HomeMy WebLinkAbout20091180.tiffDate of signature
RESOLUTION
RE: APPROVE CONTRACT AMENDMENT #2 FOR FAMILY PLANNING 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 Contract Amendment #2 for the Family
Planning 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, 2009, and ending June 30, 2010, with further terms and conditions being as stated in said
contract amendment, and
WHEREAS, after review, the Board deems it advisable to approve said contract
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 Contract Amendment #2 for the Family Planning 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 contract amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 20th day of May, A.D., 2009.
ATTEST:
BOARD OF COUNTY COMMISSIONERS
WFcLD Cr', COLORADO
\liam F. Garcia, Chair
Weld County Clerk to'the o g.
BY
Pro-Tem
Deputy • erk to the Board
APPROVED AS TO FORM:
, arb Kirkmeyer
°SU- .C
David E. Long
( C: ttzc_ 3� 5�
2009-1180
HL0036
C36/lf�G'`l
a@rn
COLORADO
Memorandum
TO: William F. Garcia, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment W/L, �2c4
DATE: May 5, 2009
SUBJECT: Amendment #2 to Contract for the Family
Planning Program
Enclosed for Board review and approval is Amendment #2 to the contract between the Colorado
Department of Public Health and Environment (CDPHE) and Weld County for continuation of a
comprehensive family planning program.
Under the provisions of this amendment, Weld County Department of Public Health and
Environment will provide contraceptive services to both men and women in their reproductive
years. These services will include comprehensive health and social histories, physical
examinations, contraceptive information, and supplies. Education and counseling regarding
family planning, infertility, sterilization, nutrition, sexually transmitted diseases, and follow-up
and/or referral services will also be provided. The amendment also contains new provisions
concerning the monitoring of vendor performance on state contracts and inclusion of contract
performance information in a statewide contract management system.
For the above services, Weld County will be reimbursed an amount not to exceed $181,115 for
the time period July 1, 2009 through June 30, 2010. Of this amount, $119,918 are federal pass
through funds and $61,197 are from the State of Colorado. I recommend your approval of this
task order.
Enclosure
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2009-1180
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD - FPP
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
10-00044
CONTRACT AMENDMENT #2
THIS AMENDMENT, made this 17th day of April, 2009 by and between the State of Colorado for the use and
benefit of 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), whose address or principal place of business is 915 — 10th Street, Greeley, Colorado 806M for
the use and benefit of the WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,
whose address or principal place of business is 1555 North 17th Avenue, Greeley, Colorado 80631, hereinafter
referred to as "the Contractor".
FACTUAL RECITALS
Authority exists in the Law and Funds have been budgeted, appropriated, and otherwise made available and a
sufficient unencumbered balance thereof remains available for payment; and
Required approval, clearance, and coordination has been accomplished from and with all appropriate agencies; and
The parties entered into a Master Contract, dated December 19, 2006 with contract routing number 08 FAA 00052.
Pursuant to the terms and conditions of the Approved Task Order Contract, the parties entered into a Task Order
Contract, dated April 20, 2007, with contract encumbrance number PO FLA FHS0800081, and contract routing
number 08 FLA 00081, whereby the Contractor was to provide to the State the following:
Contractor shall conduct a comprehensive family planning program.
The purpose for this amendment is described below.
To renew the contract for one year, to modify the Additional Provisions and the Statement of Work
and to incorporate a new provision to the General Provisions of the Task Order Contract,
concerning the monitoring of vendor performance on state contracts and inclusion of contract
performance information in a statewide contract management system.
