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Home My WebLink About20090474.tiffRESOLUTION RE: APPROVE CHAPTER GRANT AGREEMENT FOR PRENATAL NUTRITION EDUCATION CLASSES AND AUTHORIZE CHAIR TO SIGN - MARCH OF DIMES BIRTH DEFECTS FOUNDATION 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 Chapter Grant Agreement for Prenatal Nutrition Education Classes 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 March of Dimes Birth Defects Foundation, commencing January 1, 2009, and ending June 30, 2009, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, 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 Chapter Grant Agreement for Prenatal Nutrition Education Classes 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 March of Dimes Birth Defects Foundation be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 23rd day of February, A.D., 2009, nunc pro tunc January 1, 2009. BOARD OF CO COMMISSIONERS WELDrQ UNT ORADO ATTEST: I Weld County Clerk to the BY. /.ILI Depu Cler . the Board, APP • V' I AT -O' = ' M: ounty attorney Date of signature- 3ibt09 Sean P.Conway fbara Kirkmeyer cl—)David E. Long l acher, Pro-Tem a- co : f -LC. -=.20 2009-0474 HL0036 COLORADO Memorandum To: William F. Garcia, Chair Board of County Commissioners From: Mark E. Wallace, MD, MPH, Director Department of Public Health & Environment Date: February 20, 2009 Subject: Contract for Prenatal Education Classes in High School Enclosed for Board review and approval is a contract between March of Dimes Colorado Chapter and the Weld County Department of Public Health and Environment for prenatal education classes in high school. This contract was discussed at the Board's Worksession of February 12, 2009. With approval of this contract, the Department of Public Health and Environment will be reimbursed an amount not to exceed $3,000 for providing prenatal education classes in ten high schools in Weld County. The March of Dimes, Colorado State Chapter, has awarded the Weld County Department of Public Health & Environment with a chapter community grant award (award letter received 1/26/09) to implement "Partners Collaborate to Offer Free Prenatal Nutrition Education Classes to High School Students in Weld County School District Six". The proposal has been approved in the amount of $3,000.00 for a one-year time period of January 1, 2009 to December 31, 2009. The WCDPHE Prenatal Program staff will collaborate with local partners including the University of Northern Colorado, Weld County School District 6, and the Expanded Food and Nutrition Education Program (EFNEP), administered through Colorado State University, to offer free prenatal nutrition education classes for pregnant teens within ten high schools in Weld County. The March of Dimes health education materials will be used, including the Pregnancy Workshop and Comenzando Bien curricula. Other March of Dimes materials to be used include: Folic Acid is Good For Me, Eating Healthy, Smoking During Pregnancy, Drugs and Pregnancy, Alcohol and Pregnancy, and Becoming a Dad brochures along with recipes from the Teen Parents curriculum (used by EFNEP) to teach teens how to prepare healthy snacks and meals. The award money will be used to purchase the March of Dimes curricula and brochures, class folders and labels, food items for in -class preparation, and incentives/rewards for teen moms. The classes are aimed at educating teen moms about the importance of prenatal nutrition education to improve birth outcomes. The goal of the project directly collaborates with the March of Dimes' mission to improve the health of babies by preventing birth defects, premature birth and infant mortality. The source of funding is private. I recommend your approval of this contract. Enclosure 2009-0474 MARCH OF DIMES BIRTH DEFECTS FOUNDATION CHAPTER GRANT AGREEMENT Grantor (March of Dimes Chapter): Colorado Address: 1325 South Colorado Blvd., B-508 Denver, CO 80222 Grantee: Weld County Department of Public Health and Environment Contact Person: Kristin Dodge, MPH Address: 1555 N. 17th Avenue , Greeley, CO 80631 Phone #: 970-304-6420, ext 2300 Grant Award: $3000 Grant Period: 01-01-09 to 12-31-09 Project Name and General Description: Partners Collaborate to Offer Free Prenatal Nutrition Education Classes to High School l Students in Weld County School District Six Contact Person:'' Scott D. Matthews Phone #: (303) 692-0011 ext. 304 Congratulations on your Grant Award! We have listed below specific guidelines all March of Dimes Grant Award recipients must follow. The award of grant funds for your project (the "Project") is contingent upon your agreement to comply with these guidelines: 1. Grant Announcement and Publicity. Grantee must submit a press release announcing the receipt and purpose of the Grant Award (the "Grant") to the March of Dimes Chapter for our review and approval. Our communications staff will assist you in developing a suitable press release and will make recommendations to you for its distribution. You may be requested to attend a photo session for presentation of the Grant Award. We may request you or representatives of the Project to participate as speakers at March of Dimes events, such as fundraisers, educational conferences, press conferences, March for Babies promotions, volunteer leadership meetings, etc. Participation is not mandatory. 