HomeMy WebLinkAbout20112842.tiff OPTION LETTER
Date: State Fiscal Year: Option Letter No. 1 CMS Routing# 12 I'D 36972
' 9/27/2011 2012
1) OPTIONS:
a. Option to renew only (for an additional term)
2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options 1(a-e): In accordance with Section(s) I-IV of the Original Contract routing
number 10 IHM 13553 between the State of Colorado, Department of Human Services, and Weld
County, the State hereby exercises its option for an additional term beginning October 1, 2011
and ending on September 30, 2012 at a cost/price specified in Exhibit C, OR an increase in the
amount of services at the same rate(s)as specified in Exhibit A and B.
b. For use with all Options: The amount of the current Fiscal Year contract value is increased by
$400,000 to a new contract value of$1,042,711 ($161,288 for FY 10, $481,483 for FY 11, and
$400,000 for FY 12)to as consideration for services/goods ordered under the contract for the
current fiscal year 2012. The first sentence in Section 1 paragraph 2 is hereby modified
accordingly. The total contract value including all previous amendments, option letters, etc. is
$1,042,711.
3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or
October 1, 2011, whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
atiFIggieDepartment of manServices
Bicrffp, eitive Director
By: Andrew Martinez, Associate irector: Business Support
and Services, Chief Financial O err, Mental Health Services
in Date: / -L r7 / /
ALL CONTRACTS REQUIRE APPROVAL 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 , McDerrmott, CPA
By: _,1246:14414a/z2_____
Valri Gimple
Date: rife/20#
Effective Date: 1/6/09-Rev 8/25/09
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B. Excel workbook—CPPS Budget and Narrative FY2011-2012 to explain projected
expenditures covering the third year of the continued project. Instructions are included in
the Excel workbook. At least two people from our project will attend the DBH two-day
professional development training which will be held in Denver, October 5-6, 2011.
Division of Behavioral Health
Colorado Prevention Partnership for Success
Budget and Narrative
Weld County Department of Human Services/ North Range Behavioral
Agency: Health
Fiscal Year: 2011-2012 (October 1, 2011 - September 30, 2012)
Personnel
1 Project Coordinator- 1.FTE: $49,000.00 $49,000.00
2 Project Coordinator Fringe Benefits @30% =$49,000.00 $14,700.00
X 30%= $14,700.00
3 Project Evaluator- .50 FTE: $75,000.00 x 50% = $37,500.00
$37,500.00
4 Project Evaluator Fringe Benefits @24%= $37,500.00 x $9,000.00
.24%= $9,000.00
5 Project Evaluator Assistant .25 FTE: $38,000.00 X 25%= $9,500.00
$9,500.00
6 Project Evaluator Assistant Fringe Benefits @ 20%= $1,900.00
$9,500.00 X 20%=$1,900.00
7 Administrative Assistant/Support- .25 FTE @ $12,000.00
$25.00/hour x40 x12= $12,000.00
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1 Social Marketing/ Media consultant= 20 hrs/month x 12 $15,600.00
@ $65.00= $15,600.00
2 Website and 2- Facebook management- GMAN @ $26,400.00
$1,000.00/month x 12=$12.000.00 and Growth Weaver
@ $1200.00/month x 12= $14,400.00
3 TIPS trainer @ $300.00/monthly trainings x 12= $3,600.00
$3,600.00
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Weld County Prevention Partners 17
Travel
In service area 4 staff local travel: 200 miles/month @ .46/mi= $4,416.00
$368.00x12=$4,416.00
Out-of-service area 4 staff out of area: Denver CPPS meetings, other $2,208.00
trainings @ 100/month @.46/mi=$2208.00
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Operating Expenses
1 Office Supplies Office equipment, technology-2 WIFI hubs @ $2,940.00
$60.00/monthx2x12=$1440.00 and supplies-
$125.00/month x 12=$1,500.00
2. Community Community Meetings-PLC-WC, EPI group,various $14,400.00
Meeting/Coalitions community teams @ $300.00/meeting x 4 meetings/ 12
months=$14,400.00 Includes room space, food, stipends
to volunteers, supplies, giveaways and incentives.
