HomeMy WebLinkAbout20131117.tiffRESOLUTION
RE: APPROVE AMENDMENT #1 TO TASK ORDER CONTRACT FOR STATE TOBACCO
EDUCATION AND PREVENTION PARTNERSHIP GRANT AND AUTHORIZE CHAIR TO
SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with Amendment #1 to Task Order Contract for
the State Tobacco Education and Prevention Partnership Grant between the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Weld County Department of Public Health and Environment, and the Colorado Department of Public
Health and Environment, commencing July 1, 2013, and ending June 30, 2014, with further terms
and conditions being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that Amendment #1 to Task Order Contract for the State Tobacco Education and
Prevention Partnership Grant between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Weld County Department of
Public Health and Environment, and the Colorado Department of Public Health and Environment be,
and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 6th day of May, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
WELD CO A P4 COLORADO
ATTESA
Weld County Clerk to th
BY:
Deputy Clerk to the Bo
APPRO
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Iliam F. Garcia, Chair
Doug h R dema(=1lerP o-Tem
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Sean P. Conway
9 A k -6e -c_
Mike Freeman
rney EXCUSED
Date of signature:
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Barbara Kirkmeyer
tie; heZ
2013-1117
HL0040
Memorandum
TO: William F. Garcia, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment
DATE: April 25, 2013
SUBJECT: A35 State Tobacco Contract
Enclosed for BOCC signature is the A35 State of Colorado tobacco grant contract renewal. This
is the second (2) year of a three (3) year agreement with the Colorado Department of Public
Health and Environment (CDPHE). There are eight (8) deliverables in this grant that were
originally approved by the Board and CDPHE in 2012. The deliverables remain the same, with
some slight variance in the activities to accomplish the deliverables. There are 3.0 FTE positions
supported by this grant. The grant will enable the Weld County Public Health Tobacco Program
to continue its work in youth tobacco prevention and cessation strategies for the county.
The total grant amount is $340,277; and the contract period is July 1, 2013 to June 30, 2014.
CDPHE is requesting to have a signed and returned contract no later than May 17 in order to
maintain continuity of our work and funding.
2013-1117
4.
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD -STEPP
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
14-55697
AMENDMENT FOR TASK ORDERS #1
This Amendment is made this 24TH day of April, 2013, by and between the State of Colorado, acting by and
through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal place
of business is 4300 Cherry Creek Drive South, Denver, Colorado 80246 hereinafter referred to as the "State";
and, BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY (a political subdivision of the state of
Colorado). 915 10th Street. Greeley, Colorado 80632-0758. for the use and benefit of the Weld County
Department of Public Health and Environment, whose address or principal place of business is 1555 17`"
Avenue. Greeley, Colorado 80631, hereinafter referred to as the "Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract, dated January 17, 2012, with contract routing number 13 FAA 00051.
Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated
October 1, 2012 with contract encumbrance number PO FLA PPG1348329, and contract routing number 13 FLA
48� collectively referred to herein as the "Original Task Order Contract, whereby the Contractor was to provide
to the State the following:
To provide tobacco cessation, reduce initiation of tobacco use, decrease tobacco prevalence
among youth and decrease exposure to secondhand smoke.
The State promises to increase the amount of funds to be paid to the Contractor by Three Hundred Forty
Thousand Two Hundred Seventy Seven Dollars (S340.277.00) for the renewal term of twelve (12) months,
ending on June 30, 2014, in exchange for the promise of the Contractor to perform the revised work described
herein.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree
as follows:
1. Consideration for this Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Amendment, and promises and agreements herein set forth.
2. It is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order
Contract, contract routing number 13 FLA 48329, collectively referred to herein as the Original Contract,
which is. by this reference incorporated herein, All terms, conditions, and provisions thereof, unless
specifically modified herein, are to apply to this Amendment as though they were expressly rewritten,
incorporated, and included herein.
3. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified,
altered, and changed in the following respects only:
A. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified
by contract routing number 13 FLA 48329. This Amendment is for the renewal term of July
Page 1 of 5 Rev 3/16/2010
T
2013. through and including June 30. 2014. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Three Hundred Forty
Thousand Two Hundred Seventy Seven Dollars (S340.277.00) for an amended total financial
obligation of the State of FIVE HUNDRED NINETY FIVE THOUSAND FOUR HUNDRED
EIGHTY FIVE DOLLARS $595,485.00). This is an increase of Three Hundred Forty
Thousand Two Hundred Seventy Seven Dollars ($340.27',.00) of the amount payable from the
previous term. The revised Additional Provisions are incorporated herein by this reference and
identified as "Exhibit D". The revised Statement of Work is incorporated herein by this
reference and identified as "Exhibit E". The revised Budget is incorporated herein by this
reference and identified as "Exhibit F".
The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original
Task Order Contract are reaffirmed.
4. The effective date of this Amendment is July 1, 2013, or upon approval of the State Controller, or an
authorized delegate thereof, whichever is later.
5. Except for the Special Provisions and other terms and conditions of the Master Contract and the General
Provisions of the Original Task Order Contract, in the event of any conflict, inconsistency, variance, or
contradiction between the terms and provisions of this Amendment and any of the terms and provisions of
the Original Task Order Contract, the terms and provisions of this Amendment shall in all respects
supersede, govern, and control. The Special Provisions and other terms and conditions of the Master
Contract shall always control over other provisions of the Original Task Order Contract or any subsequent
amendments thereto. The representations in the Special Provisions to the Master Contract concerning the
absence of personal interest of state of Colorado employees and the certifications in the Special Provisions
relating to illegal aliens are presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR
ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGE 1'ED,
AND OTHERWISE MADE AVAILABLE.
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Page 3 of 5 Rev 3/16/2010
IN WITNESS WHEREOF, the parties hereto have executed this Amendment on the day first above written.
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
BOARD OF COUNTY COMMISSIONERS OF
WELD COUNTY (a political subdivision of the
state of Colorado) for the use and benefit of the
Weld County Department of Public Health and
Environment
(A f'
"Signature of Authorized Officfi y 0 6 2013
William F. Garcia
Print Name of Authorized Officer
STATE:
STATE OF COLORADO
John W. Hickenlooper, Governor
Chair, Board of Weld County Commissioners
Print Title of Authorized Officer
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
PROGRAM APPROVAL:
By:
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until
signed and dated below by the State Controller or delegate. Contractor is not authorized to begin
performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not
obligated to pay Contractor for such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER
David J. McDermott, CPA
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ao/3-//l7
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Page 5 of 5 Rev 3/16/2010
EXHIBIT ➢
ADDITIONAL PROVISIONS
To Task Order Dated 10/1/2012 — Contract Routing Number 13 FLA 48329 — Contract Amendment Routing
Number 14 FLA 55697
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
1. The list of acronyms attached hereto as Attachment O-1 may be referenced to in Exhibit D, Exhibit E,
and all and any attachments thereof in this Task Order Contact.
This Task Order Contract contains state funds
To receive compensation under this Task Order Contract, the Contractor shall submit a signed monthly
CDPHT Reimbursement Invoice Form. This form is accessible from the CDPHE interact website
hitp://www.colorado.eov/cs/Satellite/CDPHE-Main/CBON/1251622941228 and is incorporated herein by
reference. CDPHE will provide technical assistance in accessing and completing the form. The CDPHE
Reimbursement Invoice Form must be submitted within sixty (60) calendar days of the end of the billing
period for which services were rendered. Expenditures shall be in accordance with the Statement of Work
attached hereto as Exhibit E and incorporated herein and the associated Budget attached hereto as Exhibit
F and incorporated herein. All other expenditures shall not be reimbursed without prior written consent of
the State. All expenditures must be reasonable and necessary for the performance of this Contract, and
must comply with The State of Colorado, specifically the Colorado Department of Public Health and
Environment, fiscal guidelines and rules.