NOW THEREFORE, it is hereby agreed that
1. Consideration for this amendment to the original task order contract, dated April 20, 2007 with contract
routing number 08 FLA 00081 and contract encumbrance PO FLA FHS0S00081, consists of the payments
which shall be made pursuant to this amendment and the 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 00081 as amended by Contract Amendment # I, Contract
Routing Number 08 FLA 00656, and Limited Amendment for Task Orders #1, Contract Routing Number
Page 1 of 4 rev 4/3/09
0Coq- IIgG
09 FLA 00044, and Grant Funding Letter # 1, Contract Routing Number 09 FLA 00771, collectively
referred to herein as the Original Task Order 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 agreed 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 08 FLA 00081 This Amendment is for the renewal term of July 1,
2009, through and including June 30, 2010. Exhibit A, Additional Provisions, of the Original
Task Order Contract is hereby revised for the renewal term and incorporated herein by this
reference and identified as Exhibit H.
B. The maximum amount payable by the State for the work to be performed by the Contractor during
this renewal term is One Hundred Eighty -One Thousand, One Hundred Fifteen Dollars.
($181,115.00) for an amended total financial obligation of the State of FIVE HUNDRED
SEVENTY-SIX THOUSAND, NINE HUNDRED FIFTY-TWO DOLLARS, ($576,952.00).
This is an increase of One Hundred Eighty -One Thousand, One Hundred Fifteen Dollars.
f$181,115.00) of the amount payable from the previous term. The revised specification to the
original Statement of Work for this renewal term is incorporated herein by this reference and
identified as Exhibit I. The revised Budget for this renewal term is incorporated herein by this
reference and identified as Attachment 1-1. The Original Task Order Contract is modified
accordingly.
C. The General Provisions of the Contract are hereby modified to incorporate the following language:
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the
provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102
concerning the monitoring of vendor performance on state contracts and inclusion of contract
performance information in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this
Task Order Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies
and Guidance. Evaluation of Contractor's performance shall be part of the normal contract
administration process and Contractor's performance will be systematically recorded in the
statewide Contract Management System. Areas of review shall include, but shall not be limited to
quality, cost and timeliness. Collection of information relevant to the performance of Contractor's
obligations under this Task Order Contract shall be determined by the specific requirements of
such obligations and shall include factors tailored to match the requirements of the Statement of
Project of this Task Order Contract. Such performance information shall be entered into the
statewide Contract Management System at intervals established in the Statement of Project and a
final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term. Contractor shall be notified following each performance and shall address or correct any
identified problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to
meet the performance measures established under the Statement of Project, the Executive Director
of the Colorado Department of Personnel and Administration (Executive Director), upon request
by the Colorado Department of Public Health and Environment, and showing of good cause, may
debar Contractor and prohibit Contractor from bidding on future contracts. Contractor may contest
the final evaluation and result by: (i) filing rebuttal statements, which may result in either removal
or correction of the evaluation (CRS §24-105-102(6)), or (ii) under CRS §24-105-102(6),
exercising the debarment protest and appeal rights provided in CRS §§24-109-106, 107, 201 or
202. which may result in the reversal of the debarment and reinstatement of Contractor, by the
Executive Director, upon showing of good cause.
Page 2 of 4 rev 4/3/09
•
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 upon approval of the State Controller or July 1, 2009, whichever is
later.
5. Except for the "Special Provisions", in the event of any conflict, inconsistency, variance, or contradiction
between the provisions of this amendment and any of the provisions of the original contract, the provisions
of this amendment shall in all respects supersede, govern, and control. The "Special Provisions" shall
always be controlling over other provisions in the contract or amendments. The representations in the
Special Provisions concerning the absence of bribery or corrupt influences and personal interest of State
employees 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 3 of 4 rev 4/3/09
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 for the use and benefit of the
WELD COUNTY DEPARTMENT OF PUBLIC
HEALTH AND E RONMENT
(a pali(iyftU Ivi ' n of the state of Colorado)
Signature of Authorized Officer MAY 2 (1 2009
William F. Garcia
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
STATE:
STATE OF COLORADO
Bill Ritter, Jr. Governor
By:
PROG
By:
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Signatory avers to the State Controller or
that Contractor has not begun performance or
that a Statutory Violation waiver has been
requested under Fiscal Rules
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.
