HomeMy WebLinkAbout20111697.tiff RESOLUTION
RE: APPROVE STATEMENT OF WORK FOR COLORADO IMMUNIZATION
PROGRAM (CIP) OUTREACH PROJECT 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 a Statement of Work for the Colorado
Immunization Program (CIP) Outreach Project from 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, to the Colorado Department of Public Health and
Environment, commencing July 1, 2011, and ending June 30, 2012, with further terms and
conditions being as stated in said Statement of Work, and
WHEREAS, after review, the Board deems it advisable to approve said Statement of
Work, 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 the Statement of Work for the Colorado Immunization Program
(CIP) Outreach Project from 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, to 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 Statement of Work.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 18th day of July, A.D., 2011, nunc pro tunc July 1, 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ���� L �� �ti' "�_-- -- ,Barbara Kirkmeyer Chair
Weld County Clerk to the Board
` Sea '+z.,Conway, Pro-Tem
BY:Deput Jerk to the Board
William F. Garcia
AP O D A 0 M: EXCUSED
,David E. Lon
ount ttorney
ougla Radema her
Date of signature: 497/67//
Chc6 At, et t j L 2011-1697
—1- 161- I I '3- au- i l HL0038
Memorandum
1861 - 2011
TO: Barbara CKounty Co, Chair
Board of County Commissioners
W E L DEC 0 U N T Y FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment
DATE: June 20, 2011
SUBJECT: 1Z/CIP Outreach Project Statement of
Work
Enclosed for Board review and approval is contract amendment between the Colorado
Department of Health and Environment and the Board of County Commissioners of Weld
County on behalf of the Department of Public Health and Environment (WCDPHE). This
Statement of Work is for the CIP Outreach Project within the Immunization Program.
If approved, the funding for this statement of work will allow the Department to provide public
health nursing and OT support for outreach clinic services aimed at the provision of the 4th DtaP
vaccination for children ages 12-24 mo. of age.
The term of this contract is for one year, ending on June 30, 2012. Funding for this statement of
work will not exceed $22,646. I recommend your approval of this statement of work.
Enclosure
2011-1697
STATE OF COLORADO
John W. Hickenlooper,Governor p4 coio
Christopher E. Urbina,MD, MPH /F. .p
Executive Director and Chief Medical Officer tee ..,o
Dedicated to protecting and improving the health and environment of the people of Colorado x rc „- *
4300 Cherry Creek Dr. S. Laboratory Services Division 's
Denver, Colorado 60246-1530 8100 Lowry Blvd.
Phone(303)692-2000 Denver,Colorado 80230-6928 Colorado Department
Located in Glendale,Colorado (303)692-3090 of Public Health
http://www.cdphe.state.co.us and Environment
2011-12 CIP Outreach Project
Statement of Work
Agency Name: Weld County Department of Public Health and Environment
The Immunization Program at the Colorado Department of Public Health and Environment (CDPHE)
has funds available to support the establishment, continuation, or expansion of outreach clinical
services to children 12-24 months of age and, in particular, the administration of the 4th DtaP shot.
The specific target population for this application is children who:
Are the most under-immunized children in your community, ages 12-24 months, because:
• they have no medical home, or the one they have does not provide immunizations
• report not having received previous immunization services
• are VFC-eligible (Are American Indian or Alaskan Native, on Medicaid or qualified through
a State Medicaid Waiver, are underinsured, or have no health insurance)
Funding period 7/1/11 — 6/30/12
Starting the project Work is not to begin on the proposed project until the grantee receives a
contract or purchase order from the Colorado Immunization Program (CIP).
Progress reports Online project updates are due on:
• October 15, 2011
• April 15, 2012
Online progress reports are due on:
• January 15, 2012
• July 15, 2012
Project monitoring Throughout the funding period, the CIP will conduct ongoing project
monitoring and provide technical assistance as needed. In the event that
project performance does not meet the agency's stated goals, a follow-up
work plan will be created and additional technical assistance will be
provided. In an extreme situation, and in consultation with the agency, the
CIP reserves the right to reduce or withhold quarterly payments due to poor
project performance.
Payments Contractor will invoice the CIP quarterly using the invoice provided.
1
Project continuation The possibility exists for this project to be continued in future years if funding
allows.