Submit completed CDPHE Reimbursement Invoice Form to:
Colorado Department of Public Health and Environment
Tobacco Program Generalist
PSD - STEPP - A5
4300 Cherry Creek Drive South
Denver, CO 80246
To be considered for payment, billings for payments pursuant to this Task Order Contract must be received
within a reasonable time after the period for which payment is requested, but in no event no later than sixty
(60) calendar days after the relevant performance period has passed. Final billings under this Task Order
Contract must be received by the State within a reasonable time after the expiration or termination of this
Task Order Contract; but in no event no later than sixty (60) calendar days from the effective expiration or
termination date of this Task Order Contract.
Unless otherwise provided for in this Task Order Contract, "Local Match", if any, shall be included on all
invoices as required by funding source.
The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless
approved in writing by CDPHE.
4. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty (30) calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables
that have a different time negotiated by the State and the Contractor.
To be attached to CDPHE
Task Order v1.0 (3/12) contract template
Page 1 of 3 Revised: 12/19/06
EXHIBIT D
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable, or is otherwise deficient, then the State shall notify
the Contractor of the failure or deficiencies, in writing, within thirty (30) calendar days of: 1) the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable, the Contractor shall have a reasonable period of time, not to exceed ten (10) calendar
days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies within
ten (10) calendar days, the Contractor shall be in default of its obligations under this Task Order
Contract and the State, at its option, may elect to terminate this Task Order Contract or the Master
Contract and all Task Order Contracts entered into pursuant to the Master Contract.
5. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination.
The State has determined that this Task Order Contract does not constitute a Business Associate
relationship under HIPAA
6. Contractor shall request prior approval in writing from the State for all modifications to the Statement of
Work/Work Plan or for any modification to the direct costs in excess of twenty-five percent (25%) of the
total budget for direct costs. Any request for modifications to the Budget in excess of twenty-five percent
(25%) of the total budget for direct costs or $250,000.00, whichever is less, shall be submitted to the State
at least 90 days prior to the end of the contract period and may require an amendment in accordance with
Section 5 of this Task Order Contract.
7. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in
Data, Documents and Computer Software or Other Intellectual Property, unless otherwise provided for, all
data collected or produced or derived exclusively from the Contractor's or subcontractor's work under this
Task Order Contract shall remain the sole property of the State, whether in individual, aggregate, identified
or de -identified form or any other form required by the State. To facilitate follow-up, research, surveillance
and evaluation, any such data collected, used or acquired shall be made available in any form required by
the State, to the State and any other entity designated by the State.
Any such data collected, used or acquired shall be used solely for the purposes of this Task Order Contract.
The Contractor and its subcontractors agree not to release, divulge,publish, transfer, sell, or otherwise
make known any such data to unauthorized persons without the express prior written consent of the State or
as otherwise required by law. This includes a prior written request by the Contractor to the State for
submission of abstracts or reports to conferences, which utilize data collected under this Task Order
Contract.
Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or
work papers necessary to perform its duties under this Task Order Contract and in accordance with
professional standards.
S. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in
Data, Documents and Computer Software or Other Intellectual Property, or Section 231, General
Provisions, Media or Public Announcements, the State of Colorado, specifically the Department of Public
Health and Environment, shall be the owner of all printed materials, graphic representations, educational
materials, audio-visual products, or any other media, in whatever form, created under this Task Order
Contract. This requirement applies, but is not limited to, any brochure, flyer, presentation, billboard, radio
To be attached to CDPHE
Task Order v1.0 (3/12) contract template
Page 2 of 3 Revised: 12/19/06
,
EXEIIBIT D
spot, website, banner advertisement. The State reserves the right to require logos, or other wording on any
material, representation, product or other media form created under this Task Order Contract.
Any material, representation, product or other media form that will use the State's or logo orinformation
must be approved by the State prior to production and distribution. A minimum of ten (10). business days is
required for the review and approval process.
9. Funds provided under this Task Order Contract may not be used to: supplant funding for any existing
programs/models; develop new cessation programs/models; develop curricula for youth or adults not
reviewed and approved by the State pay for individual cessation aids or nicotine replacement therapy; fund
capital improvements; or fund costs of enforcement of state or local laws and ordinances.
10. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 25,
Conformance with Law, the Contractor shall comply with the provisions of Section 601 of Title VI of the
Civil Rights Act of 1964, as amended, which states that "no person in the United States shall on the
grounds of race, color or national origin, be excluded from participation in, be denied the benefits of, or be
subjected to discrimination under any program actively receiving Federal financial assistance." The Office
for Civil Rights has established that it is the responsibility of any program that is a recipient of federal
funds to ensure that any Limited English Proficient (LEP) person or beneficiary have meaningful access to
programs, services and information. The Contractor and contract personnel shall adopt and implemeht
policies and procedures in which reasonable steps are taken to provide language assistance in order to
ensure equal access to LEP persons or beneficiaries. The Contractor and contract personnel shall advise
LEP individuals that language assistance will be provided at no cost to the LEP person or beneficiary.
11. The Contractor affirms that it maintains no affiliations or contractual relationships, direct or indirect, with
tobacco companies, owners, affiliate, subsidiaries, holding companies or companies involved in any way in
the production, processing, distribution, promotion, sales, or use of tobacco.
12. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be
the owner of all equipment as defined by Federal Accounting Standards Advisory Board (FASAB)
Generally Accepted Accounting Principles (GAAP) purchased under this Task Order Contract. At the end
of the term of this Task Order Contract, the State shall approve the disposition of all equipment.
13. The Contractor shall not use funds provided under this Task Order Contract for the purpose of lobbying as
defined in Colorado Revised Statutes (C.R. S.) 24-6-301(3.5)(a).
14. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding
Letter substantially equivalent to Attachment D-2. The Grant Funding Change Letter is not valid until it
has been approved by the State Controller or designee.
