SIG' BLOCK CTR040486 MARICOPA COUNTY STD CONTROL SERVICES A5_FOR SUPPLIER SIGNATURE.PDF

INTERGOVERNMENTAL AGREEMENT (IGA) 
Amendment 
ARIZONA DEPARTMENT 
OF HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
Agreement No.: CTR040486 
IGA Amendment No.: 5 
Procurement Officer 
Karla Varela 
Page 1 of 4 
STD Control Services 
1.
Effective upon signature by all parties and pursuant to the Terms and Conditions, Provision Six (6), Contract Changes,
Section 6.1, Amendments, Purchases Orders and Change Orders it is mutually agreed that the Intergovernmental
Agreement referenced is amended as follows under this Amendment Five (5):
1.1 Price Sheet is revised and replaced;
1.2 Exhibit A has been added.
ALL CHANGES ARE REFLECTED BELOW IN RED. 
All other provisions of this Agreement remain unchanged. 
Maricopa County Department of Health Services 
Contractor Name:  
Authorized Signature 
4041 North Central 
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
       2021. 
Print Name 
Procurement Officer 
Contract No.: CTR040486, 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 
ATTEST:
_________________________________________
County Office of the Clerk of the Board       Date

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT 
OF HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
Agreement No.: CTR040486 
IGA Amendment No.: 5 
Procurement Officer 
Karla Varela 
 
Page 2 of 4 
 
PRICE SHEET 
Effective through 12/31/2023 
 
 
COST REIMBURSEMENT LINE ITEMS 
BUDGETED AMOUNT 
1. Personnel Services & ERE 
$1,824,654.00 
2. Professional & Outside Services  
$0.00 
3. Travel 
$500.00 
4. Other Operating 
$2,000.00 
5. Occupancy Expense 
$0.00 
6. Capital Outlay Expenses 
$0.00 
7. Other 
$0.00 
8. Indirect 
$328,340.00 
TOTAL Not to Exceed 
$2,155,494.00

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT 
OF HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
Agreement No.: CTR040486 
IGA Amendment No.: 5 
Procurement Officer 
Karla Varela 
 
Page 3 of 4 
 
EXHIBIT A 
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): 
1 NH25PS005157-01-00 
 
 
Subrecipient name (which must match the name 
associated with its unique entity identifier): 
Maricopa County Department of Health Services 
 
 
Subrecipient's unique entity identifier (DUNS #): 
117201765 
Federal Award Identification Number (FAIN, sometimes 
it’s the same as the Grant Number): 
NH25PS005157 
 
 
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; 
3/11/2021 
 
 
Subaward Period of Performance Start and End Date; 
01/01/2021-12/31/2021 
 
 
Subaward Budget Period Start and End Date: 
01/01/2021-12/31/2021 
 
 
Amount of Federal Funds Obligated by this action by the 
pass-through entity to the subrecipient (this is normally the 
contract amount): 
$2,155,494.00 
 
 
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): 
$2,155,494.00 
 
 
Total Amount of the Federal Award committed to the 
subrecipient by the pass-through entity 
$2,155,494.00

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT 
OF HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
Agreement No.: CTR040486 
IGA Amendment No.: 5 
Procurement Officer 
Karla Varela 
 
Page 4 of 4 
 
Federal award project description, as required to be 
responsive to the Federal Funding Accountability and 
Transparency Act (FFATA) 
Strengthening Sexually Transmitted Disease 
Prevention and Control in Arizona 
 
 
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: 
93.977 - Preventive Health Services 
Sexually Transmitted Diseases Control Grants 
 
 
Identification of whether the award is R&D 
 No 
 
 
Indirect cost rate for the Federal award (including if the de 
minimis rate is charged) per § 200.414 
19.20%