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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: 3 Arizona Procurement Portal Amendment No.: 2 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 The Price Sheet is revised and replaced by the Price Sheet of this Amendment Three (3); and 1.2 Scope of Work, Page Nineteen (19), Provision 4.12, added item 4.12.2 that is hereby revised in this Amendment Three (3) to read: 4.12.2 Provide Supplemental Adult Flu activities as defined by the County Health Department and approved by the Immunization Program Office, to increase the flu vaccination rates for adults, especially high-risk adults, within the county. These efforts are intended to help keep hospitalization rates for flu down during the COVID-19 pandemic. 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-86-18-018-3-08 Maricopa County Clint Hickman Chairman, Board of Supervisors 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: 3 Arizona Procurement Portal Amendment No.: 2 Procurement Officer Nicole Marquez 2 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