HomeMy WebLinkAbout20253303 Mariah Higgins
From: Bill Fritz
Sent: Monday, November 24, 2025 1:19 PM
To: CTB
Cc: Jason Chessher; Shaun May
Subject: STI Grant OL#3 for communication
Attachments: OL# 3 STI.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Please find Option Letter#3 for our STI grant attached. Please share with the board as a communication.Thanks
Bill
aouHrr,o
Bill Fritz
Finance Manager
Weld County Department of Public Health and Environment
Desk: 970-400-2122
1555 North 17th Ave., Greeley, CO 80631
0LI 00
Joky Ow Team
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Co KTAutn.co o 1S cc: AcT(sww/cn)
2025-3303
►.2/og/25 ►2 /04 (25
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Docusign Envelope ID:379C2512-5079-4AE4-ACE9-3BCF98B66DD5
State of Colorado Grant Modification
Option Letter#3
State Agency Agreement Performance Beginning Date
State of Colorado for the use f>: benefit of the February 2, 2017
Department of Public Health and Environment Current Agreement Expiration Date
Grantee June 30, 2026
Board of County Commissioners of Weld County Current Agreement Maximum Amount
(a political subdivision of the state of Colorado) Initial Term
for the use and benefit of Weld County 02/02/2017-12/31/2017: $11,935.00
Department of Public Health and Environment Extension Terms
Grantee UEI 01/01/2018-12/31/2018: $13,020.00
MKKXT9U9MTV5 01/01/2019-12/31/2019: $13,020.00
Option Letter Number 01/01/2020-12/31/2020: $13,020.00
Option Letter#3 01/01/2021-12/31/2021: $31,759.00
Original Agreement Number 01/01/2022-12/31/2022: $116,077.00
17 FHHA 95844 01/01/2023-12/31/2023: $71,760.00
Option Agreement Number 01/01/2024-01/31/2025: $73,572.00
2025*1321 OL#3 02/01/2025-06/30/2026: $96,210.00
Total for all State Fiscal Years: $440,373.00
Grant Option Letter Page 1 of 3 Version 11/2024
Docusign Envelope ID:379C2512-5D79-4AE4-ACE9-3BCF98B66DD5
1. Options:
A. Option to extend for an Extension Term
B. Option to change the quantity of Goods under the Agreement
2. Required Provisions:
A. In accordance with Section 5 of the Original Agreement referenced above, the State hereby
exercises its option for an additional term, beginning November 20, 2025 and ending on the
current agreement expiration date shown above, at the rates stated in the Original Agreement,
as amended.
B. In accordance with Section 5Bv of the Original Agreement referenced above, the State hereby
exercises its option to Increase the quantity of the Services at the rates stated in the Original
Agreement, as amended. Exhibit C, Budget is deleted and replaced in its entirety with Exhibit
C, Budget attached to this Option Letter. The budget is as follows: 2/1/2025-6/30/2026
$73,572.00 and an additional $22,638.00 available upon execution of this option letter.
C. The Agreement Maximum Amount table on the Agreement's Signature and Cover Page is hereby
deleted and replaced with the Current Agreement Maximum Amount table shown above.
3. Option Effective Date:
The effective date of this Option Letter is upon approval of the State Controller or November 20, 2025
whichever is later.
Grant Option Letter Page 2 of 3 Version 11/2024
Docusign Envelope ID:379C2512-51379-4AE4-ACE9-3BCF98B66DD5
STATE OF COLORADO STATE CONTROLLER
Jared S. Polls, Governor Robert Jaros, CPA, MBA, JD
Colorado Department of Public Health and
Environment
Jill Hunsaker Ryan, MPH, Executive Director
DocuSigned by: DocuSigned by:
[ asp aidU4SoLit, F4..4 Wdlz40.4
733051-4MA004oC...
Ll. L4715OL4lf 7
By: l elsea Gilbertson, Procurements it By: Kurt Williams, Controller
Contracts Section Director
Date: 2025-11-24 Amendment Effective Date:2025-11-24
In accordance with §24-30-202, C.R.S., this
Agreement is not valid until signed and dated
below by the State Controller or an authorized
delegate.
Grant Option Letter Page 3 of 3 Version: 11.2024
Docusign Envelope ID:379C2512-5D79-4AE4-ACE9-3BCF98B66DD5
Exhibit C
4 . COLORADO
e T W Department of Public
' ' Health ftEnvirolunent
Colorado Department of Public Health and Environment •
BUDGET JUSTIFICATION FORM
CT 2025.1321
,... Annette Odell
CentnetorNeme Weld County Department of Public Health and Environment Pngram Contact Naaia- NP Coordinator
T3ne,.Phane ind Ettai- 970-400.2324
aodell@weldgov.com
Bill Fritz
er
HadgetPer'4od 2/1/2025-6/30/2026 ' Ttde,Phone and - - Frnrocr0 Man22
bfritz(a)weld.tov
Project Neme Oil Screening&Treatment : Co..Eeeumbnnee - 2025 .321
Brpemdimre Categoeei, - • .
t r SJa7Prlouri Aumoyot to Add NesAmount
! � ' 181hge 'Adtiial'I9meun PYdln���l'�butre Otljiud timemt
` Penennel�`ervlcu
i '-` _ ; � )leileIIn Canter wed�srnpih Reyu«taa ''! ""'"I''-:'
��
� ,Pnrdyae Opde[ .._
Po,ltim Tltle/EmployeeName t.rioipHonafWork(forhaurlyempl177eUieueinciude 44.34% - - -
tlee toady ran and number of hour n year dacdpdon)
Medical Aaeiateot Process and collect samples and prepare them for lab S52,500.00 S23,278.50 4% Bane $6,465.01 52,500.00 58,965.01
Nurse Collect samples,review results end provide treatment if S77,300.00 $34,274.82 2% Base 54,194.96 $4,500.00 58,694.96
needed
Nurse Practitioner Collect eemplee,review regatta and provide treatment if S150,900.00 S66,909.06 4% Base $8,712.00 S10,000.00 $18,712.00
needed
Program Supervisor Provide program oversight, m ight,run reports and submit data to $150,900.00 S66,909.06 1% Base 52,178.00 55,638.00 S7,816.00
CDPIE for grant
Provide outreach program oversight,logistical,scheduling,and
Outreach Coordinator& opvataal overnight.Iacreaer local capacity"nand tegtiug $77,619.00 $34,416.26 23% SUP? S22,334.99 $0.00 522,334.99
Administration Personnel and treatment for those at greatest risk of contracting and/or
transmitting SII,in the community
Outreach Public Health Nurse IIPr��e and collect ampler and prepare them for lab outreach 581,177.00 535,993.88 7% SUPP 58,202.00 50.00 $8,202.00
." ,,�.', =TotalPuaoidel 9ersieea(lnekldngl glEetUBf4) St 4gli.96 - S32,b3800 7d,73L96
' i°"i _ SnppBef dFOpenthil Expehttee
1 ! i a dty ehodirig1oli#5. OHgnndAmonht
_'� l+b�,`. d ,� -., .6aeriptian Bata - ��+n^`] (Baaetlr..,'.•t "."`aitip4etr+t
_ Ameuat toldd NeatAmomsf:.:
CT/GC Screening Teat CT/GC Screening Ten $20.00 143 Base 51,195.04 $0.00 51,195.04
Syphilis treatment Bicilln.22 per dose $0.22 25 Base $5.50 $0.00 55.50
Chlamydia treatment Doxycyotne 1.00 per treatment $1.00 50 Base $50.00 $0.00 $50.00
Gonorrhea treatment Ceftriaxone 2.23 per done S2.23 15 Base $33.45 $0.00 533.45
Ole+�8 Supply coma ruckpeadver s7peioi,ofce s'Miea,couriv
S tea& a E pxa amvices or oNv opantional aupptea 5286.00 1 Base 5286.00 $0.00 5286.00
CT/GC Screening Test CT/GC Scraping Ten $20.00 359 SUPP 57,180.00 $0.00 $7,180.00
Syphilis treatment Bicillio.22 per dose $0.22 10 SUPP $2.20 . $0.00 $2.20
Chlemydia treatment Doxycycline 1.00 per treatment $1.00 25 SUPP $25.00 $0.00 $25.00
Gonorrhea treatment Cefbiexone 2.23 per doer $2.23 10 SUPP $22.30 $0.00 $22.30
Education and Materials Education materials for clients or materiels needed for 550.00 1 SUPP $50.00 $0.00 $50.00
promoting the program to the community
Supplies&Opvathrg Expense. Supply arts each as advertisement,office supplies,courier $70 00 1 SUPP $70.00 50.00 $70.00
xrvica or other opvational suppler
r '.;,�. ,-Tanl supplies.A Opehtlng Ropensd• r;:$8,919.49 • !S.no. • ',10919A9
4°4" - DeorWPdou "1 Rate- Qnu Fnnding$amar, Oflghn.IAmemt- Amopee to Add NeewAmeaut
i (HMeerBUPP) 14*,6,d
Mileage Travel to and from events or neeaaary travel for the program $0.67 652 SUPP 5436.84 50.00 S436.84
-^;E4,.:P w,' a �.° a`,., ,w '," ,;, v Tot'alTravel ,,0431.:60 ;nee r $4ax0C, _
' j. Other ens. � " -_ i .
Itepef Den reipdeh a'Rte.. .Cl'!endly (Bate.$tt,*. .-Oet� t AmamtitoA{!d Ne,eAnmmnt
Training for STI for aurae 5299.00 1 Hue $0.00 $0.00 50.00
Ix,. - "..,`1btal Ohara Crete `g $0.00 4001 30310
-- .i r i, -.a fit ''i;;; Contractual(peymmin te third porn..oragtNiea),,,; '"
Item:cr - "{,;:- Duetlption •• #ate 41400ty jBassar$UPP) edupd , Amount taAJd 7.N1gtmaunt....
$0.00 $0.00 $0.00
^^
Sub-Total Before Indirect -_ flue $13,110.96 - 522,638.00 545,757,96- --
-,` - Sub-Tani Befoielndlvet SUPP $38,323.49- - 50.00, S38,323,49
p PYmdte $mxe Ot*-44M-°rat
--- u;�a9 Xkul 3 {`/q°�i 1k°celpNo° Rate= g
(g�orSl7PPf� l'keJpatad 4Rriti*toddd 'NewAmoml`.-
.Contract Number 2025*1321 Option Letter 11 1
Docusign Envelope ID:379C2512-5D79-4AE4-ACE9-3BCF98B66DD5
Exhibit C
2025 Indirect Rate 19.741/e Base 54,564.00 $0.00 $4,564.00
2025 Indirect Rate I9.74.% SUPP 57,565.00 50.00 57,565.00
Tote'Indirect $12,129.00 $0,00 $12,129.00
Sub-Total Before indirect+Indirect PCHD BASE Funding $27,604,00 $22,638,00 $50,322.00
Sub-1bhi Before Indirect+tndtrert.PCRD SUIT Funding S45,609.00 50.00 $45888.00
. i_ !'1 ,. Fttudlustnod .$15,572.00 $22,,68.06 - 596,210.00'
Contract Number 2025*1321 Option Letter 11 2
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088
CONTRACT MODIFICATION SUBMITTAL CHECKLIST
Contractor/Subrecipient Name Weld County Public Health
0 All Contractor name occurrences and Secretary of State Status Summary Page match exactly
Modification Routing# 2024*2731 OL#2 Original Routing# 2020*3023
CORE# 2024*2731 or r NO ENCUMBRANCE
Modification Start Date 1/1/2024 Modification End Date %31/2025
SOW Modification Pre-approval-OnBase Approval# Enter# (if applicable)
Division Acronym STI/HIV/VH Unit Acronym STI Prevention
Submitter Name Chad Jones Email chad.jones@state.co.us
SOW Delegate Name Chad Jones Email chad.jones@state.co.us
Purpose(s)of Modification(Select all that apply)
fl Scope of Work ❑ Budget ® Renewal ❑ No Cost ❑ Assignment ❑ Other If'Other' Describe
Modification DOCUMENT TYPE Select Only One
A B C
A. Amendment ❑
B. Option Letter
C. Assignment ❑
Modification - DocuSign BackupDocuments MakalltDotnfTr ee
ii selected Document Type.
