HomeMy WebLinkAbout20101092 RESOLUTION
RE: APPROVE AMENDMENT #2 TO TASK ORDER CONTRACT FOR NURSE HOME
VISITOR PROGRAM 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#2 to Task Order Contract for
the Nurse Home Visitor Program 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, 2010, and ending June 30, 2011, 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 #2 to the Task Order Contract for the Nurse Home Visitor
Program 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 24th day of May, A.D., 2010.
BOAR
OF COUNTY COMMISSIONERS
OUNTTY, COLORADO
ATTEST: •
1861 t ,,-} .L: gla• Rademacier, C air
Wel County Clerk to the B. .rd
44 , •
rbara Kirkmeyer 'ro-Tem
Dep Clerk t t e Board
Sean P. Con
AF*71RGVED AS T M:
i liam F. Garcia
County Attorney EXCUSED
David E. Long
Date of signature: 10 hi t0
4 aul. 9Ut# bJali & l,C.' t� - '^ 2010-1092
k it' HL0037
Memorandum
Kit Li H.
TO: Douglas Rademacher, Chair
Board of County Commissioners
wipFROM: Mark E. Wallace, MD, MPH, Director
O Department of Public Health and
Environment
COLORADO• DATE: April 29, 2010
SUBJECT: Nurse Home Visitor Contract
Amendment #2
Enclosed for Board review and approval is Amendment #2 to the contract between the Colorado
Department of Public Health and Environment and Weld County Board of Commissioners for
the Department of Public Health and Environment's Nurse Home Visitor program. Funding for
this program will be provided by Colorado State Tobacco Settlement Funds and Medicaid
payments for targeted case management services. For the time period July 1, 2010 through June
2011, funding is projected to be $708,718 with $630,921 coming from the State Nurse Home
Visitor Program and approximately $77,797 from Medicaid reimbursements.
At no cost to the client, specially trained registered nurses provide bi-monthly home visits to
low-income, first time mothers residing in Weld County. These home visits begin in pregnancy
and continue until the client's child reaches the age of two years. Clients are educated and
encouraged to develop positive maternal/child health practices, an understanding of
infant/toddler developmental needs, effective parenting, and maternal economic self-sufficiency.
I recommend your approval of this amendment.
Enclosure
2010-1092
STATE OF COLORADO
Bill Ritter,Jr.,Governor
James B.Madin,Executive Director �.p4 coq
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr.S. Laboratory Services Division ate`
Denver,Colorado 80246-1530 8100 Lowry Blvd. •1816�k
Phone(303)692-2000 Denver,Colorado 80230-6928 ----
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
http://www.cdphe.state.co.us and Environment
WORK STATUS CONFIRMATION LETTER
Vendor Name: Contract Routing Number:
CRS §24-30-202 requires the State Controller to approve all State Contracts. The above referenced Amendment is not valid
until it is signed and dated below by the State Controller or delegate.Therefore,your agency is not authorized to begin
performance until you are notified that it's signed. If your agency begins performing Contract tasks prior to that date,the
State of Colorado is not obligated to pay your agency for such performance or for any goods and/or services provided prior to
the date signed.
By signing below,your confirm that(Signature MUST be that of the person signing the Contract)
a) No work has been performed under this contract
b) No work will begin under this contract until the contract is signed by the State Controller or on the effective
date,whichever is later.
C' eicn r9rm
Signature of Aut onzed Officer Douglas Rademacher
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
MAY 2 4 2010
Date Signed
RETURN THIS LETTER TO:
Natalie El-Deiry,Contracts Manager
Colorado Department of Public Health&
Environment
Center for Healthy Families and Communities
4300 Cherry Creek Dr So
PSD-CHFC-A4
Denver CO 80246-1530
does /&9�
STATE OF. ,COLORADO
Bill Ritter,Jr.,Governor t L l- f tin )
S
Martha E.Rudolph,Executive Director ^,_� , :. : 1 - ,o4•co7o
Dedicated to protecting and improving the health and environment of the people of Colo d -)r-
y o
n
4300 Cherry Creek Dr.S. Laboratory Services Division LUiQ JUL ( 1. D •
Denver,Colorado 80246-1530 8100 Lowry Blvd. •r rava w
Phone(303)692-2000 Denver,Colorado 80230-6928 - - —
TDD Line(303)691-7700 (303)692-3090 ' . � 1 •a C.Li Colorado Department
Located in Glendale,Colorado of Public Health
http://www.cdphe.state.co.us and Environment
July 8,2010
Re: Nurse Home Visitor Program
FY 11 Contract Amendment
Enclosed please find a fully executed copy of the above referenced contract amendment. The funding awarded through
this contract amendment should be spent between the dates of 07/01/10 and 06/30/11.