1. Please provide the following information:
Agency name Weld County Department of Public Health and Environment
Agency mailing address 1555 N 171h AVE
Phone number 970-304-6420
Fax number 970-304-6416
2. Who is the contact person for this outreach project?
Name Samantha Orozco
Phone number 970-304-6420 Ext. 2308
Email address sorozco@co.weld.co.us
3. List the total number of children vaccinated (and to be vaccinated) at outreach clinics
during:
0-11 months 12.24 months > 25 months #children who received (or will receive)their 4'"
of age of age of age DtaP shot during outreach clinics
2010-11 funding 56 78 745 33
period (to date)
2011-12 funding 60 80 750 33
period (estimated)
4. List the total number of outreach clinics held (and to be held). Do not include your regularly
scheduled non-outreach immunization clinics.
Total Total # Total Of the total number of outreach clinics listed, how many of
# evening # these clinics will be held at a location other than your
outreach clinics weekend agency's regular immunization clinic location?
clinics (after 5pm) clinics
2010-11 funding 44 12 3 8
period (to date)
2011-12 funding 44 12 4 4
period (estimated)
5. Timeline: List the monthly activities your agency plans to complete to meet your goal(s) fo
the 2011-12 project period.
Description of the planned activities Additional comments
July 2011 Walk-in clinic Friday 8-12, One Monday Eve clinic (5-7)
Aug Walk-in clinic Friday 8-12, One Monday Eve clinic(5-7), One
walk-in clinic on Thursday and Saturday (8-12) for back to
school
Sept Walk-in clinic Friday 8-12, One Monday Eve clinic (5-7) School nurses send noncompliant
students
Oct Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7) School nurses send noncompliant
students
Nov Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7) School nurses send noncompliant
2
students
Dec Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
Jan 2012 Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
Feb Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
Mar Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
April Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
May Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
June Walk- in clinic Friday 8-12, One Monday Eve clinic (5-7)
6. Budget
Expenses Describe in detail I 2010-11 IZ Local Total
Outreach Budget
Project In-kind
Funding
Personnel > RN and OT FTE's RN 16,592.09
Travel Off Site clinic Travel 325
Marketing Advertising local papers, flyers 450
Incentives Toys, Stickers, juice, snacks, staff incentives 425
Equipment General clinic supplies, vaccine transport 1754.69
coolers (2 refrigerator/freezer units at
$550.19 each)
Office Paper, printing, ink, computer airtime 425
supplies charges, general office supplies
Indirect 13.39% 2,674.22
Total $22,646.00
Personnel RN $27.11/ hour, 7 hours per week = $189.77 For 49 weeks = $ 9,298.73
38.93% Fringe= $ 3,620
RN total $ 12,918.73
OT$ 13.49 /hour, 4 hours per week = $53.96 X 49 weeks $2,644.04
38.93% Fringe= $1029.32
OT total $3,673.36
Total staff: $12,918.73 + $3,673.36= $16,592.09
LOCAL HEALTH PARTNER ACCEPTANCE OF 2011-12 OF Outreach Project REQUIREMENTS:
I Barbara Kirkmeyer , on behalf of the Board of Weld County Commissioners
hereby acknowledge that the requirements for the above-named Immunization Service Purchase Order have been
reviewed, and are accepted and agreed to. I further acknowledge that I have the necessary authority to sign this
acceptance on behalf of tle entity mentioned above.
� c � Aim Chair
JUL 18 2011
Signature / Title Date
3
aC//—/H97
2011-12 CIP IZ Outreach Project Invoice
INVOICE
Agency Name:
Invoice# (if applicable):
Today's Date: Billing period:
TO: Teri Lindsey
Colorado Department of Public Health & Environment / Immunization Program
4300 Cherry Creek Drive South, DCEED-IMM-A3
Denver, CO 80246-1530
Ph: 303-692-2732 / Fax: 303-691-6118
EXPENSES DESCRIPTION AMOUNT
Personnel
Travel
Marketing
Incentives
Equipment
Office Supplies
Indirect
Other
TOTAL DUE $
Name of agency staff authorized to complete this invoice:
Agency Address:
City:
State: Colorado
Zip Code:
Agency Tax ID #:
Purchase Order # / Contract Routing # :
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