Include requested backup documents(as required)and contract in DocuSign envelope in order from 1-11. A B C
1. Contract Modification Quality Assurance Checklist ❑ ❑ ❑
2. Contract Modification Submittal Checklist ❑ ® ❑
3. Cover Page of original contract document and cover page of most recent assignment,if applicable ❑ ® ❑
4. If Subrecipient,Pre-Award Financial Risk Assessment#(See Internal Audit Site) Enter# ❑ ❑
(Renewal required each year)
5. Insurance Certificate(s)***Insurance Policy Dates must be current on effective date of contract***
If Assignment,Certificate of Insurance(COI)for Assignee only.
NOT required for Interagency Agreement or Intergovernmental Contract. ❑ ❑ ❑
Waiver-OnBase Approval ID# Enter# Insurance Waiver Type: Enter Type of Waiver Granted
6. ❑Sole Source REVISION(Modification required when increased amount,change in SOW,or date change)
New PCS Sole Source Request# Enter PCU Request# ❑ ❑
New PCS Sole Source Term Select SS Term Start Date to Select SS Term End Date
New NPSS1# Enter NPPSS1#
7. Secretary of State Status Summary Page(Amendment or Option Letter for a new term)
(Must state the entity is in'good standing') ❑ ❑ ❑
(If Assignment,SOS for Assignee only; NOT required for Interagency Agreement,Intergovernmental Contract)
If'Doing Business As'(dba),Secretary of State Status Summary Page for dba ❑ ❑ ❑
8. Signature Authority Letter or Corporate Documentation(If contract signed by other than apparent authority) ❑ ❑
(See OSC Policy Signature Authority Delegation)
9. SAM Exclusion Summary Page(Record verified and no exclusions/restrictions)(See SAM Verification Guidance( ❑ ❑ ❑
(If Assignment,SAM for Assignee only; NOT required for Interagency Agreement Contract or LPHA)
10. Contract Modification(cover page,signature page,main body) ❑ ® ❑
11. Contract Modification Exhibits(as shown on cover page of modification being submitted) ❑ ® ❑
Modification Submittal Checklist Version 08.24.23 1
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088
CMS RECORD (X)=
Required for contracts$100,000 over the life of the contract Completed
1. Record Type—Record type chosen is'Modification'. ❑
2. Linked Record—Record is linked to the Master Record ONLY. 0
3. Record Title—Title follows the naming convention for a Modification to a Master Record. 0
4. Data Field: Vendor Name—Has been selected in the'Contractor/Vendor'field. 0
5. Data Fields: If this Modification is to renew or extend a contract,has the contractor's work to date been
certified as complying with the terms of the contract AND the Master CMS contract record updated?
Choose'Yes'when renewing or extending the expiration date and enter'Yes'in the corresponding field in ❑
the Master Record. If the Modification is not to renew or extend,choose'N/A'and do not make any
changes in the corresponding field in the Master Record.
6. Data Field: Certification—If applicable,enter date of MOST RECENT annual certification of contractor
work—If contract has been renewed or extended,enter expiration date of the contract.We are using the
expiration date of the contract to represent the last contractor performance evaluation of the contract ❑
period(quarterly or 3x per year).If the Modification is not to renew or extend, leave blank.
If the corresponding field in the Master Record is set to'Yes'as a result of a previous renewal/extension,do
not change it.
7. Data Fields: All other relevant data fields are completed per CDPHE protocol. ❑
8. Update Master Record—Cumulative Dollar Amount,Latest Performance End Date,and Recertification data ❑
fields have been updated as applicable.
