HomeMy WebLinkAboutDPH Contract 19631 Amendment DIVISION OF PUBLIC HEALTH
DPH CONTRACT 19631
AMENDMENT
The Department of Health Services, on behalf of the Division of Public Health and Oshkosh Health Department
agree to amend their original agreement for Contract 20824 as follows:
REVISION: SECTION III. COST OF SERVICES
Delete: " an amount not to exceed$52,213
Insert: " an amount not to exceed$25,663
Adjustment will be made to the Community Aids Reporting System(CARS) based on the information in the table
below.
Agency# Agency Contract Period Profile# Current Contract Change New Contract
Type Contract Level Amount Level
472894 260 08/01/11-07/31/12 155015 $52,213 -526.550 $25,663
All other terms and conditions of the original agreement remain unchanged.
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Contractor's Authorized Representative Date
Sandra L. K. Breitborde, MA, MS
Deputy Administrator
Division of Public Health
Department of Health Services
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Grantee's Authorized Representative Date
Name:
Title: