CTR074629 Contract amendment No. 1.pdf

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

Revised 05/29/2024

Dietetic Internship

It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:

1. Pursuant to Terms and Conditions, Provision Six (6) Contract Changes, subsection 6.1 Amendments, the Contract is hereby revised with the following:

1.1. The Scope of Work is revised and replaced.

1.2. The Price Sheet is revised and replaced.

ALL CHANGES ARE REFLECTED IN RED

All other provisions of this agreement remain unchanged.

Maricopa County Public Health Department

Contractor Name: County Authorized Signature

4041 North Central Avenue, 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 2025.

Print Name Procurement Officer

Contract No.: CTR074629, 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

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

Revised 05/29/2024

1. Background

The availability of dietetic internships nationally is very limited resulting in few nutrition graduates working in Arizona Women, Infants, and Children (WIC) local agencies being accepted each year. Acceptance for dietetic internships is not determined by the Arizona Department of Health Services (ADHS) but by the Accreditation Council for Education in Nutrition and Dietetics (ACEND). This situation is impacting the ability of WIC local agencies to recruit Registered Dietitian Nutritionists statewide to provide high-risk nutrition counseling to WIC clients as well as provide training and mentoring of paraprofessional staff. The United States Department of Agriculture provides reimbursement of reasonable and necessary costs using federal Special Supplemental Nutrition Program for WIC grant funds for dietetic supervised practice programs or other out-of-service training programs for WIC and eligible in-kind staff. To support local infrastructure development for nutrition personnel in the WIC program, the ADHS WIC Program is proposing to provide financial support for the administration of a part-time WIC Dietetic Internship as an additional track in the Maricopa County Public Health (MCDPH) Dietetic Internship.

2. Objective

To annually increase, by no more than six (6), the number of Registered Dietitian Nutritionists in the Arizona WIC Program through targeted funding, ensuring effective program administration and support for staff development, ultimately improving nutrition services for eligible families.

3. Scope of Service

The purpose of this IGA is to support workforce development activities in the Arizona WIC Program by collaborating with MCDPH�s ACEND-accredited dietetic internship. The Contractor shall administer the WIC track dietetic internship under the umbrella of MCDPH Dietetic Internship, for the purpose of increasing the number of Registered Dietitian Nutritionists in the Arizona WIC Program.

4. Requirements

The Contractor shall:

4.1. Maintain accreditation with ACEND.

4.2. Provide at minimum one (1) Full Time Employee to serve as the Dietetic Internship Coordinator with the following minimum qualifications, knowledge, skills, and experience:

4.2.1 Master�s degree in nutrition, dietetics, food management or health related field, granted by a United States regionally accredited college of university.

4.2.2 Completion of a didactic program in dietetics and supervised practice program approved by the

ACEND.

4.2.3. Shall have the Registered Dietitian Nutritionist credential.

4.2.4. Minimum of three (3) years experience in staff management and/or as dietetics practitioner.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

Revised 05/29/2024

4.2.5. Teaching experience as a dietetic preceptor.

4.2.6. Knowledge of ACEND standards of education and broad knowledge of clinical and administrative dietetics.

4.2.7. Knowledge of human nutrition, physiology, food science, biochemistry, education theory and techniques.

4.2.8. Ability to integrate food and nutrition services with other services in the practice setting.

4.2.9. Ability to promote effective professional relationships in the practice of dietetics.

4.2.10. Ability to communicate clearly and effectively in both written and verbal forms.

4.2.11. Ability to solve problems, generate ideas, and think creatively.

4.2.12. Ability to organize and coordinate multiple projects.

4.2.13. Skills in organizing and directing the work effort of others.

4.2.14. Skill in problem-solving, strategic thinking, negotiation, and sound judgment.

4.2.15. Skill in planning and executing projects and programs.

4.2.16. Ability to work in a multi-task environment and meet tight deadlines.

4.2.17. Strong organizational and computer skills.

4.2.18. Knowledge of food and nutrition policy regulation and governance.

4.2.19. Ability to motivate and mentor students and staff.

4.2.20. Skills in time management, fiscal planning and marketing.

4.2.21. Travel to affiliate sites throughout the state of Arizona required.

4.3. Recruit potentially eligible internship candidates and select candidates who fulfill requirements as outlined by the Commission on Dietetic Registration for Registered Dietitian Nutritionists.

4.4. Select, maintain agreements with, and evaluate affiliate sites and preceptors within the Program.

4.5. Serve as the primary point of contact and provide oversight of the intern when in required rotations and coordinate with the WIC local agency when the intern is not in required rotation and/or during WIC work weeks.

4.6. Provide verification statements for graduates.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

Revised 05/29/2024

4.7. Maintain compliance with WIC Policy Memorandum #95-22, Arizona WIC Policy and Procedure Manual and State of Arizona Accounting Manual.

4.8. Provide routine status updates to ADHS including information such as programmatic updates, intern progress and performance, and interns� registration exam status.

