CTR050593 A5 Price.pdf
PDF 158 KB Posted
- Attached to
- Master Agreement AZ|CTR050593
- Contract number
- CTR050593
- Issued by
- Arizona
About this file
This document is a Request for Proposal Contract Amendment from the Arizona Department of Health Services (ADHS), Office of Procurement, located in Phoenix, Arizona. The contract is identified as CTR050593, with Amendment No. 5, and overseen by Procurement Officer Lucas Terry.
The amendment presents a cost reimbursement line-item budget for the period of July 1, 2025 - September 30, 2025, with a total annual amount not to exceed $33,500.00. The budget breakdown includes $20,696.25 for Personnel, $8,517.00 for ERE (Employer Related Expenses), $630.00 for In-State Travel Expenses, and $3,656.75 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 is contingent upon ADHS issuing a signed Purchase Order, which will specify the contract number and authorized dollar amount.
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Text version
REQUEST FOR PROPOSAL
CONTRACT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR050593 AMENDMENT NO.: 5 PROCUREMENT OFFICER:
Lucas Terry
Revised 06.18.2024
COST REIMBURSEMENT LINE-ITEM BUDGET
Price Sheet for July 1, 2025 - September 30, 2025
ACCOUNT CLASSIFICATION AMOUNT
Personnel $20,696.25
ERE $8,517.00
Professional and Outside Services $0.00
Travel Expenses (In-State) $630.00
Out of State Travel $0.00
Occupancy $0.00
Other Operating $3,656.75
Capital Outlay $0.00
Indirect (if Authorized) $0.00
Other $0.00
TOTAL: Annual Amount Not To Exceed $33,500.00
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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