2. Grant Application. The Grant Application and supporting documentation that you submitted to the March of Dimes is the basis for your Grant and is incorporated by reference into this Grant Agreement. 3. Payment and Audit. You will receive 50% of your Grant on or before January 31, 2009 and the remaining 50% upon approval of your progress report. You agree to use the Grant for the Project described in the Grant Application unless prior written approval is received from our Program Service Committee. We may review or audit any charges to the Project related to the Grant and may require you to refund the Grant if you improperly expend any portion of the Grant. Also, we may require you to refund the Grant if you fail to fulfill mutually agreed upon Project objectives or promises you have made in this Agreement 4. Reporting. You will give us at least one written progress and expenditure report summarizing the Project's progress and expenses, and evaluating its overall success. You will give us additional reports that we reasonably request. You agree to cooperate with us in connection with the Project. We may make visits to your site, but you will be contacted in advance to schedule visits. 5. Materials Development, Ownership and Licensing. All rights, title and interest in materials ("Works") developed under this Grant shall be owned by you. You hereby grant to the March of Dimes a royalty free irrevocable world- wide license in perpetuity to reproduce, publish or otherwise use and authorize others to use the Works created under this Grant. [Grantees developing public or professional education products or other materials with support from this Grant must submit copies of those Work(s) to the Chapter for review and approval prior to their final production and distribution.] You will give us credit on all Works developed under this Grant. The credit you are required to give us must say "Funded by a Community Grant from the March of Dimes". All Works consisting of medical, or educational materials developed under the Grant also must be imprinted with a disclaimer that says: "This material is for information purposes only and does not constitute medical advice. The opinions expressed in this material are those of the author(s) and do not necessarily reflect the views of the March of Dimes". 6. Academic and Professional Publication Rights and Credits. Each of us may exercise publication rights and privileges in connection with professional or academic papers or other writings it may develop in connection with the Works, project activities, findings and data relating to this Grant. The one of us who publishes will give the other a credit for the other's contribution on any such publication. Effective 1/02; Revised 11/03 ERROR! UNENOWN DOCUMENT PROPERTY NAME. March of Oimes Grantee Agreement 2006, page 2 7. Trademarks. Except as provided under Paragraphs 5 and 6 above, neither of us may use the others name, logo, project (or program name), or any of its other trademarks (or service marks) without first obtaining the other's written approval. 8. Directive Advice. You agree not to give directive advice concerning abortion, as part of a March of Dimes funded Project. 9. Insurance and Compliance. You promise to maintain insurance coverage in an amount that is not less than the coverage customarily maintained by someone engaged your activities. You also promise to comply with all laws and regulations that apply to you and the project, and pay all of your own license fees and taxes. Each of us agrees to comply with the Health Insurance Portability and Accountability Act of 1996 and its privacy rules and all other laws regulating patient privacy and other patient rights. We will cooperate with each other in complying with these rules and regulations. 10. Indemnification. To the maximum extent permitted by law, you agree to indemnify and hold us and all of our officers, directors, employees, and [Trustees] harmless from and against all liability, damage or expense (including reasonable attorneys' fees) which we may incur as a result of your acts or omissions, or those of any of your employees, consultants, contractors or agents, in connection with the Project or any breach by you this Agreement. 