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HomeMy WebLinkAbout03/18/2002 Item 031
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Mohave County Department of Health and Social Services
Budget Change Request 02/22/2002
MCH-Prenatal Block Grant 236-04-5145
g :\hea Ithde\ad msha re\bud~et02\PBG-MC H Bud .xls
IAcct FY01/02 FY01/02 Total
Adopted Adjustment Adjustment
Number Description Budget Request To Base
331.40 Federal Grants (540,011.00) ($37,743.50) 52,267.50
399.00 Transfer from General Fund $0.00
Total Revenues ($40,011.00) ($37,743.50) 52,267.50
401.10 Salaries/Wages $0.00
401.20 Overtime 50.00
401.30 Temporary Employees 57,105.00 $7,105.00 $0.00
401.40 Short Term Disability 50.00
401.90 Market Study Adjustment $000
401.95 Split Fund Salary Allocation 59,382.00 $9,382.00 $0.00
402.00 Employee Benefits $000
402.10 FICA $544.00 $544.00 $000
402.20 Unemployment Compensation $0.00
402.30 Health Insurance $0.00
402.40 Workers Compensation $39.00 $39.00 $0.00
402.60 State Retirement $000
402.95 Split Fund Benefit Allocation $2,002.00 $2,002.00 $0.00
PERSONAL $19,072.00 519,072.00 $000
41100 Office Supplies $50.00 550.00 $0.00
411.40 Copies Duplicating Supplies $000
412.60 Fuel, Oil & Lubricants $000
412.90 Misc. Operating Supplies 5500.00 $50000 50.00
414.00 Minor Small Tools 50.00
SUPPLIES 555000 $550.00 SO.OO
I 431.00 Professional Services 51.60000 51,600,00 50.00
I 431.50 Health Services Examinations 50.00
: 431.80 Training Costs 5000
I
431.90 Other Outside Services 516,939.00 $16,939.00 $0.00
432.10 Telephone $50000 5500.00 50.00
432.30 Postage 55000 $50.00 50.00
433.10 Travel Expenses $750.00 5750.00 5000
433,20 Motor Pool Crlarges 5500.00 $50000 $000
433.30 Freight Charges 50.00
434.30 Job Advertising 50.00
434.50 Publicity 5000
435.10 Printing Expenses 50.00
435.30 Duplicating Expense 550.00 550.00 SOoO
479.30 Dues, Subscriptions, Mbrship $000
479.60 Prior Year (Deficit/Contingency) $18,512.00 516,245.00 (52,267.00)
479,91 Out of State Tax $000
OTHER CHARGES $38,901.00 536,634,00 (52,26700)
I 485.30 Furniture & Equipment 50.00
I 485.50 Data Processing Equipment 5000
485.52 Computer Software 5000
485.70 Minor Capital 5100-5999 SO.OO
CAPITAL EXPENDITURES SO.OO SO.OO SO.OO
TOTAL EXPENDITURES S58,523,00 $56,25600 ($2.267.00)
Revenue less Expenditures :318,512.00 $18,512::>0 I I
Beginning Fund Balance I
Fund Balance 518.512.00 $18,512,50 I
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ARIZONA DEPARTMENT OF
iJ INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 West Adams, Room 303
, . ~- AMENDMENT Phoenix, Arizona 85007
, . (602) 542-1040
.. .,. Contract Management Specialist
Contract N2: 961091 Amendment Nil: 3 Joe Castro
County Prenatal Block Grant
1. Amendment Begin Date: 2/9/02
2. Ending Date: 6/30/02
It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
3. The contract budgeted amount is being reduced by $2,267.00
4. The Price Sheet page 11 for Amendment # 2, is replaced by Price Sheet page 2 for Amendment #3,
which reflects the decrease in the Unit Rate for the last two Quarterly Reports for the fiscal year.
All other provisions of this agreement remain unchanged.
Mohave County Health Department
CONTRACTOR NAME AUTHORIZED SIGNATURE DATE
PO Box 7000 Patty Mead
ADDRESS PRINTED NAME:
Kingman, AZ 86402 Director
CITY, STATE, ZIP CODE TITLE
Pursuant to A.R.S. ~ 11.952, the undersigned public agency attorney This Intergovernmental Agreement Amendment shall be effective the
has determined that this Intergovernmental Agreement is in proper form date indicated. The Public Agency is hereby cautioned not to
and is within the powers and authority granted under the laws of the commence any billable work or provide any material, service or
State of Arizona. construction under this IGA until the IGA has been executed by an
authorized ADHS signatory.
State of Arizona
d~~ -, .2 _? ,,,-_ () '<" Sig"d <hi, _~ d,y of ,2002
SIm:JATUAE DATE
{fAl/cUI/!. . t Ir &-14 '1l7 c hat,.J/; 11/
PRINTED NAME AND TITLE / Procurement Officer
,I n01- - C\ 1 f{;
Attorney General Contract NO T\l\ which is an Agreement between RESERVED FOR USE BY THE SECRETARY OF STA TE
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 of the State of Arizona,
SIGNATURE DATE
Assistant Attorney General
PRINTED NAME
L
- ..
-. ..-.
INTERGOVERNMENTAL AGREEMENT (lGA) ARIZONA DEl>'>\. 'iTMENT OF
HEAL TH ~;-<::VICES
1740 West A;""'h,S, Room 303
AMENDMENT Phoenix, A:':'-"':1a 85007
(602) ::. <, -1040
Contract NQ: 961091 Amendment No. 3 Contract Ma'-~':'~"""".'._""l?'..,t Specialist
Joe ,'\i:.stro
PRICE SHEET
SERVICE DELIVERY FREQUENCY NUMBER PER BUDGET UNIT RATE AN~lAl COST
PERIOD
...
QUARTERLY PROGRAM ACTIVITIES 1st and 2nd TWO Reports $10,002.75 $.:;.'\', ;\05.50
QUARTERS NTE: -'-'\.~_O06.00
QUARTERLY PROGRAM ACTIVITIES 3"' and 41n TWO Reports $8,869.00 NTE: :$ ~ 7,738.00
QUARTERS
.--
.
.--
NTE = Not to exceed
BUDGET TERM: 7/1/02 TO 6/30/02
Page 2 I