ADHS18-175355 A1 FOR SIGNATURE.PDF

INTERGOVERNMENTAL AGREEMENT (IGA)  
AMENDMENT 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 N. 18th Avenue, Suite 530 
Phoenix, Arizona 85007 
Contract No.: ADHS18-175355 
Amendment No.: 1 
APP Amendment No.: 1 
Procurement Specialist: 
Carlos Carranza Jr. 
 
Page 1 of 2 
 
Prop 201 Smoke Free Arizona 
 
 
Effective upon signature, it is mutually agreed that the Contract referenced is amended as follows: 
 
1. Pursuant to Terms and Conditions, Page Seven (7), Provision Six (6), Contract Changes, Subsection (6.1), 
Amendments, Purchase Orders and Change Orders, the Price Sheet of the Agreement is hereby revised and replaced 
by the Price Sheet of this Amendment One (1). 
 
2. Pursuant to Terms and Conditions, Page Seven (7), Provision Six (6), Contract Changes, Subsection (6.1), 
Amendments, Purchase Orders and Change Orders, the Special Terms and Conditions is revised to add the following: 
 
22.      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 b) an additional 
Purchase Order is issued for purchase of services under this contract.   (Continued on next page) 
 
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED. 
Maricopa County by and through its  
Maricopa County Public Health 
 
CONTRACTOR SIGNATURE 
 
 
 
Contractor Name 
 
4041 N. Central Ave., Suite 1400 
Contractor Authorized Signature 
Address 
 
Phoenix                             ARIZONA              85012 
Printed Name 
City                                              State                             Zip 
Title 
CONTRACTOR ATTORNEY SIGNATURE 
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 the State 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 
 
Signed this ______ day of _______________________ 
20_____ 
 
Signature                                                          Date 
 
 
Printed Name 
Procurement Officer 
 
Contract No. ADHS18-175355, which is an Agreement between public 
agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned 
Assistant Attorney General, 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 
 
Printed Name:  
Clint Hickman
Chairman, Board of Supervisors
Anne Longo
ATTEST: 
By: ____________________________ 
      Clerk of the Board 
Date: ___________________________

INTERGOVERNMENTAL AGREEMENT (IGA)  
AMENDMENT 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 N. 18th Avenue, Suite 530 
Phoenix, Arizona 85007 
Contract No.: ADHS18-175355 
Amendment No.: 1 
APP Amendment No.: 1 
Procurement Specialist: 
Carlos Carranza Jr. 
 
Page 2 of 2 
 
NEW Price Sheet/Fee Schedule 
 
Effective July 1, 2020 
 
Type of Unit 
Unit Rate 
Budget Period: 7/1 – 6/30 
Education and Compliance Activities including 
Complaint Inspection and Advisory Inspection 
$175.00 
Per Visit 
Education Services: Including Presentations, 
Trainings, Health Fairs, Conference Exhibits, 
Worksite Wellness, etc.: 
 
**Note: for more 10 attendees a sign in sheet 
or other form of documentation will be 
required otherwise will only be paid $500 
 
0-10 attendees: $500 per event 
10-25 attendees: $750 per event 
25-50 attendees: $1,000 per event 
50-100 attendees: $1,250 per event 
100+: attendees: $1,500 per event 
 
Estimated quarterly amount 
$204,103.25 
Not to exceed Annual Total 
$816,413.00 
 
Note: If the contractor has unused funds from the previous quarters, the contractor 
shall carry forward the funds to the following quarters, up to the term of the budget 
period. 
 
             All expenses are inclusive of any travel and travel related expenses.