Please review your contract amendment carefully,as non-substantive changes may have been made. This may include minor
edits in page numbers,document labels,or formatting. In the event larger revisions were required,your organization would
be notified in detail of these changes.
If there are any questions regarding this contract amendment,please contact Laura Lippman, Fiscal Officer,at 303-692-
2357 or laura.lippman@state.co.us, or Jacqueline O'Bryan,Contracts Manager,at 303-692-2485 or
iacoueline.o'bryan@state.co.us.
Sincerely,
Fiscal Services Unit
Enclosure
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSIYNIIVP
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
11-15839
AMENDMENT FOR TASK ORDERS#2
This Amendment is made this 15 day of March,2010, 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,for the use and benefit of the WELD
COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT(apolitical subdivision of the
state of Colorado),whose address or principal place of business is 1555 North 17` Avenue,Greeley,Colorado
80631,hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract,dated January 23,2007,with contract routing number 08 FAA 00052.
Pursuant to the terms and conditions of the Master Contract,the parties entered into a Task Order Contract,dated
May 25,2007,with contract encumbrance number PO FLA FH50800184, and contract routing number 08-FLA
00184,as amended by Funding Letter#1, contract routing number 08-FLA-00741, Limited Amendment#1,
contract routing number 09-FLA-00019, Grant Funding Change Letter#2,contract routing number 09-FLA-00951,
Contract Amendment#1, contract routing number 10-FLA-00019 and Grant Funding Change Letter#3,contract
routing number 10-FLA-13559 collectively referred to herein as the"Original Task Order Contract,whereby the
Contractor was to provide to the State the following:
Contractor is to provide nurse home visitor services to low-income,first-time mothers in the
state of Colorado.
The State promises to pay the Contractor the sum of Six Hundred Thirty Thousand,Nine Hundred Twenty-One
Dollars, ($630,921.00) in exchange for the promise of the Contractor to continue to perform the work identified in
the Original Task Order Contract for the renewal term of 12 months, ending on June 30,2011.
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 08-FLA-00184, as amended by Funding Letter#1, contract routing
number 08-FLA-00741,Limited Amendment#1,contract routing number 09-FLA-00019,Grant Funding
Change Letter#2, contract routing number 09-FLA-00951,Contract Amendment#,1 contract routing
number 10-FLA-00019 and Grant Funding Change Letter#3, contract routing number 10-FLA-13559
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:
Page 1 of 3 Rev 3/16/2010
A. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified
by contract routing number 08-FLA-00184. This Amendment is for the renewal term of July 1,
2010,through and including June30,2011. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Six Hundred Thirty
Thousand,Nine Hundred Twenty-One Dollars,($630,921.00)for an amended total financial
obligation of the State of TWO MILLION,TWO HUNDRED EIGHTY-EIGHT THOUSAND
SIX HUNDRED ONE DOLLARS,($2,288,601.00). This is an increase of Six Hundred
Thirty Thousand Nine Hundred Twenty-One Dollars,($630,921.00)of the amount payable
from the previous term. The revised Statement of Work is incorporated herein by this reference
and identified as"Exhibit J". The revised Budget is incorporated herein by this reference and
identified as"Attachment J-1".
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 1,2010 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,BUDGETED,
AND OTHERWISE MADE AVAILABLE.
Page 2 of 3 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: STATE:
BOARD OF COUNTY COMMISSIONERS OF STATE OF COLORADO
WELD COUNTY for the use and benefit of Bill Ritter,Jr.Governor
the WELD COUNTY DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
(a political subdivision of the state of Colorado)
( (0O5‘ Elkit:PctvvC "r By•6ignature ohorized Officer For the Executive Director
MAY 2 4 2010 DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Douglas Rademacher
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
PROGRAM APPROVAL:
By:
II
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.
TATE CONTROLLER
D+vid J.McDersyitt,C'i.
