CTR051841 A5 Executed.pdf

INTERAGENCY SERVICE AGREEMENT (ISA)

AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 5 Procurement Officer Anthony Beckum

Helpers Program for Behavioral Health

Effective upon signature of both parties, it is mutually agreed that the Agreement referenced in this Amendment Five (5) amended as follows:

1. Pursuant to the Uniform Terms and Conditions, Provision Twelve (12), Miscellaneous, Section 12.4, the Agreement is hereby amended as follows:

1.1. The Price Sheet is revised and replaced); and

1.2. Exhibit B is revised and replaced.

ALL CHANGES ARE REFLECTED IN RED

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date

The above referenced Contract Amendment is hereby executed this _____ day of __________ 20______ at Phoenix, Arizona

(To be filled out by ADHS Procurement Office)

Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

ARIZONA BOARD OF REGENTS, UNIVERSITY OF

ARIZONA

Contractor’s Name Procurement Officer Signature

Elisha Johnson, JD Director of Clinical Trials & Contracting

06/28/2023 javascript:window.parent.navigate(%22/media_461531632/Arizona_State_Seal.html%22);

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

AGREEMENT NO.: CTR051841 AMENDMENT NO.: 5 Procurement Officer Anthony Beckum

PRICE SHEET

Year Four (4)

04/29/2023 - 04/28/2024

Contract Expenses Cost

Personnel/ERE* $197,843.00

Professional & Outside Services* $11,877.00

Travel Expenses $0

Other Operating* $13,000.00

Indirect (10%) $22,272.00

Total (Not to Exceed) $244,992.00 *Indicates indirect calculation

The Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total Agreement amount among the categorical line items. Transfers of funds are only allowed among funded line items as detailed in the original ISA. Transfers exceeding ten percent (10%) of the contracted amount, or to non-funded line items, shall require an Agreement Amendment.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

Exhibit B

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 NU58DP006816-02-00

Subrecipient name (which must match the name associated with its unique entity identifier):

Arizona Board of Regents, University of Arizona

Subrecipient's unique entity identifier (UEI #): 80-634-5617

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU58DP006816

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; 06/21/2020

Subaward Period of Performance Start and End Date; 6/29/2020 - 04/28/2025

Subaward Budget Period Start and End Date: 04/29/2023 - 04/28/2024

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient: $244,992

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): $1,708,792.00

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity $1,413,252

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA)

National and State Tobacco Control Program

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity Centers for Disease Control

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: 93.387

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 10%