RYANWHITE_DENTAL DENTAL A1 (1).PDF

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CONTRACT NO:  C-86-19-025-3-01 
AMENDMENT NO: 1 
AMENDMENT TO RFP CONTRACT 190140 
Between MARICOPA COUNTY  
By and Through DEPARTMENT OF PUBLIC HEALTH 
and DELTA DENTAL PLAN OF ARIZONA 
I. 
The above named contract is hereby amended as specified below: 
Section 6.28 Incorporation of Documents: 
6.28.1, Exhibit A, Pricing: 
i.
Proposed Effective Date:  May 1, 2020
ii.
Annual Maximum Benefits: Decreased from $3,500.00 to
$1,500.00 per person per benefit year.
II.
All other terms and conditions of the original contract and its amendments shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties agree to the changes indicated herein: 
FOR AND ON BEHALF OF 
MARICOPA COUNTY 
By:  
Clint Hickman     
 Date 
Chairman, Board of Supervisors 
ATTEST 
Clerk of the Board 
Date 
APPROVED AS TO FORM 
 Attorney for Maricopa County 
Date 
/s/ Anne Longo
05/14/2020

carmen.batista@maricopa.g 
By: ov 
Dqb1 Ogned kr' rartnertbalistapanarkeptgar 
DItcr.zarm,b4413trnalkopagav 
Dale: /0?105.13 14.0-54 -0701 
Title: Ryan White Part A Program Manager 
AMENDMENT #1 TO CONTRACT 
DELTA DENTAL OF ARIZONA, GROUP # 4715 
Contract #4715 dated December 1, 1996, between Delta Dental of Arizona and Maricopa County Office of Health 
Promotion & Education Dental Insurance Program, is hereby amended, effective May 1, 2020, as follows: 
Appendix A, Summary of Benefits, Plan Year Maximum is hereby amended as follows: 
PLAN YEAR BENEFIT MAXIMUM: Changed from $3,500 to $1,500 per Person, per Benefit Year. 
AUTHORIZED SIGNATURES 
Maricopa County Office of Health Promotion & 	
Delta Dental of Arizona 
Education Dental Insurance Program 
By: 
R. Allan Allford
.ife 
671  • 
Title: 	
President/CEO 
Date:  May 13, 2020 	
Date: 	
May 13, 2020