4.9. Require the interns to maintain student or Nutrition and dietetic technician professional liability insurance -

$1,000,000 per occurrence/$3,000,000 aggregate.

5. Funding Restrictions

Funds cannot be used for any of the following:

5.1. Lobbying activities, including the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to support or defeat any proposed or pending regulation, administrative action, or order issued by the executive branch of any State or local government.

6. Tasks

The Contractor shall:

6.1. Manage fiscal resources and ensure program operates within budget.

6.2. Establish contractual agreements with multiple sites to serve as affiliate agencies for internship rotations.

6.3. Establish practicum sites and coordinate activities to ensure that competencies are met.

6.4. Establish the overall program goals, strategies, and priorities of the program including programmatic evaluation and outcomes.

6.5. Develop and implement policies and procedures for the effective management and operation of the dietetic internship program.

6.6. Complete all necessary correspondence with Accreditation Council for Education in Nutrition and Dietetics and - Academy of Nutrition and Dietetics (AND), including any annual or requested reports, and program Self Study as required.

6.7. Integrate learning experiences in administrative, clinical, and community dietetics into the didactic and clinical components of the internship program.

6.8. Coordinate and direct the efforts of staff participating as preceptors and/or instructors in the internship program.

6.9. Plan and coordinate the master rotation schedules with interns, WIC local agencies, affiliation sites and other local dietetic internship programs as necessary.

6.10. Establish and maintain a continuous and systematic process of curriculum development, assessment, evaluation, and implementation.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

Revised 05/29/2024

6.11. Review and analyze dietetic intern performance evaluations and take appropriate action to provide support when minimum standards of performance are not being met.

6.12. Prepare and deliver presentations, grade projects and assignments as necessary.

6.13. Ensure the internship program remains current with standards established by ACEND.

6.14. Develop recruitment information materials for qualified WIC candidates and establish procedures for the dissemination of program information to WIC agencies and individual WIC staff requesting information.

6.15. Establish selection criteria for acceptance into internship program, and establish an executive committee for selection of candidates with representation from Maricopa County Public Health and ADHS.

6.16. Review and evaluate all application packets for presentation to selection committee.

6.17. Obtain Letters of agreement from each accepted WIC Employee/Intern and their Local WIC Agency that they will be working for during their internship.

6.18. Coordinate the evaluation process of the selection committee and inform applicants of decisions.

6.19. Maintain professional currency in areas relevant to directing the dietetic internship, dietetic registration and continuing education requirements.

6.20. Develop and implement individualized plan for professional growth including participation in professional organizations and activities.

6.21. Guide and mentor the intern graduates to be successful in their dietetic registration exams.

6.22. Participate as an active member of the Arizona Dietetic Practicum Advisory Committee.

6.23. All application materials which shall be used by interested applicants by October 1st of the agreement year.

6.24. Selection criteria to be used to rate applicants by January 1st of the agreement year and all application packets of candidates by January 15th of the agreement year.

6.25. Acceptance letters to no more than six (6) qualified employees accepted to the Arizona WIC Part-Time

Dietetic Internship as accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND), the Academy of Nutrition and Dietetics �s accrediting agency for education programs preparing students for careers as Registered Dietitian Nutritionists.

6.26. Master Rotation schedule by August 15th.

6.27. Study materials for the dietetic registration exam to be provided to each intern prior to the completion of the internship and to ADHS upon request.

6.28. Verification statements to each intern following the successful completion of the dietetic internship and Master�s degree requirement by no later than July 30th immediately following the internship year.

6.29. Contractor Expenditure Report (CER), due thirty (30) days following each month of services including all supporting documentation showing allowable costs.

6.30. Labor Activity Reports or 100% certification of time in accordance with WIC PPM and annual Civil

Rights Course per USDA requirements for WIC-funded personnel no later than September 30th .

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

6.31. Prepare Contractor Expenditure Report (CER) thirty (30) days following each month of services.

6.32. Prepare a Quarterly Cost Summary report thirty days (30) days following the end of each quarter of services.

7. State-Provided Items

ADHS will provide:

7.1. Contractor Expenditure Report (CER) template, provided electronically.

7.2 Quarterly Cost Summary Report template, provided electronically.

8. Approvals

ADHS will require prior approval of:

8.1. Purchases of Capital Equipment (single item purchase of $5,000 or more) will require approval prior to purchasing.

8.2. All marketing materials (the use of ADHS logo, brochures, posters, public service announcements, paid media, videos, etc.) which have been developed, written, published, or recorded by the Counties and paid for with funds from this award must be first approved by ADHS prior to the dissemination of such materials or airing or use of such announcements.

9. Deliverables

The Contractor shall submit:

9.1. Submit internship and Master�s degree requirement by no later by October 1st of the agreement year.

9.2. Contractor Expenditure Report (CER), due thirty (30) days following each month of services including all supporting documentation showing allowable costs.