To be attached to CDPI-IE
Task Order v1.0 (3/12) contract template
Page 3 of 3 Revised: 12/19/06
ATTACHMENT D-1
Commonly Used Acronyms and Abbreviations That May Be Referenced In the Scope of Work:
ACS - American Cancer Society
ACNS Alamosa County Nursing Service
ACF Administration for Children and Families
ADA Americans with Disabilities Act
ADAD Alcohol and Drug Abuse Division
AHA American Heart Association
AIDS Acquired Immune Deficiency Syndrome
ALA American Lung Association
ALA(C) American Lung Association (of Colorado)
AMCHP Association of Maternal Child Health Programs
ANA Americans for Non -Smokers' Rights
ARC Addiction Recovery Centers
ARRA American Recovery and Reinvestment Act
ASC Adams State College
ASSIST American Stop Smoking Intervention Study
ASTHO Association of State and Territorial Health Office
B&G Boys & Girls
BACCHUS BACCHUS Peer Education Network
BAG Build a Generation
BBLHC Boulder Broomfield Latino Health Coalition
BC Boulder County
BCCP Breast and Cervical Cancer Program
BCHD Bent County Health Dept
BCPH Boulder County Public Health
BCPFLA Baca County Public Health Agency
BCDSS Baca County Dept Social Services
BCTEPP Bent County Tobacco Education Prevention Partnership
BGC Boys & Girls Club
BGCMD Boys & Girls of Metro Denver
BHS Broomfield High School
BMTF Baby & Me Tobacco Free
BOLES Board of Cooperative Educational Services
BOH Board of Health •
BRFSS Behavioral Risk Factor Surveillance System
BVBAG Buena Vista Build a Generation
BVSD Boulder Valley School District
Bx Biopsy
C Choice
CAD Coronary Artery Disease
CASB Colorado Association of School Board
CB Community -based System
CBE Clinical Breast Exam
CBO Community -based Organization
CC Clear. Creek
CC Custer County •
CC Community Coordination/Coordinator
CCAP Larimer County Child Care Assistance Program
CCC Colorado Cancer Coalition
CCCHE Colorado Community Coalition for health Equity
CCGC Colorado Clinical Guidelines Collaborative
CCIAA Colorado Clean Indoor Air Act
CCMC Colorado Clinical Managed Care Network
CCMC Commission for Case Manager Certification
CCPD Cancer, Cardiovascular, and Pulmonary Disease
Page 1 of 6
ATTACHMENT D-1
CCTCI Colorado Chew Tobacco Collaborative Initiative
CCTEPP Custer County Tobacco Education Prevention Partnership
CDC Centers for Disease Control and Prevention
CDE Colorado Department of Education
CDPHE Colorado Department of Public Health and Environment
CDU Chronic Disease Unit
CEC Career Education Center
CEO Chief Executive Officer
CFDA Catalog of Federal Domestic Assistance
CFTC Colorado Foundation for Families and Children
CFPI Colorado Family Planning Initiative
CHIN Community Health Information Network
CICP Colorado Indigent Care Program
CID Colorado Judicial Department
CM Case Management
CMC Colorado Mountain College
CMS Contract Management System
CMS Creative Media Solutions
CNCC Colorado Northwestern Community College
CNS County Nursing Service
CO Colorado
COD Colorado Donated Dental Services Program
COPAN Colorado Physical Activity and Nutrition Program
COV Colorado Van Program
CPCF Colorado Parent and Child Foundation
CPHA Colorado Public Health Association
CPT Current Procedural Technology
CRC Colorectal Cancer
CRCCP Colorectal Cancer Screening Program
CRUE Culturally Responsive Urban Education
CSAP Colorado Student Assessment Program
CSH Coordinated School Health
CSU Colorado State University
CSU-P Colorado State University -Pueblo's
CTC Connect to Care
CTEPA Colorado Tobacco Education and Prevention Alliance
CTFK Campaign for Tobacco -Free Kids
CTRP Colorado Tobacco Research Program
CTP Crossroads Turning Point
CU University of Colorado, Boulder
CWCCI Colorado Women's Cancer Control Initiative
CY Contract Year
DAISI Denver At-home Intervention Service initiative
DASH Division of Adolescent & School Health (CDC)
DCMH Delta County Memorial Hospital
DH Denver Health
DHHA Denver Health and Hospital Authority
DHS Department of Human Services
DHHS Unites States Department of Health and Human Services
DOR Department of Revenue
DOS Delta Opportunity School
BSS Department of Social Services
E&I Education and Information
EAP Employee Assistance Program
EBHV Evidence -Based Home Visiting to Prevent Child Maltreatment Grant Program
ECC Early childhood council
ECC Electrocardiogram
ECCLC Early Childhood Council of Larimer County
Page 2 of 6
ATTACHMENT D-1
ECLC Early Childhood Leadership Council/Commission
E.D. Executive Director
ERR Electronic Health Record
EHS Early Head Start
EMR Electronic Medical Record
EMT Emergency Medical Technicians
EPA Environmental Protection Agency
EPE Epidemiology Planning and Evaluation
ESL English as a Second Language
ETS Environmental Tobacco Smoke (a.k.a. secondhand smoke)
FIRC Family and Intercultural Resource Center
FICA The Federal Insurance Contribution Act
FDA Food and Drug Administration
FIT/FOBT Fecal Immunochemical Test/Fecal Occult Blood Test
FNA Final Needle Aspiration
FPP Family Planning Program
FPL Federal Poverty Level
FRCC Front Range Community College
FTE Full Time Equivalent
FTP File Transfer Protocol
FY Fiscal Year
FYI Family Youth Initiatives
GASO Great American Smoke -out
GED General Education Development
GASP CO Group to Alleviate Smoking Pollution of Colorado
Get REAL (GR) Resist! Expose Advertising Lies (Youth Empowerment Program)
GLBT Gay, Lesbian, Bisexual, and Transgender
GYN Gynecological
HCP Health Care Program For Children with Special Needs
HCYS - Huerfano County Youth Services
HHS Health and Human Services
HIPPA Health Insurance Portability and Accountability Act of 1996
HIPPY Home Instruction for Parents of Preschool Youngster
HIT Health Improvement Team
HIV Human Immunodeficiency Virus
HPV Human Papillomamavirus
HR Human Resources
hr hour
HRSA Health Resources and Services Administration
HSL • High School Leadership
ID Identification
IIK Invest in Kids
ISHT Interagency School Health Team
IT Information Technology
JAC Juvenile, Assessment Center
KIS Keeping in STEPP
KMH Keefe Memorial Hospital
KPC Kevin Patrick Caleum
LAHCDHD Las Animas Huerfano Counties District Health Department
LBW Low Birth Weight
LC Learning Community
LGBT Lesbian, Gay, Bisexual, Transgender
LEM Latins en Movimiento
LHA Local Health Agency
LHD Local Health Department
LLC Limited Liability Company
LRCC Latino Regional Community Coalition
LRPC Latino a Research and Policy Center
Page 3 of 6
ATTACHMENT D-1
LST Life Skills Training
LSTPEN Latino Statewide Tobacco Prevention and Education Netw
LWB Live Well Broomfield
MCHA Montezuma Housing Authority
MCHD Montezuma County Health Department
MCHS Montezuma -Cortez High School
MCPN Metro Community Provider Network
MCRC Media Campaign Resource Center — CDC
MD Medical Doctor
MHCBBC Mental Health Center Serving Boulder and Broomfield Counties
MIECHV Maternal, Infant and Early Childhood Home Visiting Program
MO Month
MOB Medical Office Building .
MOU Memorandum of Understanding
MPA Master of Public Administration in Health and Human Services
MPH Master of Public Health
MRI Magnetic Resonance Imaging Scan
MS Master of Science
MSA Master Settlement Agreement
MUH Multi-user Housing
MYAT Multi -Disciplinary Youth Assessment Team
N/A Not Applicable
NACCHO National Association of County and City Health Officials
NACR Native American Cancer Research
NAQC North American Quitline Consortium
NASBE National Association of State Board of Education
NCCRT National Colorectal Cancer Round Table
NCHD Northeast Colorado Health Department
NO National Cancer Institute
NE .North East
NFP Nurse -Family Partnership
NFPNSO Nurse -Family Partnership National Service Office
NHVP Nurse Home Visitor Program
NIDA National Institute on Drug Abuse
NIH National Institute of Health
NJH National Jewish Medical and Research Center
N -O -T Not -on -Tobacco, (ALA's Youth Smoking Cessation Program)
NP Nurse Practitioner
NPP Nurturing Parenting Program
NRT Nicotine Replacement Therapy
NSBA National School Boards Association
OSH Office on Smoking or Health (CDC)
OTC Over the Counter
PA Physician's Assistant
PAC Prevention Awareness Crew
PACT Partners Assessing Chew Tobacco
PAT Parents as Teachers
PCCHD Pueblo City -County Health Department
PPC Personal Care Providers
PE Presumptive Eligibility
PEN Parent Engagement Network
PVCHC Peak Vista Community Health Center
PHN Public Health Nurse
PIO Public Information Officer
PM Peer Mentor
PMC Parkview Medical Center
PMR Planning Management Region
PN Patient Navigator
Page 4 of 6
ATTACHMENT D-1
PO Purchase Order
PPC Policy Partner Committee
PPFC Pikes Peak Family Connections
PPN Prevention Policy Network
PRA Policy Resource Alliance
PRAMS Pregnancy Risk Assessment and Monitoring Survey
PRIDE Pure Respect Initiative Direct Education
PSA Public Service Announcement
PSD Prevention Service Division
