HomeMy WebLinkAbout20080208.tiff RESOLUTION
RE: APPROVE RESCINDING RESOLUTION#2007-3831,DATED DECEMBER 26,2007,AND
APPROVE TASK ORDER CONTRACT FOR IMMUNIZATION 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, by Resolution#2007-3831, dated December 26, 2007, the Board approved a
Limited Amendment for Task Order#1 for the Immunization 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, and
WHEREAS, after review, the Board deems it advisable to rescind Resolution#2007-3831,
dated December 26, 2007, and
WHEREAS, the Board has been presented with a Task Order Contract for Immunization
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
February 1, 2008, and ending December 31, 2008, with further terms and conditions being as
stated in said task order contract, and
WHEREAS,after review, the Board deems it advisable to approve said task order contract,
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 Resolution#2007-3831,dated December 26,2007,for Limited Amendment
for Task Order#1 for the Immunization 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Environment, be, and hereby is, rescinded.
BE IT FURTHER RESOLVED by the Board of County Commissioners of Weld County,
Colorado, that the Task Order Contract for Immunization 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 task order contract.
2008-0208
HL0035
0 f C3 -tS O f oz5 -06
RE: RESCINDING RESOLUTION #2007-3831, DATED DECEMBER 26, 2007, AND APPROVE
TASK ORDER CONTRACT FOR IMMUNIZATION PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 14th day of January, A.D., 2008.
BOARD OF COUNTY COMMISSIONERS
ELD COUNTY, COLORADO
•
ATTEST: 44/44/ h . `a, II % �� v
LOS II' H. Jerke, Chair
Weld County Clerk to the Boardfu
Robert D. Masden, ro- em
BY: 4 C%%/ C
Dep t Clerk the Board L K )
Willia . Garcia
APPROVEBAS T.
David E. Long
unty Attorney mt-,
Douglas R demacher
Date of signature: ll i7I 0g
2008-0208
HL0035
Memorandum
TO: William H. Jerke, Chair
Board of County Commissioners
Mark E. Wallace, MD, MPH
VI D cFROM:
Director, Department of Public Health
and Environment „ < /�f 1 __ e
COLORADO DATE: January 9, 2008 v l Vl C�
SUBJECT: Task Order Contract for the
Immunization Program
Enclosed for Board review and approval is a task order contract between the Colorado
Department of Public Health and Environment (CDPHE) and Weld County for the Immunization
Program. With the approval of this contract, Weld County will be reimbursed an amount not to
exceed $55,786 (all Federal pass through funding) for immunization program activities
performed during the time period February 1, 2008 through December 31, 2008.
On December 26, 2007, the Weld County Board of Commissioners approved Limited
Amendment #1 to the Immunization Task Order contract for fiscal year 2007 in the amount of
$8,399. Since the CDPHE did not have time to process this amendment in 2007; they are now
rescinding it and have included the $8,399 funding in this current contract instead.
The Weld County Department of Public Health and Environment will use these funds to provide
community education regarding the rules of the Colorado Board of Health pertaining to the
immunization of students attending school and rules pertaining to the infant immunization
program. WCDPHE will also collaborate with the State's Supplemental Nutrition Program
(WIC), will serve as a resource for the Weld County Immunization Coalition, and will provide
walk-in immunization clinics each month for persons of all ages. I recommend your approval of
this task order contract.
Enclosure
:6 r ; Di ,,.
2008-0208
STATE OF COLORADO
Bill Ritter,Jr.,Governor
James B.Martin,Executive Director ��ov:coed\
Dedicated to protecting and improving the health and environment of the people of Colorado y�%
4300 Cherry Creek Dr.S. Laboratory Services Division ;+
Denver,Colorado 80246-1530 8100 Lowry Blvd. •te7a
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
January 7, 2008
Dear Colleague:
Attached please find a copy of your CY2008 Immunization Core Service Delivery Contract. This agreement
represents the contracting period of February 1,2008 thru December 31, 2008.
You will notice the amount is higher than in past years. This is due to the fact that we did not receive your signed
Limited Amendment#1 for supplemental funds in 2007 in time to process in 2007; so we are including that
supplemental amount in your 2008 agreement.
Please review,make four(4)copies,have the appropriate person sign all four(4)copies and mail back to me,
Beth Hoffman, your earliest convenience.
Beth Hoffman,Financial Manager
Immunization Program
4300 Cherry Creek Dr. South IMM A-3
Denver,CO 80246
If you have any questions,please do not hesitate to call me at 303-692-2314, e-mail beth.hoffman(jstate.co.us or
Cindy Wait at 303-692-2972, e-mail cynthia.waitAstate.co.us or Teri Lindsey at 303 692-2732, e-mail
teri.lindsey@state.co.us.
Thank you for your continued immunization efforts to prevent vaccine-preventable diseases in Colorado!