9.3. Quarterly Cost Summary Report, due thirty (30) days following each quarter of services.

10. Notices, Correspondence, Reports

10.1 Supporting documentation, and invoices/CERs from the Contractor to ADHS shall be sent to:

Arizona Department of Health Services Attn: Alexandra Stolworthy, MS, RDN, IBCLC, WIC Nutrition Consultant Arizona Department of Health Services 150 N 18th Avenue, Suite 320 Phoenix, AZ 85007-3242 Email: Alexandra.Stolworthy@azdhs.gov Phone: 480-536-3290

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

10.2 Notices, correspondence, and reports (and payments if sent to same address) from ADHS to the

Contractor shall be sent to:

Lisa Clarke, MS, RDN, CNSC Dietetic Internship Coordinator Maricopa County Department of Public Health 4041 N Central Avenue, Suite 1400 Phoenix, AZ 95012 Email: Lisa.Clarke@maricopa.gov Phone: 480-431-2092

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR074629 IGA Amendment No: 1 Procurement Officer:

Ryan Garcia

Revised 05/29/2024

PRICE SHEET

Cost Reimbursement October 1, 2025- September 30, 2026

Service Description Rate

Personnel Expenses* $70,319.00

Employee Related Expenses* $27,450.00

Professional & Outside Services* $38,290.00

Travel Expense* $6,242.00

Occupancy Expenses* $888.00

Other Operating Expenses* $17,080.00

Capital Outlay Expenses $0.00

Indirect Costs* (16.66%) $26,707.00

Total Annual not to exceed: $186,976.00

If applicable, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between line items with the written approval from an ADHS program representative.

Transfers exceeding ten percent (10%) or to a non-funded line item shall require an Agreement Amendment.

*Indicates indirect rate calculation

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MARICOPA, COUNTY OF

Unique Entity ID

LM85MG1513K5

CAGE / NCAGE

3QJA2

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Aug 20, 2026

Physical Address

4041 N Central AVE STE 1400

Phoenix, Arizona 85012-3314

United States

Mailing Address

4041 N Central AVE STE 1400

Phoenix, Arizona 85012-3314

United States

Business Information

Doing Business as

Maricopa County Department of Public Health

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 03

State / Country of Incorporation

(blank) / (blank)

URL

www.maricopa.gov

Registration Dates

Activation Date

Aug 26, 2025

Submission Date

Aug 20, 2025

Initial Registration Date

Feb 2, 2004

Entity Dates

Entity Start Date

Jul 1, 1957

Fiscal Year End Close Date

Jun 30

Immediate Owner

CAGE

3PZS5

Legal Business Name

MARICOPA COUNTY

Highest Level Owner

CAGE

(blank)

Legal Business Name

(blank)

Executive Compensation

Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of

P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.

Proceedings Questions

Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions.

Exclusion Summary

Active Exclusions Records?

No

SAM Search Authorization

I authorize my entity's non-sensitive information to be displayed in SAM public search results:

Yes

Entity Types

Business Types

Entity Structure

U.S. Government Entity

Entity Type

US Local Government

Organization Factors

(blank)

Profit Structure

(blank)

Last updated by Cheryl Bucalo on Aug 20, 2025 at 05:44 PM MARICOPA, COUNTY OF

Nov 19, 2025 08:38:30 PM GMT https://sam.gov/entity/LM85MG1513K5/coreData?status=null Page 1 of 2

Socio-Economic Types

Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the

SBA supplemental pages during registration.

Government Types

U.S. Local Government

County

Financial Information

Accepts Credit Card Payments

No

Debt Subject To Offset

No

EFT Indicator

CAGE Code

3QJA2

Points of Contact

Electronic Business

Cheryl Bucalo, Purchasing and Contracts

Supervisor

4041 N. Central AVE. Suite 1400

Phoenix, Arizona 85012

United States

John Lick, Grant Unit Manager 4041 N Central AVE Suite 1400

Phoenix, Arizona 85012

United States

Government Business

John Lick, Grant Unit Manager 4041 N Central AVE Suite 1400

Phoenix, Arizona 85012

United States

Cheryl Bucalo, Purchasing and Contracts

Supervisor

4041 N. Central AVE. Suite 1400

Phoenix, Arizona 85012

United States

Past Performance

John C Lick, Grant Unit Manager 4041 N. Central AVE.

Phoenix, Arizona 85012

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

923120

NAICS Title

Administration Of Public Health Programs

622110 General Medical And Surgical Hospitals

Product and Service Codes

PSC PSC Name

Q999 Medical- Other

Disaster Response

Yes, this entity appears in the disaster response registry.

Bonding Levels Dollars

(blank) (blank)

States

Arizona

Counties

(blank)

Metropolitan Statistical Areas

(blank)

Last updated by Cheryl Bucalo on Aug 20, 2025 at 05:44 PM MARICOPA, COUNTY OF

Nov 19, 2025 08:38:30 PM GMT https://sam.gov/entity/LM85MG1513K5/coreData?status=null Page 2 of 2