PTEPP Pueblo Tobacco Education and Prevention Partnership
PVC Prairie View Clinic
Ql Quarter One
Q2 Quarter Two
Q3 Quarter Three
Q4 Quarter Four
QI Quality Improvement
QOL Quality of Life
RDAC Regional Disparities Advisory Council
RFA Request for Applications
RFP Request For Proposals
RIE Reach, Implementation and Effectiveness
RIHEL Regional Institute for Health and Environment
RMC Rocky Mountain Center for Health Promotion & Education
RMRI-I Rocky Mountain Rural Health
RMYC Rocky Mountain Youth Corps
RN Registered Nurse
Rx Prescription
RY Reconnecting Youth
SafeCare
SAMHSA Substance Abuse Mental Health Services Administration
SB School -based System
SBAG Salida Build A Generation
SBHC School -Based Health Centers
SCYC School Community Youth Coalition
SCRHC Southern Colorado Regional Health Collaborative
SD Service Delivery
SECH Southeast Colorado Hospital
SEMHS Southeast Mental Health Services
SES Socio-Economic Status
SEW School Employee Wellness
SGR Surgeon General's Report
SHAG Smoke -free Housing Action Committee
SRI School Health Index
SHS Secondhand Smoke
SIDS Sudden Infant Death Syndrome
SLV San Luis Valley
SMART Staying Motivated at Reducing Temptations
SMART OUTCOME OBJECTIVE Specific, Measurable, Achievable, Realistic, Time -Bound
SMSU Self Management Service Unit
SRO School Resource Officer
STD Sexually Transmitted Disease
STEPP State Tobacco Education and Prevention Partnership
STW Straight -to -Work
SVVSD St. Vrain Valley School District
SWOT Strengths, Weaknesses, Opportunities, Threats
SYNAR Synar Regulation
TA Technical Assistance
TABS Tobacco Attitudes and Behavior Survey
Page 5 of 6
ATTACHMENT D-1
TAG Technical Advisory Group (for evaluation & TPEG)
TANF Temporary Aid to Needy Families
TARP Tobacco Advocacy and Resource Partnership
TBD To Be Determine
TCP Tobacco Control Partners
TDAC Tobacco Disparities Advisory Council
TDG Tobacco Disparities Grant
TDS . Tobacco Disparities Subcommittee
TEACH Teaching Equity to Advance Community Health
TEFAP The Emergency Food Assistance Prom=
TEPCGP Tobacco Education Prevention and Cessation Grant Program
TEPP Tobacco Education Prevention Partnership
TFCCI Tobacco -Free Colorado Communities Initiative
TFLC Tobacco Free Latimer County
TFS Tobacco -Free Schools
TFS Law Tobacco -Free Schools Law
TOYS Tony Grampsas Youth Services
Title V Title V of the Social Security Act
TND Project Toward No Drug Abuse
'MEG Tobacco Program Evaluation Group
TPI Tobacco Prevention Initiative
TRC Tobacco Education and Prevention and Cessation Program Review Committee
TRI Tobacco Rapid Improvement Activity
TRIA Tobacco Rapid Improvement Assessment
TTI Tony Grampsas Tobacco Initiative
UCD University of Colorado — Denver
UCDHSC Health Sciences Center at UCD (sometimes abr. UCHSC)
UCDHSC University of Colorado at Denver and Health Sciences Center
UAL Uniform Resource Locator
US United States of America
USSTC US Smokeless Tobacco Company
VP Vice President
Well COA Wellness Councils of America
WHU Women's Health Unit
WIC Women, Infants, Children
WWC Women's Wellness Connection
Y@C Youth at Crossroads
YE Youth Empowerment
YPH Youth Partnership for Health
Yr Year
YRBS Youth Risk Behavior Survey
YSAP Youth Substance Abuse Prevention Coalition
YTS Youth Tobacco Survey
YVMC Yampa Valley Medical Center
5 A's Ask, Advise, Assess, Assist, Arrange
2A's R Ask, Advise, Refer
Page 6 of 6
s
ATTACHMENT D-2
GRANT FUNDING CHANGE LETTER
Date:
State Fiscal Year:
TO: Insert Grantee's name
Grant Funding Change Letter #
CMS Routing #
In accordance with Section of the Original Contract routing number , [insert the following
language here if previous amendment(s), renewal(s) have been processed] as amended by [include all
previous amendment(s), renewal(s) and their routing numbers], [insert the following word here if
previous amendment(s), renewal(s) have been processed] between the State of Colorado, Department
of Public Health and Environment and Contractor's Name beginning Insert start date <insert start date of
original contract> and ending on Insert ending date <insert ending date of current contract amendment>,
the undersigned commits the following funds to the Grant:
The amount of grant funds available and specified in Section of <insert contract amendment
number and routing number> is ❑ increased or ❑ decreased by $amount of change to a new total
funds available of $ <insert new cumulative total> for the following reason: . Section
is hereby modified accordingly.
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or , whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
PROGRAM APPROVAL:
By:
By: Lisa McGovern, Purchasing & Contracts Unit Director
Date:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Grants. This Grant is not valid until signed and dated below by
the State Controller or delegate. Grantee is not authorized to begin performance until such time. If Grantee begins performing prior
thereto, the State of Colorado is not obligated to pay Grantee for such performance or for any goods and/or services provided
hereunder.
STATE CONTROLLER
David J. McDermott, CPA
By:
Date:
Page 1 of 1
Effective Date: 1/6/09 -Rev 8/25/09
1
EXHIBIT E
Project Description:
Deliverable 1: By June 30 2014, calls by Weld County residents to the Colorado Quitline cessation services will increase by 5% of baseline
Target Population: Clients and employees of targeted organizations; Clients from private and community health clinics (e.g. Salud Ft. Lupton, North Colorado Family
Medicine and Family Physicians of Greeley), approximately 20,000 individuals, in addition to the approximately 7,500 potential individuals served by Sunrise Community
Health Center, North Range Behavioral Health, etc.
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Deadline
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Measurement
Number of clients tracked by Quitline
referral question; number of individuals
referred and attending community classes
and presentations by age group, number of
providers attending educational events.
Number of individuals who received.
QuitLine services by 6/30/2014.
Quarters of
activity
Activity
Activity 1.1: Expand the assessment of current provider reminder
system for cessation and determine needed improvements to
ensure effective evidence -based system toinclude three additional
community health clinics.
EXHIBIT E
WCDPHE
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WCDPHE
-1
Start:
7/1/2013
End:
6/30/20I4
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Start:
7/1/2013
End:
6/30/2014
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Number of providers attending 5As
presentations and educational events.
Number of individuals who received
training.
Number of providers/supervisors contacted
after'5As presentations and educational
events, and training.
Number of classes scheduled at each
location.
Number of clients referred and attending
community classes by age group.
Participants need to attend at minimum
75% of the course to be considered
completed.
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Activity 1.2: Conduct education for at least 20 providers per
quarter on the importance of the 5A's for increasing cessation
attempts, referring to the Quitline and in-house cessation
opportunities. This will be conducted through meeting with the
providers individually and/or setting up staff training events at the
facility depending on the needs of the clinic and/or provider.
Activity 1.3: Provide technical assistance regarding the 5As
training to three community health clinics by meeting with
supervisor or clinic managing staff to see how the implementation
of the training is going with the trained individuals. Staff will
continue to follow up with and provide technical assistance to'
Sunrise Community Health Center, North Range Behavioral
Health and WCDPHE.
Activity 1.4: Work with community health clinics to coordinate
class locations and times. Each community clinic will actively
promote cessation classes and assist in recruiting via provider
referrals.
Activity 1.5: Conduct at least two supplemental community -based
tobacco cessation classes per quarter to at least 5 participants
using an evidence -based curriculum (e.g. American Cancer
Society's Freshstart or American Lung Association's Freedom
From Smoking) to clients and employees recruited from three
identified health clinics in addition to Sunrise Community Health
Center, North Range Behavioral Health and WCDPHE.
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Deliverable 2: By June 30 2014, at least 2 targeted Weld County organizations serving priority populations will assess, develop, strengthen, and expand their policies to
protect their clients and consumers from secondhand smoke exposure.