ATE CONTROLL , R
id J. McDer , ott
By:
nKevin Edwards (Yvonne Anc�krson
Date:
IRobert Jaros
onald Rieck
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMT
Page 4 ofWjVrev 4/3/09
Mark E. Wallace, MD, MPH -Dire
& 2-//si
EXHIBIT H
ADDITIONAL PROVISIONS
To Task Order Contract Dated 04/17/09 - Contract Routing Number 10 FLA 00044
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
The revised Additional Provisions are effective July 1, 2009.
1. This Task Order Contract contains federal funds (see Catalog of Federal Domestic Assistance (CFDA)
number 93.217)
2. The United State Department of Health and Human Services ("US DHHS"), through the Colorado General
Assembly has awarded federal funds, hereinafter "Award", to perform — a comprehensive family planning
program. The State has formulated a comprehensive State plan, with associated budgets, to disburse these
funds throughout the state of Colorado. Under this comprehensive State plan, the State shall allocate these
funds to qualified entities to provide comprehensive family planning services to the citizens of the state of
Colorado on behalf of the State.
If the underlying Award authorizes the State to pay all allowable and allocable expenses of a contractor as
of the effective date of that Award, then the State shall reimburse the Contractor for any allowable and
allocable expenses of the Contractor that have been incurred by the Contractor since the proposed effective
date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable
and allocable expenses of a contractor as of the effective date of that Award, then the State shall only
reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by
the Contractor on or after the effective date of this Task Order Contract, with such effective date being the
later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the
State Controller or delegee.
3. To receive compensation under this Task Order Contract, the Contractor shall submit a signed Monthly
Family Planning Program (FPP) Cost Reimbursement Statement in a format acceptable to the State. A
FPP Cost Reimbursement Statement is incorporated and made part hereof by reference. This document
is located at: Illti)::',WWW,.ectibc.state.co.tis.,p_p/womens TPNursingC onsntsForms.html?colt—open. A FPP
Cost Reimbursement Statement must be submitted within sixty (60) calendar days of the end of the billing
period for which services were rendered. FPP Cost Reimbursement Statements must be accompanied by
detailed cost ledger to reflect all purchases being invoiced under that contract and should include date of
payment, payee name and amount, and check or voucher number, when available. Expenditures shall be in
accordance with the Statement of Work attached hereto as Exhibit I. These items may include, but are
not limited to, the Contractor's salaries, fringe benefits, supplies, travel, operating, indirect costs which are
allowable, and other allocable expenses related to its performance under this Task Order Contract.
FPP Cost Reimbursement Statements shall: I) reference this Task Order Contract by its contract routing
number, which is located on page one of this Task Order Contract; 2) state the applicable performance
dates; 3) state the names of payees; 4) include a brief description of the services performed during the
relevant performance dates; and, 5) show the total requested payment. Payment during the initial, and any
renewal or extension, term of this Task Order Contract shall be conditioned upon affirmation by the State
that all services were rendered by the Contractor in accordance with the terms of this Task Order Contract.
FPP Cost Reimbursement Statements shall be sent to:
Serafin Diaz, Fiscal Officer
Family Planning Program
Prevention Services Division
To be attached to CDPHE
Task Order v1.0 (11/05) contract template
Page 1 of 3 Revised: 12/19/06
EXHIBIT H
Colorado Department of Public Health and Environment
PSD - A4
4300 Cherry Creek Drive South
Denver, CO 80246
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.
4. The Contractor is authorized to make limited transfers of funds from one line item in its Budget to another
line item in its Budget but must notify the Program Director by email prior to the transfer. A transfer from
one line item to another line item may not exceed ten percent (10%) or One Thousand Dollars ($1000),
which ever is less, of the total amount of the line item from which the transfer is made unless prior written
approval is received from the Program Director. If the Contractor desires to transfer more than ten percent
(10%) or One Thousand Dollars ($1000), which ever is less, from one line item in its budget to another line
item in its budget then the Contractor shall request and receive prior written approval from the Program
Director by completing and submitting a Budget Revision Request Form, incorporated and made part
hereof by reference. This document is located at:
hop: we .cdphe.stateco.us pp womensll ONursingCon sutstorms.htmlico12=open.