11. Assignment. Except as expressly permitted under the Grant Application, you shall not assign this Grant Agreement or subcontract work in connection with the Project without our prior written approval. All permitted subcontract agreements entered into between you and any subcontractor in connection with this Grant must obligate the subcontractor to comply with the terms of the Grant Agreement and act in a manner consistent with the Grant Application. 12 Defunding, Termination and Survival. Your Grant is subject to the availability of funding and we may terminate or modify your Grant if funding is discontinued or reduced. This Grant Agreement also may be terminated by us if you improperly expend funds that you are provided under this Grant Agreement or you fail to fulfill mutually agreed upon Project objectives or promises. We also may terminate this Grant Agreement if there are adverse changes in your business circumstances, capacity, fiscal stability, or if any Grant related applications, forms or other documentation have been falsified. If this Grant Agreement is terminated, you will promptly return to us a total amount equal to all improperly expended funds plus all unexpended funds- Paragraphs 3, 5, 6 and 10 shall survive the term of this Grant Agreement 13 Headings. The headings used in this Grant Agreement are for convenience only and are not intended to have any legal effect. 14. Entire Agreement. This Grant Agreement is the entire agreement between us and may be modified only in a written document that has been signed by both of us. READ AND AGREED TO: Grantor. By: State Director undation Grantee (O ani By: ( Shelly Goodchild, Colorado State Director Please PNp� R//// 1V1e a Tile Dated: Dated: Weld County. Coloradn Signature William F. Garcia, Chair, Board of Commissioners Please Print Name and Title ,2009 Dated: February 23 ,2009 Federal I.D. No.: 84-6000-813 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT BY: [\ACvrkl((,�.�-��`ttt� Mark E. Wallace, MD, MPH - Director &Co -O'17 if Form 1N_9 (Nev. November 1999) rN:panmantot the treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give form to the requester. Do NOT send to the IRS. Please print or type Name (if a joint account or ycu changed your name. see Specific Instructions on page 2.) Business name, if different Irom above. (Sec Specific Insuuctions on page 2.) Chock appropriate box: • IndividuaIlSnie proprietor 0 Corporation O Partnership [] Other ► Address (number, street. end apt. or suite no.) Requester's name and address :(optional) City. state, and ZIP code Part 1 Taxpayer Identification Number (TIN) List account numborisl here topnonal) Enter your TIN in the appropriate box. For ind viduals, this is. your.social security number (SSW .However, if you are a resident alien OR a sole proprietor, see the instructions on page 2. social security number II I i ! t I For other entities. it is your employer Part it For Payees,Exempt From Backup. identification number (EIN). If you do not have a OR number, see How to TIN 2. Withholding (See the instructions get a on page Note: If the account is in more than one name, Employer identification earnest on page 2.) seethe chart on page 2 for guidelines on whose II I I t t 1 IMI number to enter. e•ilimmim ertification Under.penalties of perjury, I certify teat: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 em'rot,subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue. Service ORS) that i am subject to backup withholding as a result of a failure to report all interest or dividends, or (c)dhe iRS has notified me that i am no longer subject to backup withholding. Certification instructions. You must cross out item 2 above if you have been notified bythe IRS that •you are.currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contribltions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification. but you must. provide your correct TiN.(See the instructions on page 2.) Sign Here Signature ► Purpose of form. A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, Income paid to you. real estate transactions. mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9, if you..are a U.S. person (including a resident alien), to give your correct TIN to the person requesting it (the requester) and. when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you' are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. If you .are a foreign person, IRS prefers you use a• Form W -B (certificate of foreign status). After December 31, 2000, foreign persons must use an appropriate Form W -a. Note: if a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9, What