NOTES:
Click here to enter text
Modification Submittal Checklist Version 08.24.23 2
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 17 FHHA 95844
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: CONTRACTOR:
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County
Department of Public Health and Environment (a political subdivision of the state of Colorado)
Disease Control and Environmental Epidemiology 915 10th Street
Chlamydia Greeley,Colorado 80632-0758
4300 Cherry Creek Drive South for the use and benefit of the
Denver,Colorado 80246 Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley,Colorado 80631
CONTRACTOR DUNS: 075757955
CONTRACTOR ENTITY TYPE:
CONTRACT MADE DATE: 1 1/29/2016 Political Subdivision
CORE ENCUMBRANCE NUMBER: BILLING STATEMENTS RECEIVED:
201700002993 Monthly
TERM: STATUTORY AUTHORITY:Not Applicable
This contract shall be effective upon approval by
the State Controller,or designee,or on 2/12017, CLASSIFICATION:Sub-Recipient
whichever is later.The contract shall end on 12/31/2017.
CONTRACT PRICE NOT TO EXCEED: $11,935.00
PROCUREMENT METHOD: FEDERAL FUNDING DOLLARS: $11,935,00
Exempt STATE FUNDING DOLLARS: $0.00
BIDRFP LIST PRICE AGREEMENT NUMBER: OTHER FUNDING DOLLARS: $0.00
Not Applicable Specify"Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
LAW SPECIFIED VENDOR STATUTE: FY17: $5,425.00
Not Applicable FYI 8: $6,510.00
STATE REPRESENTATIVE:
Maria Jackson
Department of Public Health and Environment
Disease Control and Environmental Epidemiolog PRICESTRt1C1URE: Cost Reimbursement
4300 Cherry Creek Drive South CONTRACIDRREPRESENTATIVE:
Denver,Colorado 80246 Mark Wallace,Executive Director
Weld County Department of Public Health
and Environment
1555 North 17th Avenue
Greeley,Colorado 8063
PROJECT DESCRIPTION:
This project serves to support the prevention of infertility and C.trachomatis and N.gonorrhea infection through the provision of screening,
treatment,and partner management for these infectious diseases.
CT Temp 17 95844_doCJs Page 1 of 6
0/16 y,
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088
OPTION LETTER#2
State Agency: Original Contract Number:
Colorado Department of Public Health and Environment 17 FHHA 95844
4300 Cherry Creek Drive South
Denver,Colorado 80246
Option Letter Contract Number:
Contractor: 2024*2731 Option Letter#3
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
1150"O"Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Contract Performance Beginning Date: Current Contract Expiration Date:
February 2,2017 January 31,2025
CONTRACT MAXIMUM AMOUNT TABLE
Document Contract Federal Funding State Funding Other Funding Term(dates) Total
Type Number Amount Amount Amount
Original Contract 17 FHHA $11,935.00 $0.00 $0.00 02/02/2017-
95844 12/31/2017 $11,935.00
Contract 18 FHHA $13,020.00 $0.00 $0.00 01/01/2018-
Amendment#1 105307 12/31/2018 $13,020.00
Contract 19 FHHA $13,020.00 $0.00 $0.00 01/01/2019-
Amendment#2 121540 12/31/2019 $13,020.00
GFCL#1 2020*3023 S13,020.00 $0.00 $0.00 01/01/2020- $13,020.00
GFCL#1 12/31/2020
Contract 2020*3023 $21,759.00 $0.00 $0.00 01/01/2021-
Amendment#3 Amendment#3 12/31/2021 $21,759.00
Option Letter#1 2020*3023 $10,000.00 $0.00 $0.00 09/20/2021-
Option Letter 12/31/2021 $10,000.00
#1
Contract 2022*2474 $116,077.00 $0.00 $0.00 01/01/2022-
Amendment#4 Amendment#4 12/31/2022 $116,077.00
Contract 2023*3868 $71,760.00 $0.00 $0.00 01/01/2023- $71,760.00
Amendment#5 Amendment#5 12/31/2023
Option Letter#2 2024*2731 $73,572.00 $0.00 $0.00 01/01/2024- $73,572.00
Option Letter 01/31/2025
#2
Current Contract Maximum $344,163.00
Cumulative Amount
Page 1 of 3
Option Letter Contract Number:2024*2731 Option Letter#2 Ver.27.01.20
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088
1) OPTIONS
A. Option to extend for an Extension Term
2) REQUIRED PROVISIONS:
A. In accordance with Section(s)5 of the Original In accordance with Section 2C of the Original
Master Task Order Contract referenced above,the State hereby exercises its option for an
additional term,beginning January 1,2024 and ending on the current contract expiration date
shown above,at the rates stated in the Original Task Order Contract,as amended for the
following reason: to renew the contract for an additional term.
B. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown above.
2) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or January 1,
2024,whichever is later.
Page 2 of 3
Option Letter Contract Number:2024*2731 Option Letter#2 Ver.27.01.20
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088
SIGNATURE PAGE
STATE OF COLORADO In accordance with§24-30-202 C.R.S.,this Option is not
Jared S.Potts,Governor valid until signed and dated below by the State Controller or
Colorado Department of Public Health and Environment an authorized delegate.
Jill Hunsaker Ryan,MPH,Executive Director STATE CONTROLLER
Robert Jaros,CPA,MBA,JD
DocuSigned.by: DocuSigned by:
C8CA04B14548748A..
2EDF870A1A7D4FC...
By: Signature By: Signature
Lisa McGovern Jannette Scarpino
Name of Executive Director Delegate Name of State Controller Delegate
Procurement & Contracts Section Director ft chief Financial officer
Title of Executive Director Delegate Title of State Controller Delegate
2023-10-31 2023-11-01
Date: Option Effective Date:
-- Signature Page End --
Page 3 of 3
Option Letter Contract Number:2024*2731 Option Letter#2 Ver.27.01.20
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088 Exhibit I
gCOLORADO
Errs
Colorado Department of Public Health and Environment
BUDGET JUSTIFICATION FORM
Contract Routing#2024*2731 OL#2
Board of County Commissioners of Weld Annette Odell,NP
Contractor Name County for the use and benefit of the Weld Program Contact Name Coordinator
County Department of Public Health and Title,Phone and Email 970-400-2324
Environment aodell@weldgov.com
Sonya Oster,Bus.Ops.
Fiscal Contact Name Mgr.
Budget Period 1/1/2024-1/31/2025 Title,Phone and Email 970-400-2332
soster@weld.gov
Prevention of STI,CT,GC and Syphilis
Project Name Core Encumbrance 2024*2731
Screening and Treatment
Expenditure Categories
Percent of Actual Time
Personnel Services Salary/Hourly Fringe on Contract/ Funding Source Original Amount
Benefits Purchase Order (Base or SUPP) Requested
Description of Work
(for hourly employees,please include the 43.49%
hourly rate and number of hours in your
Position Title/Employee Name description)
Process and collect samples and prepare $52,500.00 $22,832.25 4% Base $3,013.00
Medical Assistant them for lab
Collect samples,review results and provide
Nurse treatment if needed $77,300.00 $33,617.77 2% Base $2,218.00
-Collect samples,review results and provide
Nurse Practitioner treatment if needed $150,900.00 $65,626.41 4% Base $8,661.00
Provide program oversight,run reports and
Program Supervisor submit data to CDPHE for grant $150,900.00 $65,626.41 1% Base $2,165.00
t•roviae outreacn program oversight, •
logistical,scheduling,and operational
oversight.Increase local capacity around
testing and treatment for those at greatest $77,619.00 $33,756.50 23% SUPP $25,616.00
risk of contracting and/or transmitting STIs
Outreach Coordinator&Administration Personnel in the community
Option Letter Contract Number:2024*2731 Option Letter#2 Page 1 of 3
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088 Exhibit I
Process and collect samples and prepare
Outreach Nurse them for lab outreach events S81,177.00 S35,303.88 7% SUPP S8,1.54.00
"Total Personal Services(lncluding Fringe Benefits) S49,827.00
Supplies&Operating Expenses
Item Description Rate Quantity Budgeted Amount
Base
CT/GC Screening Test CT/GC Screening Test $20.00 100 $2,000.00
Syphilis RPR ScreeningTest Syphilis RPR ScreeningTest Base
YP YP $2.00 160 $320.00
Syphilis RPR Confirmatory Test Syphilis RPR Confirmatory Test $8.00 5 Base $40.00
Supply costs such as advertisement,office
