Amendment No. 19 to Contract

EX-10.21 3 g79847exv10w21.txt AMENDMENT NO. 19 TO CONTRACT EXHIBIT 10.21 (AHCCCS LOGO) ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A. CONTRACT AMENDMENT - -------------------------------------------------------------------------------- 1. AMENDMENT 2. CONTRACT 3. EFFECTIVE DATE 4. PROGRAM: NUMBER: NO.: OF AMENDMENT: 19 YH8-0001-05 OCTOBER 1, 2002 OMC - -------------------------------------------------------------------------------- 5. CONTRACTOR'S NAME AND ADDRESS: HEALTH CHOICE ARIZONA 1600 W. BROADWAY, SUITE 260 TEMPE, AZ 85282 - -------------------------------------------------------------------------------- 6. PURPOSE OF AMENDMENT: TO EXTEND THE TERM OF THE CONTRACT FOR ONE YEAR AND TO AMEND SECTIONS B, C, D AND E AND ATTACHMENTS B, F, H AND I. - -------------------------------------------------------------------------------- 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS: A. EXTENSION OF CONTRACT: In accordance with Section D, Paragraph 50, Term of Contract and Option to Renew, this contract is extended for the period 10/1/02 - 9/30/03. The Contractor's response affirming or declining the extension must be received by AHCCCSA no later than 3:00 PM, September 20, 2002. B. CHANGES IN REQUIREMENTS: In accordance with Section E, Paragraph 30, "Changes", various changes in contract requirements are indicated in this contract restatement. C. By signing this contract amendment, the Contractor is (1) agreeing to perform for an additional year according to the terms of the contract as amended, and (2) agreeing to the new and changed requirements contained herein. NOTE: PLEASE SIGN AND DATE BOTH AND THEN RETURN ONE TO: MICHAEL VEIT, MD 5700 AHCCCS CONTRACTS AND PURCHASING 701 E JEFFERSON STREET PHOENIX AZ 85034 - -------------------------------------------------------------------------------- 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT - -------------------------------------------------------------------------------- 9. SIGNATURE OF AUTHORIZED 10. SIGNATURE OF AHCCCSA CONTRACTING REPRESENTATIVE: OFFICER: /S/ CAROLYN ROSE /S/ MICHAEL VEIT - -------------------------------------------------------------------------------- TYPED NAME: CAROLYN ROSE MICHAEL VEIT - -------------------------------------------------------------------------------- TITLE: CONTRACTS & PURCHASING CHIEF EXECUTIVE OFFICER ADMINISTRATOR - -------------------------------------------------------------------------------- DATE: 9/20/02 DATE: AUG. 28, 2002 - --------------------------------------------------------------------------------