5. The services or activities under this Contract may be carried out by the Contractor, or through subcontracts
with other providers or, through collaborative partnerships with other community partners. The State
authorizes the Contractor to subcontract some, or all, or the services that are to be performed under this
Contract. However, a subcontractor is subject to all of the terms and conditions of this Contract.
Additionally, the contractor remains ultimately responsible for the timely and satisfactory completion of all
work performed by any subcontractor(s) under this Contract. If the Contractor desires to subcontract some,
or all, of the services that are to be performed under this Contract, the Contractor shall obtain the prior,
express, written consent of the State before entering into any subcontract. The Contractor shall maintain, at
a minimum a Memorandum of Understanding or other binding contractual agreement, and provide a copy
to the Family Planning Program Director fifteen (15) calendar days from the date the agreement is
executed. The Contractor shall maintain records of any subcontractors for a minimum of three years.
6. The Contractor shall comply with section 1001 of the federal Act and all applicable federal regulations, as
amended, contained in Title X, 42 C.F.R., Subpart A, Part 59, as well as all applicable state regulations.
7. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination. The
State has determined that this contract does not constitute a Business Associate relationship under HIPAA.
8. Under this Task Order Contract, the Contractor shall refer families participating in any and all programs in
its agency such as WIC, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Immunization
Clinics, HCP, Prenatal Plus (PNP), etc. to appropriate enabling and direct care service programs in the
community. All pregnant women in need of resources for prenatal medical care are provided with
information about programs such as WIC. PNP, etc. as needed; all children ages birth through two years
who may be eligible for early intervention services are referred to Early Intervention Colorado.
9. Under this Task Order Contract, the Contractor shall assure clients age twenty (20) and under and families
with children in need of EPSDT care coordination are referred to county Early and Periodic Screening.
Diagnosis and Treatment (EPSDT) Medicaid Navigators via written or telephone referral.
10. The State may require forms attached to this contract and incorporated herein by reference by updated
during the term of this contract. The Contractor will be informed of the new forms as they are developed.
Forms may be sent to contractors or will be available on the Family Planning Administrative Manual
website: hop:'iit ww vc.edphc.state co.us'pp women,:
To be attached to CDPHE
Task Order v1.0 (11/05) contract template
Page 2 of 3 Revised: 12/19/06
EXHIBIT H
11. Notwithstanding anything herein to the contrary, the parties understand and agree that all terms and
conditions of this Task Order Contract and the exhibits and attachments hereto which may require
continued performance, compliance or effect beyond the termination date of this Task Order Contract shall
survive such termination date and shall be enforceable by the State as provided herein in the event of such
failure to perform or comply by the Contractor.
To be attached to CDPHE
Task Order v1.0 (11/05) contract template
Page 3 of 3 Revised: 12/19/06
EXHIBIT I
STATEMENT OF WORK
To Task Order Contract Dated 04/17/09 - Contract Routing Number 10 FLA 00044
These provisions are to be read and interpreted in conjunction with the provisions of the 1 Order Contract specified above. The
revised Statement of Work is effective July 1, 2009.
1. The Contractor shall conduct a comprehensive family planning program ("the program") in Weld County. This
program shall comply with section 1001 of the federal Act and all applicable federal regulations, as amended,
contained in Title X, 42 C.F.R., Subpart A, Part 59, as well as all applicable state regulations. (Federal funding
from HHS, CFDA #93.217 FP Services). The funding for this program will be spent in accordance with the
Budget attached hereto and referred to as Attachment I-1.