3. Data Data Collection: Countywide sample by OMNI of the $33,350.00
Collections/Assessments HKCS; all survey materials,scanning of completed
surveys to 7400 youth @ $2.75/survey= $20,350.00,
include proctor teams stipends -4 teams x (4 people) x
$100.00 x 3 days= $4,800.00, incentives to schools -
$250.00 x 8=$2,000.00, pencils @ $1,500.00. Other
surveys i.e. parent or satisfaction/assessments: 3 x @
$500.00= $1,500.00; personnel at schools to recruit
families/permission forms -$1,200.00; extra reports to
schools 8 x$250.00=$2,000.00
4 Alternative Activities Alternative activities: Support of various pro $8,000.00
social/recreational and youth leadership events in
county (including THAT-Teen Health Alliance Today-the
youth coalition @ 2/month @ $250.00x12=$6,000.00
The LULAC Leadership Conference at UNC= $2,000.00
5 Social Marketing Social Marketing: Design, production, printing of all $36,000.00
marketing materials= $8,000.00, supplies = $6,000.00,
billboards = $3,500.00;stipends for volunteers at health
fairs, parades, booths and festivals
=$500/moxl2=$6,000.00; opening day and promotion of
"prevention campus" -WCPP new home-$1,500.00;
purchased ads in newspapers=$3500.00,
promotional/giveaway items=$6,000.00 Focus
groups/meetings/incentives: $1500.00
Weld County Prevention Partners 18
6 Retail Access/ Retail Access/Community Trials= support for monthly $6,800.00
Community Trials RAR of WC meetings, incentives to volunteers, food,12X
$150.00= $1,800.00, marketing materials/promotional
items and activities= $5,000.00
7 Prevention Education Prevention Education: Parenting classes/presentations: $33,800.00
Strengthening Families 10-14 (SF 10-14 site coordinator,
facilitators, parent incentives, food, supplies, room,
childcare providers, prizes) 4 classes (including a
Booster Class) @ $5,500.00= $22,000.00; parenting
education/presentation/presenter @ $200.00 per
session x 2/month x 12 = $4,800.00; community training
of Bridges out of poverty(presenters, food, workbook,
room) 3 trainings x$1500.00 = $4,500.00; purchase of
TEEN INTERVENE for 5 communities x2 copies of
curriculum @ $250.00=$2,500.00
8 Social Norm campaign Continued support to social norm campaign (DEFY) for $7,000.00
periferials=$3,000.00; funds for planning/implementing
new social norm campaigns=$4,000.00
9 Membership/fees 9 Membership fees-chamber of commerce, etc.= $4,200.00
$2,000.00; registrations- professional
development/trainings for 4 staff 11#19014
Subtotal of Direct Expenses $332,314.00
Indirect Expenses
Not to exceed 20%of the total contract amount @ 17%for WCPP $67,686.00
Total Expenses $400,000.00
/ � � /
�"7`�4 (71 - "_ AUG 2 9 2011
Applicant Agency Authorized Represetive Date
Weld County Prevention Partners 19
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� State of Colorado
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�.. Contract Management Information
Annual Certification
Upon renewal or continuation of a personal services contract in a subsequent fiscal year, the individual selected by
the state agency or institution of higher education (IHE), pursuant to CRS §24-103.5-101(3), to monitor the
contractor's work under the contract (Contract Monitor), shall certify as to whether the contractor is complying with
the terms of the contract pursuant to CRS §24-103.5-101(5).
Use of this Form
> The Contractor Monitor should complete this Certification annually during the term of the contract, for each renewed
or continued personal services contract (including grants) with a value over $100,000, on or before each 12-month
anniversary of the contract effective date.
> Use of this form does not replace electronic certification in the CMS record. This form may be required by your
procurement office in addition to the electronic certification. This form should support of the electronic
ccrufication.
> By signing this Certification, the Contract Monitor certifies as to whether the contractor has or has not complied
with the terms of the contract. The contractor's compliance shall be determined using the performance standards
and measurable outcomes included in the contract.
o If the contractor has not complied with the terms of the contract, the state agency or IHE shall be
entitled to any remedy available under law in the case of contract nonperformance.
▪ The original signed Certification should be maintained as part of the official contract record at the state agency or
IHE, with either a copy in the contract record or scanned .pdf copy attached to the statewide CMS record.
> This Certification is not required for contracts under Medicare, the "Colorado Medical Assistance Act", Articles 4 to 6
of Title 25.5, CRS, the "Children's Basic Health Plan Act", Article 8 of Title 25.5, CRS, or the "Colorado Indigent
Care Program", Part I of Article 3 of Title 25.5, CRS.
> This Certification does not need to he attached to the contract as an exhibit.
This Certification is not signed by the vendor/contractor.
CMS Identification Number of Original Contract: 13553 Effective Date of Original Contract: 3/1/2010
Term of Contract(check one): Annual with Renewal(s) ® Multi-year ❑ CMS ID No.of Modification(if applicable): 32803
Name of State Agency/ IHE: Department of Human Services, Division of Behavioral Health
(Department named in the contract)
Name of the Contractor/Grantee: Weld County. Department of Social Services
(Primary party named in the contract)
Name of Project/Program: Colorado Prevention Partnership for Success
Contractor/Grantee is in compliance with the terms of the contract(check one): YES ® NO ❑
Interim Rating(if any)and Date Rating Assigned(check one):
Below Standard(1) ❑ Standard(2) ® Above Standard(3) ❑
Date of last Interim Contractor Performance Evaluation: 09/29/2010
By signing below, I hereby certify, in accordance with CRS §24-103.5-101(5), that I have determined whether the vendor is
complying with the terms of the contract and have set forth my determination in the section above.
vc-kC" Specialist,Finance and Contracts
Business and Support Services
Signature Title
Printed Name Ralph E Duran
09/29/2011 303-866-7512
Date Phone
_Annual CERT_ Performance M&S Effective May 20 2010
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