By:
b 13
WELD COUNTY DEPARTMENT OF
Date:
PUBLIC HEALTH AND ENVIRONMENT
BY:
Mark E. Wallace, MD, MPH-Director
Page 3 of 3 Rev 3/16/2010
oW/C—/C9 '
EXIIIfIT.I
STATEMENT OF WORK
To Task Order Contract Dated 03/15/2010-Contract Routing Number 11 FLA 15839
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above.
The revised Statement of work is effective July 1,2010.
I. The Contractor shall coordinate its efforts with the state's NHVP Director,Colorado Department of
Health Care Policy and Financing(HCPF),and the University of Colorado at Denver and Health
Sciences Center(UCDHSC),National Center for Children,Families and Communities(National
Center),and/or subcontractors of the National Center including but not limited to the Nurse-Family
Partnership National Service Office(NFPNSO)and Invest in Kids(11K).
2. The Contractor,in accordance with the terms and conditions of the Master Contract and this Task
Order Contract,shall perform and complete, in a timely and satisfactory manner,all activities and
services related to the Colorado Nurse Home Visitor Program(NHVP). The services provided by the
contractor must be deemed by the state to be acceptable and in good faith. For a service to be
"acceptable"it must comply with all,but not limited to,the items listed below,which arc incorporated
and made part hereof by reference. These documents are located at:
httv://www.cdnhe.state.co.us/ns/nurschome/index.html
• Colorado Nurse Home Visitor Program Act,as described in §25-31-101,C.R.S.
• NHVP Grantee Administrative/Fiscal Requirements
• Rules Concerning the Nurse Home Visitor Program
• NHVP Client Eligibility Verification and Documentation Guidance Document
• NHVP Continuation Grant Application(Progress Report)
• NHVP Client Application
• Medicaid Reimbursement Guidelines
• Federal Poverty Guidelines
• NHVP Audit Recommendations(as applicable)
• NHVP Grantee Caseload Guidelines
• Nurse-Family Partnership Implementation Agreement
3. The Contractor shall submit,but not limited to,the following reports, incorporated by reference.
These documents with corresponding due dates are located at:
ulplx.sia IC co usT.'lljuschome insicghoill
• Expenditure Year-to-Date&Mid-Year Budget Projections Report
• Final Expenditure Report
• Annual Progress Report(included in the NHVP Continuation Grant Application)
4. The Contractor shall perform and complete in a satisfactory manner all activities and services stated in
the annual progress report included in the NHVP continuation grant application which is incorporated
and made part hereof by reference. This document is located at:
http://www.cdphe.state.co.us/ps/nursehome/index.html
5. The Contractor shall complete in a satisfactory manner and by the date listed,all activities stated in the
"Areas Requiring Performance Improvement Plan or Funding Conditions"in the NHVP Award
Summary letter which is incorporated and made part hereof by reference. This document is located at:
http://www.cdphe.state.co.us/ps/nursehome/index.html
6. The Contractor shall ensure that program eligibility is based on the client's income and is not restricted
by age or length of gestation and that all program brochures and referral materials are stated as such.
Page 1 of 3
E.XII1B1f.l
7. The Contractor shall utilize a State provided,linguistically appropriate NHVP Client Application in
which clients document their income or attest that they receive no income as a means of verifying
program eligibility. Client income verification and documentation must be collected and maintained in
accordance with the NHVP Client Eligibility Verification and Documentation Guidance Document.
These documents are incorporated and made part hereof by reference and are located at:
htto://www.cdphe.state.coms/psinursehome/index.html
8. The Contractor shall ensure that clients enrolled in Medicaid and the NHVP are not participating in the
Prenatal Plus Program(PNP)or any other Medicaid prenatal program.
9. The Contractor shall ensure that all nurse home visitors,supervisors and data entry staff complete all
required NFPNSO prerequisites and trainings within the required time frame. At minimum,the
contractor must ensure that the supervisor and nurse home visitors receive the Nursing Child
Assessment Satellite Training(NCAST)materials. The Contractor is responsible for scheduling and
payment of these trainings.
10. The Contractor shall collect data for evaluation purposes,using forms developed by the National
Center and/or its subcontractors. Enter the data collected into the Clinical Information System(CIS)
program,on a monthly basis:taking all appropriate steps to maintain client confidentiality and obtain
any necessary written permissions or agreements for data analysis or disclosure of protected health
information,in accordance with the Health Insurance Portability and Accountability Act of 1996
(HIPAA)regulations,including,but not limited to,authorizations,data use agreements,business
associate agreements,as necessary. The Contractor's failure to comply with any applicable provision
of HIPAA will constitute a breach of this agreement.