2. The Contractor shall make its program available to men and women in their reproductive years and shall offer
the following services, as appropriate:
A. Outreach services and/or other program efforts designed to improve client recruitment;
B. Nursing and medical services, which shall include a comprehensive health and social history and
physical examination administered in accordance with all applicable Title X regulations and, all
applicable nursing -medical policies or procedures which have been, or may be, established by the
State's Women's Health Unit ("WH");
C. Contraceptive information, education, and supplies regarding all family planning methods;
D. Education and counseling services regarding family planning, family planning methods, child spacing,
infertility, sterilization, nutrition, sexually transmitted diseases, HIV/AIDS, adolescent counseling and
other related health issues, as outlined in the Nursing and Administrative Manual;
E. Follow-up and/or referral services, as appropriate.
3. The services provided by the Contractor to the clients it serves shall be performed pursuant to law in accordance
with prevailing medical standard of care for the same or similar medical, nursing and professional services. The
services provided shall also comply with applicable Title X regulations, WHU nursing -medical policies and
procedures, and any applicable fiscal or administrative policies of the State or Federal government which can be
located at http www.cdphc.state co us ppiwinncns famplan.hunl'ico12 open. Contractor acknowledges that it
has reviewed these policies and procedures.
4. The services provided by the Contractor must be deemed acceptable, in good faith, by WH. For a service to be
"acceptable" it must comply with all applicable: Title X regulations, WH nursing -medical policies and
procedures, and any applicable fiscal and administrative policies and procedures of the State and Federal
government. All applicable Title X regulations, WH nursing -medical policies and procedures, and all
applicable fiscal or administrative policies of the State have been provided to the Contractor by the State as of
the effective date of this Contract.
5. The Contractor shall provide the State's family planning program consultants and administrators with
reasonable access to its operations to perform: periodic site reviews, data reviews, fiscal reviews or other
evaluations of the Contractor's family planning program. Evaluations of the Contractor's program shall be
based on established standards and policies of the State or the Federal government. The Contractor shall
cooperate during all periodic site visits, data reviews, fiscal reviews or other evaluations conducted by the State.
The established standards and policies for the Family Planning Program can be located in the Family Planning
Administrative Manual and the Family Planning Nursing Manual located on the Family Planning website at
http://www.cdphe.state.co.us/op/womens/famolan.html.
To be attached to CDPHE
Task Order v1.0 (11/05) contract template
Page 1 of 3 Revised: 12/19/06
EXHIBIT I
6. If necessary, the Contractor shall comply with all recommendations made by the State's family planning
program consultants and/or administrators after a periodic site visit, data review, fiscal review or other
evaluations that are necessary to bring its program into compliance with all applicable federal and state laws,
policies and regulations. The Contractor shall be in full compliance with a recommendation, if any, within three
(3) months of the date a recommendation is made by the State. If the Contractor cannot obtain full compliance
within this three (3) month period, then on or before the expiration date of that three (3) month period the
Contractor shall present sufficient written evidence to the State: to show that continuing progress is being made
towards full compliance; and, the date when full compliance shall occur. In no event, however, shall full
compliance with a recommendation occur any later than six (6) months after the date that a recommendation
was initially made by the State. If the Contractor fails to correct such deficiencies, the Contractor shall be in
default of its obligations under this Task Order Contract and the State, at its option, may elect to withhold
payment or terminate this Task Order Contract or the Master Contract and all Task Order Contracts entered into
pursuant to the Master Contract. Notwithstanding the foregoing provisions, the State may disregard these cure
periods and immediately terminate the contract without liability if it has solely determined that Contractor's
noncompliance places the health, safety or welfare of persons receiving services in jeopardy.
7. On a monthly basis, the Contractor shall collect and provide to the State, by the fifteenth calendar day of the
following month, all pertinent data regarding all services offered, and all family planning clients served, by its
program during the preceding month, submitted through the IRIS data system. This data shall be verified on a
quarterly basis to help assure accuracy. The Contractor must adhere to the Data Security, Use and
Confidentiality Agreement, incorporated and made part hereof by reference. This document is located at:
http:.cdphe.statc co us PP. omensTYNursingCou.,nisl onns.html?col"_'-open.
