HomeMy WebLinkAboutP-16-108-R Amendment 5.pdfCONTRACT INFORMATION SHEET
DATE: 11/19/2020
Contract No.: P-16-108-R Vendor Number: 0000279405
Contract Title: Mobile Health Application Name/Address: Emocha Mobile Health, Inc.
and Support for TB
855 North Wolfe St., John G. Rangos
Bldg, Ground Floor, Ste. B
Patients Baltimore, MD 21205
Contract Period: 3/15/16 - 6/30/21 Representative: Sebastian Seiguer
Using Agencies: Dept of Public Health Phone No.: 410-804-0059
Email: info@emocha.com
Terms: Net 45
Total Contract Amt.: $158,720.00
Buyer Name: Heather Stevens
Requisition No: 5622100395 Org: 56201650
Supersedes:
NEW RENEWAL X AMENDMENT
X TICK DATE 3/1/21 REFERENCE (RFQ# / RFP#)
DESCRIPTION: Provide a mobile health application and support for TB patients.
4/6/2017: Amendment #1 to extend for an additional one (1) year and increase contract amount.
3/12/2018: Amendment #2 to extend for an additional one (1) year.
4/8/209: Amendment #3 to extend for an additional one (1) year.
3/25/2020: Amendment #4 to extend to June 30, 2021, revise Att A, and increase contact maximum.
11/19/2020: Amendment #5 to revise attachment A, lower maximum
SPECIAL INSTRUCTIONS:
DISTRIBUTION: Completed By: Date: Completed By: Date
DEPARTMENT: DPH
REQUISITIONER: Mario Hernandez
Rev 1/2/15
County of Fresno
INTERNAL SERVICES DEPARTMENT
ROBERT BASH, DIRECTOR CIO
Information Te
Telecommunications
333 W. Pontiac Way, Clovis, CA 93612 / (559) 600-7110
* The County of Fresno is an Equal Employment Opportunity Employer *
AMENDMENT NUMBER FIVE (5)
Agreement Number: P-16-108-R
November 5, 2020
Emocha Mobile Health, Inc.
916 N Charles St., Ste. #200
Baltimore, MD 21201
Contract Number P-16-108-R covering Mobile Health Application is amended as follows:
The County of Fresno hereby accepts your revised Quote Number QT-1322 (Attachment A-1 Revised),
attached.
Maximum: In no event shall services performed and/or fees paid under this Agreement be in excess of
One Hundred Fifty-Eight Thousand Seven Hundred Twenty Dollars ($158,720.00).
Please acknowledge your acceptance by returning all pages of this letter to my office via email.
If you have any questions, please contact Heather Stevens, Purchasing Technician, at (559) 600-7115 or
email heastevens@fresnocountyca.gov.
FOR THE COUNTY OF FRESNO
Gary E. Cornuelle
Purchasing Manager
333 W. Pontiac Way
Clovis, CA 93612
GEC:HS
G:\PUBLIC\CONTRACTS & EXTRACTS\R\P-16-108-R\P-16-108-R AMENDMENT 5.DOCX
CONTRACT NO. P-16-108-R Page 2
Emocha Mobile Health, Inc.
November 5, 2020
G:\PUBLIC\CONTRACTS & EXTRACTS\R\P-16-108-R\P-16-108-R AMENDMENT 5.DOCX
CONTRACTOR TO COMPLETE:
Company:
Type of Entity:
Individual Limited Liability Company
Sole Proprietorship Limited Liability Partnership
Corporation General Partnership
Signature
Print Name and Title Date
Signature
Print Name and Title Date
Address City State Zip
TELEPHONE NUMBER FAX NUMBER E-MAIL ADDRESS
ACCOUNTING USE ONLY
ORG No.: 56201650
Account No.: 7295
Requisition No.: 5622100395
(1/2020)
P-16-108-R Amendment 5
Attachment A-1 (revised)