supplies,courier services or other Base
Supplies&Operating Expenses operational supplies $275.00 I $275.00
HIV Insti Rapid Test HIV Insti Rapid Test $13.00 50 Base $650.00
HIV Confirmatory Test HIV Confirmatory Test $8.00 2 Base $16.00
CT/GC Screening Test CT/GC Screening Test $10.00 345 SUPP $3,450.00
Syphilis RPR Screening Test Syphilis RPR Screening Test $2.00 304 SUPP $608.00
Syphilis RPR Confirmatory Test Syphilis TPPA Confirmatory Test $8.00 5 SUPP $40.00
HIV Insti Rapid Test-verify our cost HIV Insti Rapid Test $13.00 249 SUPP $3,237.00
HIV Confirmatory Test HIV Confirmatory Test $8.00 2 SUPP $16.00
Education materials for clients or materials
needed for promoting the program to the
Education and Materials community $50.00 1 SI'PP $50 00
Supply costs such as advertisement,office
supplies,courier services or other
Supplies&Operating Expenses operational supplies $50.00 1 SI PP $50.00
Total Supplies&Operating Expenses S10,752.00
Travel
Item Description Rate Mileage Budgeted Amount
-Travel to and from events or necessary
Milc.gc travel for the program $0 63 757 SUPP $473.13
Total Travel S473.00
Other Costs
Training for STI for nurse Base $299
Option Letter Contract Number:2024.2731 Option Letter#2 Page 2 of 3
DocuSign Envelope ID:9AEBF47E-39A6-4B09-A4B8-27084BFBC088 Exhibit I
Total Other Costs $299.00
Contractual(payments to third parties or entities)
EMR $100
Total Contractual $100.00
Sub-Total Before Indirect Base $19,657.00
Sub-Total Before Indirect SUPP $41,694.00
Indirect
2023 Indirect Rate=19.92% Base $3,916.00
2023 Indirect Rate=19.92% SUPP $8,305.00
Total Indirect $12,221.00
Total PCHD BASE Funding Base $23,573.00
Total PCHD SUPP Funding SUPP $49,999.00
TOTAL $73,572.00
Option Letter Contract Number:2024*2731 Option Letter#2 Page 3 of 3
DocuSign Envelope ID:DDO6DF85-C121-403D-9F94-A940D652D9A7
OPTION LETTER#: 1
State Agency: Original Contract Number:
Colorado Department Of Public Health and Environment 17 FHHA 95844
STI/HIVNH-1901
4300 Cherry Creek Drive South Option Letter Contract Number:
Denver,Colorado 80246 2020*3023 Option Letter#1
Contractor:
Board of County Commissioners of Weld County
1150"0"Street,Greeley,Colorado 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley,Colorado
Contract Performance Beginning Date: Current Contract Expiration Date:
September 20,2021 December 31,2021
CONTRACT MAXIMUM AMOUNT TABLE
Document Contract Federal Funding State Funding Other Funding Term(dates) Total
Type Number Amount Amount Amount
Original Contract 17 FHHA $11,935.00 $0.00 $0.00 02/02/2017- $11,935.00
95844 12/31/2017
Contract 18 FHHA $1 ,020.00 $0.00 $0.00 01/01/2018- $13,020.00
Amendment#1 105307 12/31/2018
Contract 19 FHHA $13,020.00 $0.00 $0.00 01/01/2019- $13,020.00
Amendment#2 121540 12/31/2019
GFCL#1 2020*3023 $13,020.00 $0.00 $0.00 01/01/2020- $13,020.00
GFCL#1 12/31/2020
Contract 2020*3023 $21,759.00 $0.00 $0.00 01/01/2021-
Amendment#3 Amendment 12/31/2021 $21,759.00
#3
Option Letter#1 2020*3023 $10,000.00 $0.00 $0.00 09/20/2021-
Option Letter 12/31/2021 $10,000.00
#1
Current Contract Maximum $82,754.00
Cumulative Amount
1) OPTIONS
A. Option to change quantity of services under the Contract
2) REQUIRED PROVISIONS:
A. In accordance with Section(s)5,Exhibit A of the Original Contract referenced above, the State hereby
exercises its option to increase the quantity of services at the rates stated in the Original Contract as
amended.Exhibit I,Budget,is deleted and replaced in its entirety with Exhibit I,Budget,attached to this
Option Letter,for the following reason:increase funding to provide services.