8. Within thirty (30) calendar days of receipt of a written request from the State, the Contractor shall submit
nursing -medical chart audits to the State.
9. The Contractor shall only use program income generated from client fee collections and donations for family
planning purposes that further the objectives of the legislation under which this Contract is entered into. In
accordance with Title X guidelines, the Contractor shall not charge for any Title X required services provided to
clients who are at or below 100% of the official poverty line as defined by the Federal Register by the U.S.
Department of Health and Human Services under the authority of 42 U.S.C. 9902 (2). A copy of this guideline
has been provided to the Contractor by the State as of the effective date of this Contract. If the State receives
new poverty guidelines during the term of this Contract, then the State shall immediately forward those new
poverty guidelines to the Contractor. The Contractor shall use these new poverty guidelines, if any, upon
receipt thereof from the State.
10. The Contractor's charges for services to clients who are above 100% of poverty level shall be based on a sliding
fee scale that takes into account a client's family size and/or individual income. These charges and the sliding
fee scale shall be made available to all clients of the Contractor, the general public, and the State. This most
current version of this document is available on the Family Planning website
(http:!'w v+w.cdphcstate.co.usiPk) womcn,!I ederall'oaertvGui delines.html). Charges shall be based upon the
Contractor's actual costs to provide these services as determined by a cost analysis. The Contractor and the
State shall review these costs annually. The Contractor shall insure that all clients understand that they will not
be denied services because of an inability to pay any of the Contractor's sliding fee charges.
11. All money received by the Contractor from the State under this Contract shall be used by the Contractor to
provide contraceptive services to approximately 1,869 target family planning clients (fertile clients
receiving contraceptive services).
12. The Contractor shall either use a cytology laboratory chosen by the State or, a laboratory proposed by the
Contractor and approved by the State.
To be attached to CDPHE
"rask Order v1.0 (11/05) contract template
Page 2 of 3 Revised: 12/19/06
EXHIBIT I
13. During the term of this Contract, the Contractor agrees to provide the State with the semi-annual Family
Planning Expenditure/Revenue Reports, incorporated and made part hereof by reference. This document is
located at: hop: www.cdphe state co usmp/w omens'FPNursint( onsntsForms.hunl?colt -open. The first report
is for the months of July through December will be due no later than February 5; the second report is for the
months of January through June and will be due no later than August 6.
14. During the term of this Contract, the Contractor agrees to provide the State with an Annual Family Planning
Work Plan and to submit semi-annual work plan progress reports.
15. The Contractor shall protect the confidentiality of all client records and other materials that are obtained,
created, or maintained by the Contractor under this contract. Except for purposes directly related to the
administration of this contract, no information about, or obtained from, any client shall be disclosed by the
Contractor in any form that would identify that client without the prior written consent of that client. As of the
acceptance date of this contract by the Contractor, the Contractor shall have written policies governing the
access to and, the duplication and dissemination of, all such information. The Contractor shall advise its
directors, officers, employees, agents, servants, and subcontractors, if any, that they are subject to these
confidentiality requirements.
16. The Contractor shall participate in meetings or trainings as requested by the State.
17. Funding adjustments may be made during the term of this contract. The State makes funding adjustments on
this contract using a Funding Letter substantially equivalent to Exhibit G and bearing the approval of the State
Controller or his designee; the funding letter shall not be deemed valid until the State Controller or his designee
has approved it.
