CTR050593 A3.pdf
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- Attached to
- Master Agreement AZ|CTR050593
- Contract number
- CTR050593
- Issued by
- Arizona
About this file
This document is a Contract Amendment issued by the Arizona Department of Health Services' Office of Procurement for the Health Start Program, involving Apache County Health Services District. The contract is identified as CTR050593, with Amendment No. 3 executed by Procurement Officer Lucas Terry. The amendment extends the existing contract through July 5, 2024.
The amendment includes a cost reimbursement line-item budget for State Fiscal Year 2024 (7/1/23-6/30/24) totaling $134,000. The budget is broken down into several categories: $49,630 for Personnel, $24,127 for Employee Related Expenses (ERE), $5,000 for In-State Travel Expenses, and $55,243 for Other Operating Expenses. The contract allows the contractor to transfer up to 10% between funded line items with prior written approval from the Program Manager. Authorization for service purchases will be made through ADHS-issued Purchase Orders, which will specify the contract number and authorized funding amount.
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Lucas Terry
1.2 The contract is hereby extended through 7/5/2024.
Gina Corwin
Digitally signed by Gina Corwin Date:
2023.05.02 17:46:42 -07'00'
CONTRACT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR050593 AMENDMENT NO.: 3
Procurement Officer:
Lucas Terry
Apache County Health Department CTR050593
COST REIMBURSEMENT LINE-ITEM BUDGET: SFY 2024 (7/1/23-6/30/24)
ACCOUNT CLASSIFICATION AMOUNT
Personnel $49,630.00
ERE $24,127.00
Professional & Outside Services $0.00
Travel Expense (In-State) $5,000.00
Out of State Travel $0.00
Occupancy $0.00
Operating Expenses/ Other Operating $55,243.00
Capital Outlay Expense $0.00
Indirect (if authorized) $0.00
Other $0.00
TOTAL $134,000.00
With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between funded line items. Transfers of funds are only allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an amendment.
Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a
Purchase Order that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount on the Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of ADHS unless a.) the Purchase Order is modified with an official ADHS
Procurement Change Order, and/or b.) an additional Purchase Order is issued for purchase of services under this Contract.
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