B. The Contract Maximum Amount table is deleted and replaced with the Current Contract Maximum
Amount table shown above.
3) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or September 20,
2021 ,whichever is later.
Page 1 of 2
Option Letter Contract Number:2020*3023 Option Letter#1
Ver.27.01.20
DocuSign Envelope ID:DDO6DF85-C121-403D-9F94-A940D652D9A7
SIGNATURE PAGE
STATE OF COLORADO In accordance with§24-30-202 C.R.S.,this Option is not
Jared S.Polls,Governor valid until signed and dated below by the State Controller or
Colorado Department of Public Health and Environment an authorized delegate.
Jill Hunsaker Ryan,MPH,Executive Director STATE CONTROLLER
Robert Jaros,CPA,MBA,JD
DocuSigned by: DocuSigned by:
L(LiStt 1144eukt riA,
2EDF870A1A7D4FC...
AC2AC54280C6401...
By: Signature By: Signature
Lisa McGovern Andi Hardy
Name of Executive Director Delegate Name of State Controller Delegate
Procurement & Contracts Section Director ft Controller
Title of Executive Director Delegate Title of State Controller Delegate
2021-09-16 2021-10-13
Date: Option Effective Date:
-- Signature Page End --
Page 2 of 2
Option Letter Contract Number:2020*3023 Option Letter#1 Ver.03.01.20
DocuSign Envelope ID:DDO6DF85-C121-403D-9F94-A940D652D9A7
Exhibit I
COLORADO
Department of Public
Health b Environment
Colorado Department of Public Health and Environment
BUDGET JUSTIFICATION FORM
Original Contract Routing# 17 FHHA 95844
Board of County Commissioners of Weld Annette Odell,NP Coordinator
County for the use and benefit of the Weld Program Contact Name
Contractor Name County Department of Public Health and Title,Phone and Email (970)400-2324;
Environment aodell@weldgov.com
Prevention of Infertility,GC&CT Fiscal Contact Name Tanya Geiser,Director,Finance
Project Name Screening Title,Phone and Email (970)400-2122;
tgeisergaweldgov.corn
Expenditure Categories
Percent of
Fringe Actual Time Original Amount New Amount Total Amount
Personal Services Salary/Hourly on Contract/
Benefits Purchase Requested Requested Requested
Order
Description of Work
(for hourly employees,please include the
Position Title/Employee hourly rate and number of hours in your
Name description)
Total Personal Services(Including Fringe Benefits) $0.00
Supplies&Operating Expenses
Item Rate Quantity Budgeted Amount New Amount Total Amount
CT/GC Screening Test $ 40.00 552 $15,120.00 $6,960.00 $22,080.00
Syphilis TPPA Screening Test $ 8.00 5 $16.00 $24.00 $40.00
Syphilis RPR Screening Test $ 13.00 424 $3,796.00 $1,716.00 $5,512.00
$0.00
Total Supplies&Operating Expenses $18,932.00 S8,700.00 $27,632.00
Travel
Total Travel $0.00 $0.00 $0.00
Other Costs
Total Other Costs $0.00 $0.00 $0.00
Contractual(payments to third parties or entities)
Total Contractual $0.00 $0.00 $0.00
Sub-Total Before Indirect $18,932.00 $8,700.00 $27,632.00
Indirect
2021 Indirect Rate—14.93% $2,827.00 $1,300.00 $4,127.00
Total Indirect $2,827.00 $1,300.00 $4,127.00
TOTAL $21,759.00 $10,000.00 $31,759.00
Option Letter Contract Number:2020.3023 Option Letter#1 Page 1 of 1
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