HomeMy WebLinkAbout02/18/2003 Item 010
-
ARIZONA DEPARTME1\T OF
I HEALTH SERVICES
(I NTERGOVERNMENTALAGREEMENT 1740W.Adams,Room303
(lGA) Phoenix, Arizona 85007
'~ AMENDMENT (602) 542-1040
,; _ '";0 (602) 542-1741 Fax
I Contract Management Specialist
.....:: ~ Contract No: 961091 Amendment No: #5 J. Castro
County Prenatal Block Grant
1. Amendment Begin Date: 1/06/03
2. Ending Date: 6/30/03
It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
3. Pursuant to page 3, item 9.a. of the Uniform Tenus and Conditions, the Budget amount is being reduced by $1,874.
4. The Price Sheet Page 2 of Amendment #4 is replaced by Price Sheet Page 2 for Amendment #5, which shows the
budget reductions.
All other provisions of this agreement remain unchanged
Mohave County Health Department
Contractor Name Authorized Silmature
P.O. Box 7000
Address Printed Name
Kingman AZ 86402 Chairman, Board of Supervisors
City State ZIP Title
Pursuant to A.R.S. ~ 11-952, the undersigned public agency This Intergovernmental Agreement Amendment shall be
attorney has determined that this Intergovernmental Agreement effective the date indicated. The Public Agency is hereby
is in proper form and is within the powers and authority cautioned not to commence any billable work or provide any
granted under the laws ofthe State of Arizona. 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 1003
a/"'oC~ / 27---eJ ~ -
Printed.,NameMI /.ruCr. :J.f:)...f'!>nu /jJ1o/r.te (o II/). Procurement Officer
~ v-- KK(l?J-06~0l
Attorney General Contract No. , which is an Agreement RESERVED FOR USE BY THE SECRETARY OF STATE
between public agencies, has been reviewed pursuant to A.R.S.
~ 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the
powers and authority granted under the laws ofthe State of
Arizona.
Signature Date
Assistant Attorney General
Printed Name ..
1
~.. ~
ARIZONA DEPARTME!'\T OF
INTERGOVERNMENTAL
HEALTH SERVICES
1740
W. Adams, Room 303
AGREEMENT (IGA)
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: 961091
Amendment No: #5 Contract Management Specialist
Joe Castro
Price
Sheet
NUMBER
PER
SERVICE UNITS
FREQUENCY BUDGET PERIOD
UNIT RATE ANNUAL RATE
QUARTERLY PROGRAM
15t and 2M Quarters
ACTIVITIES REPORT
2 Quarters $ 9,436
$ 18,872
3rd and 4th Quarters 2 Quarters
$ 8,499 $ 16,998
TOTAL:
$ 35,870
Budget Term: 7/1/02 to .6/30/03
2