CTR056454_MARICOPA COUNTY A3.PDF
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INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR056454 IGA Amendment No: 3 Procurement Officer Darrnell Welch 1 STD Program Congenital Syphilis Intervention Project Effective January 1, 2024, it is mutually agreed that the Intergovernmental Agreement referenced in this Amendment Three (3) is hereby amended as follows: 1. Pursuant to the Terms and Conditions, Provision Six (6), Contract Changes, Section 6.1. Amendments, Purchase Orders and Change Orders, the Contract is amended as follows: 1.1. The Price Sheet is revised and replaced. 1.2. The Exhibit A - 2 CFR 200.332 Form is revised and replaced. All revisions are indicated in red. All other provisions of this agreement remain unchanged. Maricopa County Public Health Department Contractor Name: County Authorized Signature 4041 N. Central Ave, Suite 1400 Address: Print Name Phoenix AZ 85012 City State Zip Title and Date 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 2024. Print Name Procurement Officer Contract No.: CTR056454, 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 INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR056454 IGA Amendment No: 3 Procurement Officer Darrnell Welch 2 PRICE SHEET MARICOPA COUNTY PUBLIC HEALTH DEPARTMENT ACCOUNT CLASSIFICATION AMOUNT 1. Personnel Services * $123,130.00 2. ERE $0.00 3. Supplies $0.00 4. Travel Expense * $10,960.00 5. Occupancy Expense $ 0.00 6. Other Operating Expenses * $133,960.15 7. Indirect (15.65%) $41,949.85 TOTAL (Annual Not to Exceed) $310,000.00 * Indicated Indirect Cost Calculation. NOTE: With prior approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of twenty-five percent (25%) of the total budget amount between line items. Transfers of funds are only allowed between funded line items. Transfers exceeding twenty percent (25%) or to a non-funded item shall require an amendment. INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR056454 IGA Amendment No: 3 Procurement Officer Darrnell Welch 3 Exhibit A - 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 UEI #: QMWUG1AMYF65 Federal Award Identification (Grant Number): 5 NU50CK000511-05-00 Subrecipient name (which must match the name associated with its unique entity identifier): Maricopa County Department of Public Health, STD Program Congenital Syphilis Intervention Project (CCSP) Subrecipient's unique entity identifier (UEI #): M85MG1513K5 Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU50CK000511 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; 07/27/2023 Subaward Period of Performance Start and End Date; 8/1/19 - 7/31/24 Subaward Budget Period Start and End Date: 8/1/23 - 7/31/24 INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR056454 IGA Amendment No: 3 Procurement Officer Darrnell Welch 4 Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $310,000.00 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): $310,000.00 Total Amount of the Federal Award committed to the subrecipient by the pass- through entity $310,000.00 Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) 93.323 Epidemiology and Lab Capacity for Infectious Diseases (ELC) Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity Centers for Disease Control & 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: 93.323 Epidemiology and Lab Capacity for Infectious Diseases (ELC) INTERGOVERNMENTAL AGREEMENT (IGA) Amendment ARIZONA DEPARTMENT OF HEALTH SERVICES 150 18th Ave Suite 530 Phoenix, Arizona 85007 Contract No.: CTR056454 IGA Amendment No: 3 Procurement Officer Darrnell Welch 5 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 15.65%