16-05-ED_FE_Amendment_9.pdf

ARIZONA DEPARTMENT OF EDUCATION

Procurement Section

1535 West Jefferson Street, Bin #37 Phoenix, Arizona 85007-3209

CONTRACT/AGREEMENT AMENDMENT

10. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT/AGREEMENT NOT HERETOFORE CHANGED

AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.

IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT.

CONTRACTOR ARIZONA DEPARTMENT OF EDUCATION

(SIGNATURE OF AUTHORIZED INDIVIDUAL)

NAME (Typed/Printed):

(SIGNATURE)

NAME: Steven Paulson

TITLE: TITLE: Chief Procurement Officer

DATE: DATE:

1. AGREEMENT NO.:

16-05-ED

2. AMENDMENT NO.:

3. EFFECTIVE DATE:

Upon Execution

4. PROGRAM:

EBP Conference

5. CONTRACTOR NAME:

Northern Arizona University P.O. Box 4130 Flagstaff, AZ 86011-4130

6. AUTHORITY FOR AMENDMENT: Paragraph 7, “Changes”, Paragraph 3 “Renewal of Agreement”

7. PURPOSE OF AMENDMENT: Updated Budget

8. DESCRIPTION OF THE SERVICE: Co-Sponsor Annual Evidence Based Practice Conference with NAU

9. THE ABOVE REFERENCED AGREEMENT IS HEREBY AMENDED AS FOLLOWS:

a. In accordance with paragraph 7, Changes, the budget is hereby replaced by Attachment B:

b. Pursuant to the Agreement, Paragraph 3 “Renewal of Agreement”, I hereby extend the agreement for the periods of October 1, 2022 to September 30, 2023.

Thomas Champagne

Associate Vice President, Research

10.3.2022

1535 West Jefferson Street, Bin #37 Phoenix, Arizona 85007-3209

CONTRACT/AGREEMENT ATTACHMENT B

ARIZONA DEPARTMENT OF EDUCATION INTERAGENCY

SERVICE/INTERGOVERNMENTAL AGREEMENT BUDGET/

ESTIMATED NEEDS PAYMENT SCHEDULE FOR

INSTITUTIONS OF HIGHER EDUCATION, STATE AGENCIES

AND OTHER AGENCIES

INSTRUCTIONS

Submit original to ADE Contracts Management Unit as part of proposed Agreement/amendment. Final Agreement will contain instructions for submission of periodic/completion reports

A. AGREEMENT IDENTIFICATION FOR THE BUDGET PERIOD FROM : 10/01/2022 TO: 9/30/2023

1. Applicant Agency: IHD/NAU

2. Contact Person: Adi Schaeffer

Phone No: 602-728-9534

3. Agreement No.: 16-05-ED

Index No.: 4. Funding Source (Chapter 1, etc.)

ADE

5. Date submitted 9/08/2022

6. Proposal Name (if any):

7. Check ONE ☐ New ☒ Renewal Application

☐ Completion Report ☐ Amendment ☐ADE Revision

B. AGREEMENT BUDGET

*EXPENDITURE CATEGORIES

BUDGET

(1)

REQUEST

CHANGES

(2)

AMENDED

BUDGET

(3)

EXPENDITURE

TO DATE

(4)

BUDGET

BALANCE

(5)

8. Salaries – Instructional

9. Salaries – Non-Instructional 24,337

10. Employee Benefits

11. Travel

12. Supplies and Materials 2,198

13. Purch Services/Consultant Fees 20,500

14. Tuition

15. Printing and Reproduction 650

16. Utilities and Communications

17. Other:

18. SUBTOTAL 47,685

19. Indirect Cost (8% of Line 18) 3,815

20. Capital Outlay

21. TOTAL 51,500

22. Administrative Costs

23. Cash Balance (For Completion Purposes)

*SEE INSTRUCTIONS ON REVERSE SIDE

C. COMPLETION REPORT SIGNATURE (Blue Ink Only)

I hereby certify that this is a reasonable statement of total expenditures for this contract.

Applicant Authorized Agent Date

D. SUMMARY OF AVAILABLE FUNDS INCLUDED IN BUDGET ABOVE

Prior FY C/O + FY State C/O + FY (New)+ Other = TOTAL FY

E. ESTIMATED NEEDS PAYMENT SCHEDULE ☐Original ☐Revised Date:

1535 West Jefferson Street, Bin #37 Phoenix, Arizona 85007-3209

CONTRACT/AGREEMENT ATTACHMENT B

FY_____ State C/O FY______ FY_______ Jul: Jan: Jul: Jan: Jul: Jan:

Aug: Feb: Aug: Feb: Aug: Feb:

Sep: Mar: Sep: Mar: Sep: Mar:

Oct: Apr: Oct: Apr: Oct: Apr:

Nov: May: Nov: May: Nov: May:

Dec: Jun: Dec: Jun: Dec: Jun:

TOTAL TOTAL TOTAL