II. The Contractor shall participate in meetings or trainings as requested by the State and the UCDHSC.
The Contractor must cover all training costs as applicable.
12. The Contractor shall provide the equipment and supplies needed for program implementation.
13. The Contractor shall provide the nurse home visitor services in accordance with the FY 1011 Final
Approved Budget,attached as Attachment J-I.
14. Funding adjustments may be made during the term of this contract. Grant awards are made using
NHVP funding and Medicaid reimbursement estimates. The total amount of funding for the term of
this contract may not exceed the Total Project Cost Request from the State as provided in the FY 1011
Final Approved Budget,attached as Attachment J-1. If the contractor draws more Medicaid funding,
the state will reduce the NHVP funding. Unless otherwise approved,overages of Medicaid funding in
one fiscal year are reconciled in the subsequent fiscal year. If the contractor draws less Medicaid
funding the state will increase the NHVP funding, if funding is available,during the Mid-Year Budget
Projections process.
15. The State may increase or decrease funds available under this Contract using a Grant Funding Letter
substantially equivalent to Exhibit E of Original Task Order Contract.The Grant Funding Letter is
not valid until it has been approved by the State Controller or designee.
16. The Contractor shall submit Medicaid reimbursement requests for all eligible clients in accordance
with HCPF procedures and the Medicaid Reimbursement Guidelines,which is incorporated and made
part hereof by reference. This document is located at:
http://www.cdphe.state.co.us/ns/nurschome/index.html
17. The Contractor shall provide the state's NHVP administrators and program consultants with reasonable
access to its operations to perform: periodic site reviews,data reviews, fiscal reviews or other
evaluations of the contractor's NHVP program. The contractor shall cooperate during all periodic site
visits,data reviews,fiscal reviews and other evaluations or audits conducted by the State.
Page 2 of 3
EXHIBIT.]
I S. If the State believes in good faith that an activity or service fails to meet the standard for that particular
activity or service,or is otherwise deficient,then the State shall notify the Contractor of the failure or
deficiencies in writing. If the failure or deficiency is programmatic in nature,corrective action shall be
addressed through a Performance Improvement Plan(PIP)or some other method defined by the State.
If the failure is administrative or fiscal in nature,corrective action shall be addressed through an
Action Plan or some other method defined by the State. Due dates for completion of activities listed in
a PIP or Action Plan will be negotiated on a case by case basis.
Page 3 of 3
e,,. Amcort1.t
Agency. Weld County Department of Public Health 6 Environment
Project Name: Nurse Home Visitor Program
SOURCE OF FUNDS -
Annual No of 4 ..—._-._
Salary months TOTAL A.Other 8, Medicaid '''G:'REQUESTED
AMOUNT Sources Estimate'3 ..Ffnm
Rata Budget FIE REQUIRED 9 ,. of Funding.2 ),•CDPHE,(NHVP174 '-`
PERSONAL SERVICES(betel!Expenses)
Personal Services(TNe and Name) _--._.. _ 0
p.....Dana Garver PHN II __----_ 52.547 12 .1..—_..__.._..._52547 ---- -'—' 5764 46783
Kam Hagihara-PHN II Kim.__...12...---1__-_--.. 54161 .._ _ 5944 48237
Gen Holton-PHN Ii 58,922 12 1 58922 6464 52456
Loren Pasillas Office Tech lit_____—__--___ 34,049 -_.12 1 --_—_— 34049 3735 30314
Mane Rowe•Denning-PHN tf -.._ _....._-- .- 58.115, 12--- 1-._..... 58115 .-....----- 6375 51740
Barb Silverman-PHN ft 53.173 12 1 53113 5833 _ 47340
Vesta Urruh-PHN 6_-- .. __. 51423 12 1 53423 -- 5880 47563
Contractual/Fee for Service -- — ----..
