REVISED APACHE PRICE SHEET A3.pdf
PDF 164 KB Posted
- Attached to
- Master Agreement AZ|CTR050593
- Contract number
- CTR050593
- Issued by
- Arizona
About this file
This document is a Contract Amendment (Amendment No. 3) issued by the Arizona Department of Health Services, Office of Procurement, for Contract No. CTR050593 with the Apache County Health Department. The amendment is specific to the State Fiscal Year 2024, covering the period from July 1, 2023 to June 30, 2024.
The contract amendment outlines a cost reimbursement line-item budget totaling $134,000.00, broken down across several expense categories. Key budget allocations include $49,630.00 for Personnel, $24,127.00 for Employer-Related Expenses (ERE), $5,000.00 for In-State Travel Expenses, and $55,243.00 for Operating Expenses. The document specifies that the contractor may transfer up to 10% between funded line items with prior written approval, and that any services performed must be authorized through a specific Purchase Order issued by ADHS, which will indicate the contract number and authorized funding amount.
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Text version
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.
File details come from the government source that posted it. Updated .