FY24 MARICOPAHD-MPO LIST - FY24 - 1119.PDF
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12/6/23, 11:35 AM MPO List - FY24 - 1119 https://sharepoint.hs.azdhs.gov/Procurement/mpo/Lists/MPO Dev/fd_Item_Display.aspx?List=15e3e237-e41f-4979-9dde-c36f799e3703&ID=1119&W… 2/3 Purchase Order # Change Order Current Encumbrance Original MPO # Requester Name Location Scope Bureau Contract No. Supplier Name Supplier ID (APP#) or Vendor ID (AFIS #) Supplier E-mail Supplier Address Date Effective Date Termination Date Sub Total Tax Freight Total Encumbrance Distribution is attached Does this form contain Federal Funding? STATE OF ARIZONA Arizona Department of Health Services Procurement Office 150 N 18th Avenue, Suite 530 Phoenix, AZ 85007 Manual Purchase Order BILL TO: (send invoices to invoices@azdhs.gov) SHIP TO Arizona Department of Health Services Accounts Payable 150 N 18th Ave, Suite 260 Phoenix, AZ 85007 FY24 - 1119 Payment Terms NET 30 FOB Destination No Contract Information Isabel Salazar ADHS PREV BNPA S AZ Nutrition Network BNPA RFGA2020-001-001 Maricopa County IV0000002618 RyanWhitePartA@maricopa.gov 301 W JEFFERSON ST, 9TH FLOOR PHOENIX, AZ 85003 10/16/2023 10/1/2023 9/30/2024 Line Items Extended Price is calculated by multiplying Quantity by Unit Price. Line Quantity Unit Description Unit Price (#) Extended Price ($) Totals ($) 1 1 1 Maricopa FFY 24 AZHZ Services CFDA# 10.561 $2,205,533.00 $2,205,533.00 $2,205,533.00 2 $0.00 3 $0.00 4 $0.00 $2,205,533.00 5 $0.00 Calculate Total 6 $0.00 7 $0.00 8 $0.00 9 $0.00 10 $0.00 Encumbrance Distribution No Yes Line BFY Function Dept. Obj Unit PPC Amount (#) CFDA# 1 2024 FEDCFH4251 6811 0924 $2,205,533.00 10.561 2 3 4 5 12/6/23, 11:35 AM MPO List - FY24 - 1119 https://sharepoint.hs.azdhs.gov/Procurement/mpo/Lists/MPO Dev/fd_Item_Display.aspx?List=15e3e237-e41f-4979-9dde-c36f799e3703&ID=1119&W… 3/3 Encumbrance Total ($) GAE # All PDS signed? 5 6 $2,205,533.00 240000001726 No Any off-contract MPOs over $10k require Procurement Disclosure Statements (PDS) be attached CFDA Information: Contractor shall comply with the requirements of OMB Circular. For grant restrictions, refer to https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl Federal Funding Accountability and Transparency Act If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form. This form and the instructions can be downloaded below and must be returned to the ADHS by the 15th of the month following that in which the award was received. The form shall be completed electronically, and submitted using the steps outlined in the Grant Reporting Certification Form Instructions and emailed to us. All required fields must be filled including Top Employee Compensation, if applicable. Completing the Grant Reporting Certification Form is required for compliance with the Office of Management and Budget (OMB). Failure to timely submit the Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during the term of the Award.