0
Supervising Personnel
Barbara Francisco-PHN Program Suiervisor—_--- 44,332 12 0.75 44332 --_ 4863 39469
Fringe Benefits Rate e 35.54% 145267 15936 129331
1ic3t i;i:P IALAIERVICE14,h 1«,• ,bi.431tr IIF.4 - ra r. =r Viii ri
'''';'N'.4....;1'
g..:: `:,,,y...'"4::-tom :.1' i c'-iii\r:_ i ' _,i: ° :-;tisx-;t ;::,
OPERATING(Detail ExPensas) `V��,�.�.Y&t....r.......,• 'gy:::)r-��44It,_. ,f8'�•�-7'w°-"r s I•- r Rx:__e -�. �>''
Office Operating Expenses(i e.suppiles,pens,etc) _„ ,...._ 329•..— 2671
3000
Office Expenses(rent.maim&uliNlies) ---
Postal&Shipping Services --_._..._.. _.__— —__ 1250 _...._._ --,137 .._ 1113
Printing&Publications —•- ----.- _ -•_ __ 3900 . 428. __.3472
Telephone Services(long distance and cellular service) -- __—.___._ —_----- _--4200 .. _---_ 461 3739
Outside Services
Program Expendables(diem materials not printing) 2500 -.- 274, 2226
Coe Support Materials 1210 _791 .. 6419
Computer Network Fees -- ----_ 2000 — -----_— 219 1781
Program Supplies 250O274 2226
smseb.00 $0.00 0.913.00 $23,647.00
EQUIPMENT(Maximum of$2,000.Detail Expenses) - I ' r,.-, "f .,=e.. - s,„.r ...• ':< ' -
Canputers rr Software_.. ._-. —_ -- ---0
_Cellular Phones 15 8 67—..._..- --- __— .....- - -.---
Mood Pressure Monitors 450 49 _ 401
AllittrAtI tI'1.`1s+'P: igij 1iT''".'-'4=s .'411.1,.r.( ar.. - .,n.a'°lr, "> 23:001 $0,00 I $57:00 $44004'
TRAVEL(Detail Expenses) +�
Visit Outreach Mileage 33000— t 3620 29380
NCCFC/UCHSC TrainirgTravei 38 _ _- 4 34
—..._.-- ---- --._._..---._.. . __ 247 27 220
PIPE Travel
Program Meetings(nurses,supervisor o'er —• _ _ _ 1800 197 . '. 1603
Other Travel t
tw4_ :rtlMh,PA•,.Y.li` I•�,—'AtlV�'�.'—_�''�1:.L;s. .- 63SJ(4508 DO - >)~1,A4$-09 8s14:14.00:NFP TRAINING&TECH ASSISTANCE(DeTall Expenses) r 1 t t-
Technical Assistance -_ _ 8559_ --_• 939--— 7620
t3r1-9eirg Nurse Education ---- _ - 1482 163 1319
Mal Nurse Education . . .. ..
Initial Supervisor Education _,__ ---- -- . - ------- 0
Education Materiels ._0 0 0
Professional Development(Limited to$600lnurse) 4200 513 3687
5=1G1tAl;11LMNING11"ECHASS45TAN , : $14,241.00' #0-00 $1,518.05' 512,62600'
NCAST COSTS(Detail NCAST Training d Materials)
NCAST Materials -'--.----- �- —'-'--_ -- -- -_.—._G
PIPE Training Materials --.----- —. .. ...._ C ..- _- ------ .-- -. .._._
.. _. _ —.-
1T:?13701.NGA6T orrti.w.`s�.(t' ::.....: "1 1t ,... ,f,O. � I Soap {0.00. $0.00 i $0.00
OTHER COSTS(Detail Other Program Costs) - ` ... , -_ -• .-.— -- - —"--t'
0
7:TOTAL OTHER COST5. _ _..._-.. _ - , :_10.00 WOO $0.00
'TOTAL DIRECT PROGRAM COSTS(Add budget categories 1-7) $630,423.00 $7.00 $69.207.00 $561.218.00
ADMINSTR ATFVE COSTS(Detail Adminetrative Costs) -
Adnunistrative Serviceske.acc1 ng,adm! it - 78294 8590 69705
Administrative SuppYea3� [^aupp4es}__. ._. _..----... 0 ----... - .. ----
Accountn audK:bank expenses) 0 --- ---- -- ..
Other Administrative Costs 0
TOTAL ADMINISTRATIVE COSTS $78,294.00 $0 00 $8,590.00 $69,705.00
TOTAL PROJECT COSTS IOn.,ct('ii, , adrl4rl;rlehvo Ciao) _ $708,717.00 $0.00, $77,797.00 5630,521.00
Specify"OTHER SOURCES'{gash or in411nd)from the column A.shove.
r---- $
s
Total Other Sources $0.00
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