Target Population: Clients and employees of targeted organizations; Clients from private and community health clinics (e.g. Salud Ft. Lupton, North Colorado Family
Medicine and Family Physicians of Greeley), approx 20,000 individuals; approx 300 residents at Section 8 Housing (e.g. Stage Coach Apts and Meeker Commons)
Responsible
Agency
U
WCDPHE
WCDPHE
3
WCDPHE
WCDPHE
�
U
Deadline
Start:
7/1/2013
End:
12/31/2013
Start:
01/01/2014
End:
03/31/2014
Start:
10/1/2013
End:
6/30/2014
Start:
10/1/2013
End:
3/31/2014
Start:
4/1/2014
End:
6/30/2014
Start:
4/1/2014
End:
6/30/2014
Start:
4/1/2014
End:
6/30/2014
Measurement
Organizational participant counts; copies 1
of old policies compared with model
language and new policies.
Participant count data; and informal
surveys taken and analyzed
•
Organizational participant count data;
copies of policies and meetings conducted.
Organizational participant count data;
copies of policies, and surveys taken and
analyzed.
Organizational participant count data;
copies of policies, meetings conducted,
proposed policy.
Organizational participant count data;
copies of policies passed, meetings
conducted, educational campaign
developed.
Organizational participant count data;
Number of technical assistance requests.
Quarters of
activity
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Activity 2.1: Assess tobacco -free policies of 3 community health
clinics and two Section 8 housing units. This expands work from
Year 1 which assessed the policies at Sunrise Community Health
Center, North Range Behavioral Health and WCDPHE.
Activity 2.2: Host a landlord forum to discuss SI-IS and marijuana
issues and educating property owners and managers about
secondhand smoke policies in multi -unit housing.
Activity 2.3: Establish work group and identify champions by
meeting at least quarterly with organizations identified in activity
I (above).
Activity 2.4: Conduct a survey of staff and clients at each
organization to assess smoke -free policies. Present data along with
best -practice guidelines to work group and decision makers.
Activity 2.5: Write model policies utilizing survey data, best
practice model language and feedback from decision makers.
Activity 2.6: Develop an individualized educational campaign that
will promote a tobacco free campus and educate the leadership,
employees and clients on the importance of policy change.
Activity 2.7: Provide technical assistance and materials to those
advancing and implementing their tobacco policy.
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Deliverable 3: By June 30 2014, increase community support by mobilizing at least 2 young adult communities to promote tobacco -free behaviors with their populations.
Target Population: Low SES young adults 18-24 years (2012 DOLA Census population estimate for 18 — 24 yrs Weld residents = 29,347); UNC has approximately 10,000
undergraduate students (90% in -state; 85% < 25 years old; 20% Weld County residents); AIMS Greeley has 5,200 students (3,800 are less than 30 years of age).
Responsible
Agency
a
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WCDPHE
P�
WCDPHE
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Start:
07/01/2013
End:
12/31/2013
Start:
07/01/2013
End:
06/30/2014
Start:
07/01/2013
End:
06/30/2014
Measurement
Count and demographic make-up of young
adult coalition members and outreach
activities; program documents including
coalition and related meeting sign -in sheets,
meeting minutes, copies of surveys,
checklists, presentations, focus/forum group
materials, website hits.
Count and demographic make-up of coalition
members and outreach activities; meetings
conducted, tactics decided.
Count and demographic make-up of
members and outreach activities.
Meetings conducted, monitoring efforts
conducted, checklists, focus group and
survey results
Count and demographic make-up of
members and outreach activities; meetings
conducted
Quarters of
activity
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N
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N
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Activity 3.1: Expand adult Tobacco -Free Coalition of Weld County
by recruiting at least 6 new members who represent the 18-24 year
old population through outreach and awareness at identified
organizations, schools and regions. Recruitment at Aims Greeley,
UNC Greeley, Aims Fort Lupton, AIMS Automotive & Technology
Center Windsor, IBMC, Cheeks Beauty School, and other high -
density, high risk young adult locations.
Activity 3.2: Expand membership of existing young -adult task
group to include at least 6 new members .
•
Activity 3.3: Young adult task group will monitor tobacco industry
advertising tactics near their campuses stores, employment or social
settings; monitoring will be via in-store checklists or photographic
audits of advertising/promotions by young adult coalition
participants.
Activity 3.4: Counter tobacco industry marketing tactics with the
Young Adult Task group and educate their campuses through
earned and paid media (i.e. writing articles in the local newspaper,
appearing on the local cable news channel, radio appearances, print
advertising, etc).
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EXHIBIT E
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Deliverable 4: By June 30 2014, at least two Weld County college campus partners will promote, implement, or expand tobacco -free college campus policies.
Target Population: Low SES young adults 18-24 years (2012 DOLA Census population estimate for 18 —24 yrs Weld residents = 29,347); UNC has approximately 10,000
undergraduate students (90% in -state; 85% < 25 years old; 20% Weld County residents); AIMS Greeley has 5,200 students (3,800 are less than 30 years)
Responsible
Agency
R.
Q
U
WCDPHE
WCDPFIE
WCDPHE
WCDPHE
Deadline
M_
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O 0
N N
R+l7 Om
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-45 V O
M O WO
Start:
07/01/2013
End:
06/30/2014
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Start:
04/01/2014
End:
06/30/2014
Measurement
Work with approximately 5-10 people at
each campus to measure affect and reach;
comparision of old and new policies;
meeting notes.
Organizational participant count data; copies
of policies; meetings conducted.
•
•
Organizational participant count data; copies
of policies; meetings conducted, surveys
taken and analyzed.
Copies of policies; meetings conducted,
proposed policy.
Copies of policies; meetings conducted,
educational campaign developed.
Quarters of
activity
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Activity 4.1: Identify and assess current tobacco -free policies at at
least one new young adult worksite and/or non-traditional
educational service center (UNC, Aims Campuses (Greeley, Ft.
Lupton, Windsor).
Activity 4.2: Maintain FY12/13 work groups at each identified
campus and create appropriate plans to advance tobacco -free policy
changes at respective campuses, integrating BACCHUS curriculum
(i.e. STEP By STEP).
Activity 4.3: Conduct a survey at FY13/14 targeted worksites
and/or campuses to assess opposition and potential challenges to
implementing a tobacco -free campus policy. Present this data along
with best -practice guidelines for tobacco free campus to the work
group and decision makers.
Activity 4.4: Utilizing survey data, best practice model language
and feedback from decision makers, determine and write an
evidenced -based policy for each FY12/13 targeted organization.
Activity 4.5: Develop an individualized educational campaign that
will promote a tobacco -free campus and educate campus leadership,
staff, faculty and students on the importance of a policy change
using BACCHUS material.
J
EXHIBIT E
Deliverable 5: By June 30 2014, increase community support by mobilizing at least 8 Weld County youth to sustain a youth alliance aimed at monitoring, reducing and
countering tobacco industry marketing practices in targeted areas.
Target Population: Approximately 9,000 middle and high school students in -the highest risk middle and high schools (i.e.>50% free and reduced lunch population).
Responsible
Agency
WCDPHE
WCDPHE and
Youth
Coalition
WCDPHE and
Youth
Coalition
7WCDPHE
WCDPHE and
Youth
v
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Start:
07/01/2013
End:
12/31/2013
Start:
01/01/2014
End:.
06/30/2014
Start:
04/01/2014
End:
06/30/2014
Start:
07/01/2013
End:
09/30/2013
Start:
10/01/2013
Measurement ' .
Number of students attending meetings.
Middle and high school tobacco use rates
will be monitored annually;
Sign -in sheet at coalition meetings, counts
and descriptions of youth events/activities;
copies of youth products such as
resentations, flyers, articles, web media.
Number of youth involved in project, youth
exposed to final presenation; neighborhoods
visisted, number of stores visited (goal is 11).
Reports with recommendations'for
improvement.
Number of youth involved in project, youth
exposed to final presenation; neighborhoods
visisted, number of stores visited (goal is 11).
Number of CHIP members exposed to final
presentation.
Reports with recommendations for
improvement.
Documentaton of materials created.
Number of retailers receiving packets.
Documentation of repsonse to materials.
Number of students attendingefforts.
