CTR043100 HIV SURVCAP A2 (04).PDF

INTERGOVERNMENTAL AGREEMENT (IGA) 
Amendment 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
Agreement No.: 
CTR043100 
IGA Amendment No: 
2 
Procurement Officer 
Mackenzie Hix 
Page 1 
HIV Surveillance Capacity Expansion Program 
1.
Effective upon signature by all parties and pursuant to the Terms and Conditions, Provision 6, Contract Changes,
Section 6.1, it is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1.1 The Price Sheet is revised and replaced by the Price Sheet on Page Two (2) of this Amendment Two (2).
All other provisions of this Agreement remain unchanged. 
Maricopa County 
Contractor Name:  
Authorized Signature 
4041 N. Central Avenue Suite 1400 
Address: 
Print Name 
Phoenix 
AZ 
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.: ADHS18-188819, 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-86-19-057-3-04
Jack Sellers
Chairman, Board of Supervisors
Anne Longo, Attorney for County
ATTEST:___________________________________
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.: 
CTR043100 
IGA Amendment No:  
2 
Procurement Officer 
Mackenzie Hix 
 
Page 2 
 
 
 
Price Sheet 
 
 
Cost Reimbursement Line Items 
Budget Amount 
Personnel & Employee Related Expenses 
$162,233.00 
Indirect Costs 
$29,767.00 
Total Amount (Not to Exceed)  
$192,000.00 
 
Note: With prior approval from the ADHS Program Manager, the Contract is authorized to transfer up to a maximum of 
thirty-five percent (35%) of the total budget between line items. Transfers of funds are only allowed between funded line 
items. Transfer exceeding thirty-five percent (35%) or to a non-funded line item shall require a written Contract Amendment.