is backup withholding? Persons making certain payments to you must withhold and pay to the IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that may be subject to backup withholding include interest. dividends. broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. If you give the requester your correct TIN. make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the' requester, or 2. You do not certify your TIN when required (see the Part Ill instructions•on page 2 for details), or 3. The IRS tells the requester that you furnished an incorrect TIN, or 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and di.,:rinnrie nnl.,l nr Date ► 5. You do not certify to the requester that you are not subject to backup withholding under 3 above (for reportable interest and dividend accounts opened after 1983 only), Certain payees and payments are exempt from backup withholding. See the Pact II instructions and the separate Instructions for the. Requester of Form W-9. Penalties Failureto furnish TIN.. If you fail to furnish your correct TIN to a .requester, you are.. subject to a penalty of S50 for each such failure unless your failure is due.to.. reasonable cause'arid not to Willful 'neglect. Civil penalty for: false'information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup.wiuhholding, you are subject to a $500 penalty, Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment, Misuse of TINS. lf:the requester discloses or uses TINS In violation of Federal law, the requester may be.,subject to, civil and ,'sirninai nnnalfiac. POLITICAL SUBDIVISION SALES TAX EXEMPTION CERTIFICATE (For use by Stetes, Tenitodes, or Political Subdivision thereof or the DisMct of Columbia) The undersigned hereby certifies that she is the Controller of Weld County Government and that she is authorized to execute this Certificate and that all taxable articles/services purchased from are for the exclusive use of Weld County Government. State of Colorado. It is understood that the exemption from tax in the case of sales of articles under this Exemption Certificate to the State. Territory, or Political Subdivision or District of Columbia is limited to the sale of articles purchased for their exclusive use, and it is agreed that if articles purchased tax-free under this Exemption Certificate are used otherwise or are sold to employees or others, such fact must be reported to the manufacturer of the articles covered by this Certificate. It is also understood that the fraudulent use of this Certificate to secure exemption will subject the undersigned and all parties making use of this Certificate to all applicable criminal penalties under the Internal Revenue Code. COLORADO SALES TAX CERTIFICATION OF EXEMPTION NUMBER - 98-03551-0000 FEDERAL TAX EXEMPTION NUMBER - 84-6000813 STATE TAX IDENTIFICATION NUMBER - 14-02101 Colorado statute exempts from state and state -collected sales tax all sales to tte United States government and the State of Colorado. its departments and Institutions, and its political subdivisions (county and local governments, school districts and special districts) in their governmental capacities only IC.R S. .39-26-1I4)1100(01 Some governmental entities have a Colorado -issued tax -exemption number, although they are riot required to have one Following is a copy of Weld County Governments most recent Colorado -issued Cemficete of Exemption for Sales and Use Tax Only. DR CMGprmdon COLORADO OromRUENT OF REVENUE O(N91F9F°2ei. I3 CERTIFICATE OF EXEMPTION FOR COLORADO'5 me LICENSE IS NOT TNAN$tENABLE USE ACCOUNT NUMBER Sr all gkmnrnf LIABILITY .ONLY r 98-03551-0000 03 057 N AIAY 19 §bot. 920 9-N ST 202 COUNTY OF WELD WELD COUNTY OF PO BOX 758 GREELEY CO 60632-075E GREELEY C(19.1.1: wm am Ore,— ol As.'. March of Dimes Chapter Community Grants Program PROGRESS REPORT FORMAT march of dimes Please complete a progress report for your March of Dimes chapter grant, including each of the following sections. This report should cover the period 01/01/09 - 06/30/09. Progress reports are due and should be mailed to: March of Dimes -Colorado Chapter Attn: Scott D Matthews 1325 South Colorado Blvd., B-508 Denver, Colorado 80222 1. Report on progress toward meeting each of the project objectives as listed in the final and approved grant proposal. Use the Objectives and Methods/Activities Form to report on the number of individuals served, reached and/or educated, and outcomes. 2. Describe any barriers that have prevented you from meeting your objectives, and identify steps you have taken to address these challenges. 3. Have you identified any need to modify the program from its original design since the last report? If so, please request approval for any revisions to project objectives and/or budget. 