Middle and high school tobacco use rates
Quarters of
activity
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Activity 5.1: Building on the exisiting FY12/13 youth task force,
initiate system integration efforts by partnering with at least two
groups/agencies that serve disparately affected youth to incorporate
youth -driven tobacco prevention activites within each organizaion.
At least one formal Youth Task Force meeting will occur every
month (12 formal meetings total).
Activity 5.2: In conjunction with the youth task force, conduct
community/store audits and environmental scans as part of a
"Healthy Corner Store" initiative, documenting tobacco industry
marketing tactics within in their communities and expand work to
include at least one rural Weld County community.•
Activity 5.3: Youth will conduct at least one formal presentation to
share findings of the retail environment assessments withithe •
Community Health Improvement Plan (CHIP) project in Weld (e.g.
CHIP -based healthy corner store initiative).
•
Activity 5.4: Prepare and distribute letters to at least 100 retailers in
Weld County including information about current requirements for
tobacco sales.
Activity 5.5: Educate and increase awareness and knowledge of
store employees, store managers and store owners about laws and
O
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WCDPHE and
Youth
Coalition
WCDPHE
Youth
Coalition
TFCWC
End:
03/31/2014
Start:
10/01/2013
End:
06/30/2014
Start:
07/0I/2013
End:
06/30/2014
will be monitored annually;
Sign -in sheet at coalition meetings, counts
and descriptions of youth events/activities;
copies of youth products such as
presentations, flyers, articles, web media.
Documentation of materials created. Number
of school districts were outreach is
conducted.
# of individuals reached, # of presentations
Documentation of materials created. Number
of placements. Number of impressions.
Documetnataion of community response.
cn
Activity 5.7: Develop a youth -focused spit tobacco prevention 1,2,3,4
awareness campaign using earned and paid media; primary
locations are school newspapers, billboards,youth social media.
the importance of preventing tobacco product sales to anyone under
the age of 18 by implementing the Oregon Office of Mental Health
and Addiction Services Tobacco Merchant Education checklist.
Locations include gas stations, grocery stores, pharmacies, and any
tobacco retail outlets within 2 miles of high schools that have open
campus policies. Meet with at least 3 store owners per quarter.
Activity 5.6: Educate (i.e. conduct presentations, create educational —
materials, etc) school districts (i.e. administration, faculty, staff,
Parent Teacher Associations, etc.) on the prevalence of tobacco use
at the local level (FY12/13 target Districts: Greeley/Evans District 6
& Ft. Lupton and expanding the work to include at least one rural
Weld County school district).
Deliverable 6: By June 30 2014, at least two lower SES (i.e., > 50% free/reduced lunch) school districts in Weld County will promote, implement, or expand tobacco -free
school policies and/or evidence -based or innovative alternatives to suspension programs.
Target Population: All Weld County School Districts (Fall 2011 total K-12 enrollment count equals 37,243)•
•
Responsible
Agency
WCDPHE and RMC
•
W CDFHE and
Youth Coalition
WCDPHE and AMC
WCDPHE and RMC
Deadline
Start:
07/01/2013
End:
06/30/2014
Start:
07/01/2013
End:
06/30/2014
Start:
07/01/2013
End:
06/30/2014
Start:
01/01/2014
End:
06/30/2014
a.
C.
CV
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Enrollment for two school districts; copies of
old and new policies and curricula.
Number of students attending the Weld
County Middle and High Schools in which
youth coalition focuses their efforts.
School campus policies will be reviewed and
compared against best practices.
Meetings with school district leadership;
policy assessments made, meetings notes
with school district leaders.
Meetings with school district leadership;
policy assessments made, meetings notes
with school district leaders.
Quarters of
activity
N
P.
er
N
ri
N
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Activity 6.1: Conduct Tobacco Free School policy assessments
within FY12/13 targeted school districts and expand tobacco
free policy assessments to include at least one rural Weld
County school district (Greeley/Evans District 6 and Ft.
Lupton).
Activity 6.2: Identify gaps in campus policy (using the RMC
Tobacco Free Schools Law Checklist) and the quality of current
tobacco prevention/cessation activities within targeted FY12/13
school districts and expand work to include at least one rural
Weld County school district.
Activity 6.3: In addition to determining strategies to strengthen
enforcement of Tobacco Free School policies within FY12/13
targeted schools, expand this work to include at least one Weld
County rural school district.
Activity 6.4: Meet with school officials and school
administrators to determine enforcement priorities to strengthen
policies and identify and implement creative solutions (for
example smoker's corner issues or alternatives to suspension
programs).
r
ara
H
W CDPHE and RMC
WCDPHE
0.
Q
U
Start:
07/01/2013
End:
06/30/2014
Start:
07/01/2013
End:
06/30/2014
Start:
10/01/2013
End:
03/31/2014
Meetings with school district leadership;
policy assessments made, meetings notes
with school district leaders.
Meetings with school district leadership;
policy assessments made, meetings notes
with school district leaders.
Meetings with school district leadership; policy assessments made, meetings notes
with school district leaders.
N
N
.--
cn
N
cn
N
Activity 6.5: Maintain support and technical assistance with
both FY12/13 and FY13/14 identified schools to assist with
stronger enforcement of Tobacco Free School policies.
Activity 6.6: Incorporate tobacco prevention and cessation
messages into targeted schools districts, including placement of
resources guides and promotion of/education about tobacco -free
policy as part of a larger cessation initiative.
Activity 6.7: Work with targeted FY13/14 school districts to
find staff to be trained to conduct evidence -based youth
cessation resource options (i.e. Not -On -Tobacco (NOT)
program, smokeless tobacco prevention resources, etc.) in an
effort to extend cessation opportunities for youth in Weld
County. Present cessation resource option in at least 2 schools
per quarter.
Deliverable 7: By June 30 2014, Tobacco -Free Coalition of Weld County (TFCWC) and WCDPHE will increase community awareness about evidence -based tobacco pricing
strategies by working with at least 2-4 partners on collaboration and coalition building.
Target Population: Greeley (2010 Pop., 92,889) and/or Evans (2010 Pop., 18,537)
Activity Quarters of Measurement Deadline Responsible Agency
activity
WCDPHE
WCDPHE
WCDPI IE
WCDPHE and TFCWC •
•
TFCWC
Start:
7/ 1/2013
End:
6/30/2014
Start:
7/1/2013
End:
6/30/2014
VI
M
O `
t N .Q p.
CO a'
Start:
1/1/2014
End:
6/30/2014
Start:
Q4/01/2014
End:
06/30/2014
Meeting notes and sign -in sheets
Meeting sign -in sheets and minutes.
Presentation abstract and completed
presentation.
Completed GIS map of store locations.
Number of earned media placements.
Document changes in "in-store" retail
marketing.
'd'
M
N
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N
Activity 7.1: Convene monthly Tobacco -Free Coalition of
Weld County Meetings (Cache Bank and Trust or other
meeting place as determined by coalition).
Activity 7.2: Provide research, technical assistance and
recommended guidance to the Tobacco -Free Coalition of
Weld County regarding tobacco control best practices to help
increase their effectiveness. Staff will also provide updates of
program activities at the CPHA annual conference to share
lessons learned with other health agencies.
Activity 7.2: Stores will be mapped using GIS (including
non -participating stores for future expansion) to determine
their proximity to low-income areas and schools.
Activity 7.3: Use findings from store audit tool (Activity 5.2)
ofat least 11 corner store in earned media about youth access
of tobacco products in the retail environment in an effort to
raise awareness of tobacco industry marketing strategies (i.e.
pricing) in order to lay the groundwork for future price
increase initiatives in FY 2014-2015.
Activity 7.4: Share findings of the retail environment with the
Community Health Improvement Plan (CHIP) project in
Weld (e.g. CHIP -based healthy corner store initiative) and
encourage efforts to reconfigure tobacco retail marketing
placement with healthier messaging and displays through
incentives (e.g. new display stands, literature or posters with
healthy messages) to retailers
EXHIBIT E
Deliverable 8: By June 30, 2014, Tobacco -Free Coalition of Weld County (TFCWC) will educate at least 500 of the target population (i.e. public and community stakeholders)
about the evidence of different strategies in reducing youth initiation of tobacco.
