Pass-through entity Centers for Disease Control and Prevention 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: 93.268 - Immunization Cooperative Agreements Identification of whether the award is R&D Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414