To be attached to CDPHE
Task Order v1.0 (11/05) contract template
Page 3 of 3 Revised: 12/19/06
Attachment I-1
FAMILY
APPLICANT:
FOR THE PERIOD:
PLANNING ABUDGET
Weld Count} Department of
Environment
July 1, 2009 June 30, 2010
Public Health &
PLEASE ROUND ALL
FIGURES TO THE
NEAREST DOLLAR
Salary
"/o Time
FTE
CDPHE-WHU
JULY I -DEC
30,2009
TITLE X -
FEDERAL
CDPIIE-WHU
JAN 1 - JUNE
30,2010
STATE
PERSONNEL EXPENSES:
Office Technician II
Office Technician III
Medical Assistant
Medical Assistant Supervisor
Office Manager
Public Health Nurse I
Public Health Nurse Ill
PHN Supervisor
Health Comm_ Spec. II
Nurse Practitioner
$ 14,082
$ _ 49.749
$ 67.053
$ 26.299
$ 20.707
$ 34-223
$ 17,247
,93
5 18,935
$ 15,995
$ 201,846
$ 73,417
$ 9.274
0.52
1.50
1.90
$ 13,410
$ 6.706
0.70
$ 5,260
$ 2,630
0.40
0.70
030
6,845
3.422
3.450
1,725
030
030
2.45
0.80
0.10
3,786
1,894
40.369
20.185
Nurse Practtioner Supervisor
Director Public Health Nursing
14.685
7.342
1.855
927
,:SUIFIDS
$
$T. ' Qo$ #
,;; 7t $, 7
$ 89,660
$ 44.831
Fringe Benefit Rate and Expenses
35 54%
$ 195,053.00
15.604
13.653
:. Tetgi Pasenuet.E%IMnse1 S' 54U27
S t9S 0 2.00
$105164
$58,484
CONTRACTUAL: (Independent contractor for
physicians, nurse practitioners,
Women's Clinic Greeley (Tuba' oci lu ionS)
Ratllolyy I ISG post tubnl
WC IID referral fees for sterilization procoduies
lab services,
etc)
Totato(Clmaachsal E*penaes
$0
SO
OPERATING:
Comracepdve methods
Training costs- which includes registration fen,
Lab tests
Educational materials (brochures, etc)
Clinical supplies
Orrice operatingsu patios (papers, charts, pens, etc)
Office expense (rent, utilities, maintenance)
OTIIER (Specify) Media ---
"'. Electrronic )ledical records and Computer Support
North Colorado Alliance membership
_.... _....... _.....
I
travel)
I
6.508
642
4,000
i
.
I
Mileage
:- TetaiofOperatiagE8119tOsS
$10.508
$642
EQUIPMt, NT: (Computers, Office furnitures)
.: :: '. Tu'fat ot'Fgdfpmeut Ewweasa
I'
t`OtAl.ii ARIcT%XPENSE$:
$115,772
$59,126
INDIRECT:
Indirect rate: 14.81 :Indirect Expense
4,146
2,071
ADMINISTRATIVE (10% CFPI Expansion Grant)
ONE-TIME EXPENSE (For CFPI Expansion Grant only)
TOTALAMODNTREQUE$TED
$119,918
561,197
Family
Planning Total $151,115.00
Page 1 of 1
STATE OF COLORADO
Bill Ritter, Jr., Governor
James B. Martin, Executive Director
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
TDD Line (303) 691-7700
Located in Glendale, Colorado
http://www.cdphe.state.co.us
Prevention Services Division
Center for Healthy Families and Communities
Telephone: (303) 692-2370; FAX: (303) 782-5576
July 9, 2009
Laboratory Services Division
8100 Lowry Blvd.
Denver, Colorado 80230-6928
(303) 692-3090
Ms. Judy Nero
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
Re: FPP Contract Amendment #2
Contract Routing Number 10-00044
Dear Ms. Nero:
Colorado Department
of Public Health
and Environment
Enclosed please find a fully executed copy of the above referenced Contract Amendment #2 for your files.
The additional funding awarded through this contract should be spent between the dates of July 1, 2009 and
June 30, 2010.
Please review your contract 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 Judith Crotser, Family
Planning Director at ludith.crotser(W,state.co.us or 303-692-2301 or Laura Lippman, Fiscal Officer at 303-
692-2357 or lauraiippman(Mstate.co.us.
Sincerely,
Natalie S' , r 1; \9ampbell
Contract • Manger
Center for th Families & Communities
Enclosure (1)
Do c1-IISU
Hello