Target Population: Greeley (2010 Pop., 92,889) and/or Evans (2010 Pop., 18,537)
6i
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WCDPHE and
TFCWC
WCDPHE and
TFCWC
WCDPHE and
TFCWC
WCDPHE and
TFCWC
0
0
0
Q
Start:
7/1/2013
End:
6/30/2014 •
Start:
7/1/2013
End:
12/31/2013
Start:
7/1/2013
End:
6/30/2014
Start:
10/1/2013
End:
6/30/2014
N
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Copies of presentations and written
materials, attendance records.
Copies of presentations and written
materials, attendance records, list of new
speakers in speakers' bureau.
Copies of presentations and written
materials, attendance records, list of new
locations/existing groups that have received
presentations.
Copies of letters written, clipping from
newspaper.
Quarters of
activity
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N
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Activity 8.1: Continue to recruit, identify, train and charge key
coalition members to educate community members and leaders
on issues of tobacco prevention and control and price increase
initiatives.
•
Activity 8.2: Identify at least 2 Spanish speaking key members
who would be willing to serve in the "speaker's bureau". These
two will join the previously established speaker's bureau formed
under the previous year's grant cycle.
Activity 8.3: Conduct Speaker's Bureau and community
presentations and that discuss evidence -based tobacco
prevention and control, cessation, and other services provided in
the community. Contact key leaders at area agencies and give
presentations to groups (e.g. Rotary clubs, church groups, Youth
Net).
Activity 8.4: Write at least one press release per quarter on
tobacco and health issues, including cessation services or
success stories.
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EXHIBIT F
Calotado Department
of Public Health
and Environment
Colorado Department of Public Health and Environment
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
la Task Order Dated 10/1/2012 - Contract Routing Number 13 FLA 49329 - Contract Amendment Rooting Number 14 FLA 55697
-Contractor Name
Weld County Public Health and Environment
Budget Period
July 1, 2013 -June 30, 2014
Project !Virile
Weld County Public Health Tobacco Program
Program Contact Name, Title,
- Phone and Email .
Eric Aakko; Division Director, Health Communication and
Education 970.304.6470 x 2380
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Administrative Services Director 970 -304 -
6410 1 2122
Expenditure Categories
Match or In•
Kind
Total Amount
Requested CDPHE
. Personal Services
Gross or Annual
Salary
- s I
Fringe
_ .- . g
Percent of
FTE on
ProjeR
Position Title/Employee
Name
Description of Work
Include 8 of months budgeted.
List objective
number(s) this
budget supports
Health Education Specialist
II/Rachel Freeman
1.0 FTE Health educator (12 mos) will coordinate youth
prevention activities; including at risk young adults,
collaboration with community based organizations, youth
organizations, school administrators and coordination of
school based trainings and retailer audits. Additional
duties are related to the paid and earned media.
3,4,5,6
55010.11
$21,415.44
100.00%
$76,425.55
Health Education Specialist
II/Maggie Shawcross
1.0 FTE Health educator (12 mos) will coordinate
activities related to cessation, secondhand smoke, and
tobacco free coalition; including working with multiunit
housing, colleges, collaboration with community based
organizations, and the Weld County tobacco free
coalition.
1,2,7,8
53410.57
$20,792.73
100.00%
$74,203.30
Health Educator and
Program
Coordinator/Cassie
Kauffman
05 FTE Health educator (12 mos) will provide overall
program coordination and oversight of work plan
activities. Additional responsibilities Include supporting
bilingual health educator on smoke free multiunit
housing and healthy corner stores.
1 thru 8
58836.51
$22,905.05
50.00%
• $40,870.78
Bilingual Health Education
Specialist/Ofelia 0rozco
0.3 FTE Bilingual health educator (12 mos) will
collaborate on the healthy corner store initiative in
Spanish speaking neighborhoods, provide cessation
resources in Spanish, and smoke free housing activities.
1,3,5,7
57764.06
$22,487.55
30.00%
$24,075.48
Data and Evaluation
Specialist/Cindy Kronauge
0.05 FTE Data and evaluation specialist (12 mos) will
provide evaluation assistance on all workplan activities
and evaluation coordination with the Weld County
Community Health Improvement Plan (CHIP).
1 thu 8
82749.66
$32,214.44
5.00%
$5,748.21.
Office Technician
III/Marjorie Hanson
Office technician @ $17.73 per hour (-4 hours per week)
will provide desktop publishing, design, and other duties
as regyired in fulfilling activitities.
1 thru 8
37910.57
$14,758.58
.
10.00%
$5,266.92
Page 1 of 4
a
EXHIBIT F
Colorado Department of Public Health and Environment
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
To Tusk Order Dated 10/1/2012 - Contract Routing Number 13 RA 48329 - Contract Amendment Routing Number 14 FLA 55697
Colorado Department
of Public Health
end En vonncnt
Contractor Name
Weld County Public Health and Environment
Budget Period
July 1, 2013 -June 30, 2014
. - Project Name •
Weld County Public Health Tobacco Program
-Program Contact Name, Title,
Phone and. Email
Eric Aakko; Division Director, Health Communication and
Education 970.304.6475 x 2380
Fiscal Contact. Name, Title, ,
Phone•and Email
Tanya Geiser, Administrative Services Director 970-304-
5410 u 2122
Division Director/Eric
Aakko
0.05 FIE Division director (12 mos) will provide overall
program administration, budget management, and staff1
supervision of 3.0 FTE tobacco staff.
thru 8
78996.69
$30,753.41.
5.00%
$5,487.51
Fringe @ 38.93%
Fringe benefits are 38.93%. Components Included are:
1.45% 551, .09% unemployment, .08% worker's
compensation, 13:7% PERA, .33% life insurance, 12.13%
health insurance,4.5% vacation, 4.23% for holidays and
2.3% for sick leave.
Total Personal Services
(including fringe benefits)
3
$0.00
$232,077.74
Supplies & Operating Expenses
Item
Description of Item
List objective
number(s) this
budget
supports
Rate
Quantity
Match or In
kind (if
applicable)
Total Amount
Requested from
CDPHE
Printing/Copies
Printing and photocopying (black and white @ .02 cents per copy x
20,000 = $400; color @ .06 cents per copy x 3000 = $180); replacement
of ink toners @ $300. Printing supports all activities from 1. thru 8 in the
workplan. County also supports some printing expenses as "in -kind."
1 thru 8
$880.00
1
$880.00
Postage
Postage for mailing surveys, response to complaints, etc. The County
does include some postage "in -kind" in our general operating budget, .
therefore we do not require a large postage line -Item.
1 thru 8
$0.43
300
$129.00
General Off
Paper, pens, lamination supplies, etc. The County also supports our
supplies with "In -kind" support.
Educational Supplies -
tobacco products
Purchase of emerging tobacco supplies for youth coalition meetings
(e.g. chew, snuff, tobacco). Approx. cost is $5 per item.
3,4,5,6
$5.00
5
$25.06
Meeting Supplies
$240 for material to support youth meetings,(e.g. plates, cups, napkins,
etc). Food, beverages for youth meetings, community meetings @
approx 30 people per month(12 months) X $10 per person =$3600
3,4,5,6
$3,840.00
1
$3,840.00
Total Supplies
& Operating Expenses
$0.00
$5,174.00
Travel ...
Item
Description of Item
List objective
number{s) this
budget item
supports
Rate
Quantity
Match or In
kind (if
applicable)
Total.Amount
Requested from
CDPHE
Mileage
.separate
4 health educators @ 150 miles/month X 54.5 cents a mile; travel
includes in county travel and required travel to CDPHE meetings (2
meetings).
