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