4. What, in your opinion, have been the major successes of this project? 5. Summarize results of any program evaluation efforts. 6. Complete a budget report showing project expenditures from 01/01/09 - 12/31/09. Please make sure that expenditures are shown in comparison to current year budget figures as listed in the grant proposal and that the budget sheet is signed. 7. Attach any documents that provide additional information (i.e. logs, evaluation reports). Please check to make sure that your report includes all required sections and attachments. Progress report is due July 30, 2009. O U, W E O U H D O H E W i• H LW ' i • F. a u chi C Q a i a 0 Z al z W E E - w `"-U_> 0 F ya it X U O 0 Year-End/Final Report 0 6 Month Report H c . U a,¢Cm) F-mia t cD a R c6i - d C Z • C.) tC O U ,c dy> • y O Z CA c, C) F M ¢ V Outcomes for Objective #1: C) > :U N M Outcomes for Objective #2: FOR IMMEDIATE RELEASE FOR MORE INFORMATION CONTACT: (NAME AND NUMBER) March of Dimes Awards Grant to (NAME OF AGENCY) in order to Improve the Health of Mothers and Babies in (COMMUNITY) (CITY, ST, DATE) —The March of Dimes (CHAPTER NAME) has awarded a grant to (AGENCY NAME) to support (PROGRAM NAME), that is aimed at underserved maternal and child health needs here in (COMMUNITY NAME). This program will (STATE GOAL AND RATIONALE, e g., PROVIDE SMOKING CESSATION CLASSES TO PREGNANT WOMEN. SMOKING IS KNOWN TO CONTRIBUTE TO PREMATURE BIRTH AND LOW BIRTHWEIGHT.) This grant is one of many that the March of Dimes awards in pursuit of its mission to prevent birth defects, premature birth and infant mortality. "We will use the March of Dimes grant as seed money to meet our objective of providing mothers and babies with (NAME OF SERVICE)," said (AGENCY REPRESENTATIVE NAME AND TITLE). "We are grateful to those volunteers who support the March of Dimes by participation in events like WalkAmerica and who donate in other ways. That participation and those donations make this grant possible," s/he said. (DESCRIBE GRANTEE AGENCY IN ONE OR TWO SENTENCES.) The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy to save babies and in 2003 launched a campaign to address the increasing rate of premature birth. For more information, visit the March of Dimes Web site at marchofdimes.com or its Spanish language Web site at nacersano.org. # # # # March of Dimes Foundation Colorado Chapter 1325 Sc,. Colorado Blvd., Suite B508 Denver, CO 80222 Telephone (303) 692-0011 Fax (303) 692-9229 marchofdimes.com January 5, 2009 Kristin Dodge, MPH Prenatal Education Coordinator Weld County Department of Public Health and Environment 1555 N. 17th Avenue Greeley, CO 80631 RE: "Partners Collaborate to Offer Free Prenatal Nutrition Education Classes to High School Students in Weld County School District Six" Dear Kristin: Congratulations! On behalf of the March of Dimes - Colorado State Chapter, we are very pleased to present Weld County Department of Public Health and Environment with a chapter community grant award to implement "Partners Collaborate to Offer Free Prenatal Nutrition Education Classes to High School Students in Weld County School District Six". We are very excited to have this opportunity to support this project, which has the potential to have a significant impact on the health of mothers and babies. As you may know, the Colorado March of Dimes chapter community grant process was very competitive this year. Many high quality applications were received, and we are pleased that your organization is one the projects funded by the 2009 March of Dimes Colorado Mission Grants. This award represents a substantial achievement for your organization and we are honored to partner with you on this project. Your proposal has been approved in the amount of $3,000, for a one- year time period of January 1, 2009 to December 31, 2009. Enclosed is the Chapter Grant Agreement and W-9 form that should be reviewed, signed and returned by January 15, 2009. Please mail the forms to: Scott Matthews, Director of Program Services March of Dimes - Colorado Chapter 1325 South Colorado Blvd. - Suite B508 Denver, Colorado 80222-3320 Upon receipt of these required documents, the first check in the amount of $1,500 will be issued. The balance of this award will be made upon receipt and approval of the six-month progress report, due on or before July 30, 2009. If you have any questions or need assistance in any way, do not hesitate to contact Scott Matthews at (303) 692-0011, ext. 304 or smatthews@marchofdimes.com. We wish you much success with this project. Scott D. Matthews, M.S.W, M.H.A. Director of Program Services Enclosures: Chapter Grant Agreement W-9 Form 6 -Month Progress Report Format cc: Shelly Goodchild, State Director Hello