1 thru 8
$0.55
7200
63,920.00
Total Travel
$0.00
$3,920.00
Contractual (payments to third parties or entities)
Page 2 of 4
EXHIBIT F
Colorado Department of Public Health and Environment
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
To Task Dreier Dated 10/1/2012 - Contract Routing Number 13 RA 48329 - Contract Amendment Routing Number 14 FLA 58897
Colorado Department
of Public Health
and Envimnmcnt
Contractor Name..
Weld County Public Health and Environment
. Budget Period
July 1, 2013 -June 30, 2014
Project Name .
Weld County Public Health Tobacco Program
Program ContactName, :Title,
. Phone and Email ...
Eric Aakka; Division Director, Health Communication and
Education 970304.6470 x 2380
Fiscal Contact Name, Title,
: Phone and Email
Tanya Geiser, Administrative Services Director 970-304-
8410 x 2122
Item
Subcontractor Entity Name and/or Description of Item.
List objective
number(s) this
budget item
supports
Rate
Quantity
Match or in
kind (if
applicable)
Total Amount
Requested from
CDPHE
Media - TBD
Public information and education on youth prevention related to spit
tobacco, includes paid and earned media in college (e.g. UNC Mirror
newspaper) and highschool newspapers, billboards near schools, and
Greeley Stampede in Weld County (e.g. vendor for billboards is Lamar
Advertising). .
3
$16,108.71
1
$16,108.71
Tobacco Free Weld County
Coalition
Minigrant to support the work of the coalition in educating at least 500
of the target population (i.e. public and community stakeholders) about
the evidence of different strategies in reducing youth initiation of
tobacco and increasing community awareness about evidence -based
tobacco pricing strategies
7,8
$5,100.00
1
$5,100.00
Cessation Counselors - TBD
Two cessation counselors @ $1400 each; providing assistance to
complete Objectives 1 and 2 by facilitating Spanish and English speaking
cessation classes; cessation counselors may be a continuance of
counselors selected in Year 1.
1,2
$1,400.00
2
$2,800.00
Healthy Corner Store
Initiative -Targeted Stores
TBD
Mini -grant support to assist Spanish speaking corner stores with
healthy signage and point of purchase displays.
3,5
$818.19
11
59,000.00
Health center mini -grants -
TBD
Mini -grant for community health centers to assess provider reminder
system and policy assessment @ $1,000 per center.
1,2
51,000.00
3
$3,000.00
Bob Doyle -Consultant
Colorado Tobacco Education and Prevention Alliance (CTEPA) -
consultation on smoke free housing forum and coalition development
Continue consultation activities from Year 1.
2,7,8
$4,900.00
1
$4,900.00
Lindsey Sides
Lindsey is a Positive Youth Development expert and will provide youth
coalition leadership; she has experience in collaboration with Weld
County partners to bridge gaps between nonprofit, governmental and
youth partners. She will recruit high burden and low SES youth; and
provide school district information and presentations specific to weld
County youth.
3
$14,250.00
1
'$14,250.00
University of Northern
Colorado and Aims
Community College
BACCHUS tobacco prevention curriculum (STEP by STEP) at two colleges
(UNC and Aims) @$2,500 each.
4
$2,500.00
2
$5,000.00
Total Contractual
$0.00
$60,158.71
SUB -TOTAL BEFORE INDIRECT
$301,330.45
Indirect
item
Description of Item
Negotiated Indirect cost
rate
WCDPHE 2013 indirect rate of 15.65%
$0.00
$37,743.38
indirect (other); Contractual
rate, if applicable
2%
$1,203.17
Total Indirect
$0.00
$38,946.55
Page 3 of 4
r
EXHIBIT F
Colorado Department of Public Health and Environment
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
To Task Order Dated 10/1/2012 - Contract Rooting Number 13 FLA 48329 - Contract Amendment Routing Number 14 FLA 55697
Colorado Department
of Public Hadth
and Environment
'Contractor Name
Weld County Public Health and Environment
Budget Period
July 1, 2013 -June 30, 2014
Project Name
Weld County Public Health Tobacco Program
Program Contact Name, Title,
Phone and. Email -
Fiscal Contact Name, Tdle,
Phone and Email
Eric Aekko; Division Director, Health Communication and
Education 970304.6470 x 2320
Tanya Geiser, Administrative Services Director 970-304-
5410 x 2122
TOTAL MATCH OR IN KIND
,: $aoa
TOTAL
$340,277.00
Page 4 of 4
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
ROUTING NO. 13 FLA 48329
APPROVED TASK ORDER CONTRACT - WAIVER #154
This Task Order Contract is issued pursuant to Master Contract made on 01/17/2012, with routing number 13 FAA 00051
STATE
State of Colorado for the use & benefit of the
Department of Public Health and
Environment
PSD - Tobacco
4300 Cherry Creek Drive South
Denver, Colorado 80246
TASK ORDER MADE DATE:
10/01/2012
PO/SC ENCUMBRANCE NUMBER
PO FLA PPG1348329
TERM:
This Task Order shall be effective upon
approval by the State Controller, or designee,
or on 10/1/2012, whichever is later. The
Task Order shall end on 06/30/2013.
PRICE STRUCTURE:
Cost Reimbursement
PROCUREMENT MEH IOD:
Request for Application
13ID/RFP/LIST PRICE AGREEMENT NUMBER
Not Applicable
TAU' SPECIFIED VENDOR STATUTE:
Not Applicable
SPATE REPRESENTATIVE:
Celeste Schoenthaler
Department of Public Health and
Environment
PSD — Tobacco — A-5
4300 Cherry Creek Drive South
Denver, CO 80246
CONTRACTOR:
Board of County Commissioners of Weld
County (a political subdivision of the state of
Colorado)
915 10th Street
Greeley, Colorado 80632-0758
for the use and benefit of the Weld County
Department of Public Health and
Environment
1555 17th Avenue
Greeley, Colorado 80631
CONTRACTOR ENTITY TYPE:
Colorado Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
STATUTORY AUTHORITY:
25-3.5-804, et-seq. C.R.S., as amended
CONTRACT PRICE NOT TO EXCEED:
$255,208.00
FEDERAL FUNDING DOLLARS:
STATE FUNDING DOLLARS:
$0
$255,208.00
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY 13: $255,208.00
CONTRACTOR REPRESENTATIVE:
Mark Wallace
Weld County Department of Public Health
and Environment
1555 17th Avenue
Greeley, Colorado 80631
SCOPE OF WORK:
To provide tobacco cessation, reduce initiation of tobacco use, decrease tobacco prevalence among
youth and decrease exposure to secondhand smoke.
Page 1 of 6 Rev 6/25/09
STATE OF COLORADO
John W. Hickenlooper, Governor
Christopher E. Urbina, MD, MPH
Executive Director and Chief Medical Officer
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr. S.
Denver, Colorado 80246-1530
Phone (303) 692-2000
Located in Glendale, Colorado
http://www.cdphe.state.co.us
June 24, 2013
Laboratory Services Division
8100 Lowry Blvd.
Denver, Colorado 80230-6928
(303) 692-3090
Tanya Geiser
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555sNorth 17th Avenue
Greeley, CO 80631
Hi, Tanya:
Colorado Department
of Public Health
and Environment
Enclosed is your copy of the fully executed Colorado Department of Public Health and Environment
Amendment. You may begin work on July 1, 2013.
CONTRACTOR NAME:
AMENDMENT NUMBER:
ORIGINAL CONTRACT NUMBER:
DIVISION:
PROGRAM NAME:
PROJECT NAME:
REASON FOR CONTRACT:
BOCC of Weld County/Weld County DPHE
14 FLA 55697
13 FLA 48329
Prevention Services Division/PSD
Tobacco
FY14 Tobacco
Amendment for FY14
Please contact me with questions or concerns. My contact information is listed below.
Sincerely,
KATHY JACOBSEN, MS
Contracts Administrator
Prevention Services Division
(303)-692-2479
kathy.jacobsen@state.co.us
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