ADHS18-188819 GY22 PRICE SHEET.PDF

C-86-18-051-3-06

INTERGOVERNMENTAL AGREEMENT (IGA)

ARIZONA DEPARTMENT OF
HEALTH SERVICES
150 18" Ave Suite 530
Phoenix, Arizona 85007

Amendment
Agreement No.: IGA Amendment No: Procurement Officer
ADHS18-188819 2 Mackenzie Hix
Price Sheet

18881I9HVLBYRS LAB HIV Prevention Price Sheet 01/01/2022 thru 12/31/2022 (end of IGA term)
Cost Reimbursement Line Items Budget Amount
Personnel Services — Core $0
Employee Related Expenses — Core $0
Personnel Services — Admin $0
Employee Related Services — Admin $0
Professional and Outside Services $0
Travel Expenses $0
Other Operating Expenses $280,000
Capital Outlay Expenses $0
Other (Indirect Costs) $0
Subtotal: $280,000
T888TSRWYRS Ryan White Part B Price Sheet 04/01/2021 thru 03/31/2022
Cost Reimbursement Line Items Budget Amount
Personnel Services — Core $298,800
Employee Related Expenses — Core $168,999
Personnel Services — Admin $162,200
Employee Related Services — Admin $85,590
Professional and Outside Services $0
Travel Expenses $5,500
Other Operating Expenses $15,054
Capital Outlay Expenses $0
Other (Indirect Costs) $85,257
Subtotal: $821,400
188819CC Component C Price Sheet 08/01/2021 thru 07/31/2022
Cost Reimbursement Line Items Budget Amount
Personnel Services — Core $326,976
Employee Related Expenses — Core $163,488
Personnel Services — Admin $
Employee Related Services — Admin $85,590
Professional and Outside Services $0
Travel Expenses $25,000
Other Operating Expenses $315,400
Capital Outlay Expenses $0
Other (Indirect Costs) $121,473
Subtotal: $1,037,927
{ Total: EXRS SAK

Page 9

Corrected Amount: $2,139,327 kmason