Sincerely,
Beth Hoffman,Financial Manager
Immunization Program
(303) 692-2314
beth.hoffman@state.co.us
fax: (303) 691-6118
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
ROUTING NO.08 FHA 00227
APPROVED TASK ORDER CONTRACT- WAIVER#154
This Task Osier Contract is issued pursuant to Master Contract made on 01/23/2007,with muting number08 FAA00052
STATE: CONTRACTOR
State of Colorado for the use&benefit of the BOARD OF COUNTY COMMISSIONERS OF
Department of Public Health and WELD COUNTY(a political subdivision of the
Environment State of Colorado,for the use and benefit of Weld
DCEED- IMN County,Department of Public Healthy and
4300 Cheny Creek Drive South Environment)
1555 North 17th Avenue
Denver,Colorado 80127
Greeley,Colorado 80631
TASK ORDER MADE DATE: CONTRACTOR ENTITY TYPE:
January 4,2008 Colorado Political Subdivision
PO/SC ENCUMBRANCE NUMBER CONTRACTOR FEIN OR SOCIAL SECURITY NUMBER
PO FHA IMM0800227 846000813 B
TERM BILLING STATEMENTS RECEIVED:
This Task Order shall be effective upon Quarterly
approval by the State Controller,or designee,
or on 02/01/2008,whichever is later. The STATUTORY AUTHORITY:
Task Order shall end on 12/31/2008. Section 25-4-905,CRS.,as amended
PRICE STRUCTURE: CONTRACT PRICE NOT TO EXCEED:
Fixed Price $55,786.00
PROCUREMENT METHOD: FEDERAL FUNDING DOLLARS: $55,786.00
Exempt STATE FUNDING DOIlARS: $0.00
BID/REP/LIST PRICE AGREEMENT NUMBER MAXIMUM AMOUNT AVAIIABIE PER FISCAL YEAR:
Not Applicable FY 08: $55,786.00
FY 09: $0.00
IAWSPEQFIED VENDOR STATUTE: FY 10: $0.00
Not Applicable FY 11:$0.00
FY 12:$0.00
STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE:
Beth Hoffman BOARD OF COUNTY COMMISSIONERS OF
Department of Public Health and WELD COUNTY(a political subdivision of the
Environment State of Colorado,for the use and benefit of Weld
DCFED-IMN County,Department of Public Healthy and
4300 Cherry Creek Drive South Environment,
Denver, 1555 North 17th Avenue
CO 80246-1530
Greeley,Colorado 80631
SCOPE OF WORK:
The Contractor shall promote activities to increase 8c enhance availability of age appropriate
immunizations for vaccine preventable diseases,provide educational offerings about immunizations &
support the Colorado Supplemental Nutrition Program-Women,Infants &Children(WIC).
Page 1 of 4
EXHIBITS:
The following exhibits are hereby incorporated
Exhibit A- Additional Provisions (and its attachments if any- e.g.,A-1,A-2,etc.)
Exhibit B- Statement of Work and Budget (and its attachments if any- e.g.,B-1,B-2,etc.)
Exhibit C- Limited Amendment Template for Task Orders
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made
more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task
Order Contract provide more specificity than these general clauses,the more specific provision shall control.
1. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including,but not limited to,Exhibit One thereto. The total term of this Task Order Contract,including
any renewals or extensions,may not exceed five(5)years. The parties intend and agree that all work shall
be performed according to the standards,terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(1),C.R.S.,as amended,this Task Order Contract is not valid until it
has been approved by the State Controller,or an authorized delegee thereof. The Contractor is not
authorized to,and shall not;commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or,any costs or expenses,incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date,then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date,then the Contractor shall only commence performance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract,unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated,all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract(including its exhibits
and/or attachments),or between this Task Order Contract and its exhibits and/or attachments,such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: 1)the
Special Provisions of the Master Contract;2)the Master Contract(other than the Special Provisions)and its
exhibits and attachments in the order specified in the Master Contract;3)this Task Order Contract;5)the
Page 2 of 4
Additional Provisions-_Exhibit A,and its attachments if included,to this Task Order Contract;4) the
Scope/Statement of Work-Exhibit B,and its attachments if included,to this Task Order Contract;6)other
Stibits/attachments to this Task Order Contract in their order of appearance.
4. 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 work items described in the
Statement of Work and Budget,which are incorporated herein by this reference,made a part hereof and
attached hereto as"Exhibit B".
5. The State,with the concurrence of the Contractor,may,among other things,prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract,increase or
decrease the amount payable under this Task Order Contract,or add to,delete from,and/or modify this
Task Order Contract's Statement of Work through a"Limited Amendment for Task Orders"that is
substantially similar to the sample form Limited Amendment that is incorporated herein by this reference
and identified as Exhibit C. To be effective,this Limited Amendment must be signed by the State and the
Contractor,and be approved by the State Controller or an authorized delegate thereof Upon proper
execution and approval,this Limited Amendment shall become a formal amendment to this Task Order
Contract. This contract is subject to such modifications as may be required by changes in Federal or State
law,or their implementing regulations. Any such required modification shall automatically be incorporated
into and be part of this Task Order Contract on the effective date of such change as if fully set forth herein.
6. The conditions,provisions,and terms of any RFP attached hereto,if applicable,establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal,if attached hereto,or any attachments or exhibits thereto,or the Scope/Statement of Work-
Exhibit B,establishes or creates standards of performance greater than those set forth in the RFP,then the
Contractor shall also meet those standards of performance under this Task Order Contract.
Page 3of4
IN WITNESS WHEREOF,the State has executed this Task Order Contract as of the day first above
written.
CONTRACTOR: STATE OF COLORADO:
BOARD OF COUNTY COMMISSIONERS OF BILL RITTER,JR.GOVERNOR
WELD COUNTY(a political subdivision of the
State of Colorado,for the use and benefit of the
Weld County Department of Public Health and -
Environment) 'n�
Legal Name of Contracting Entity Y`4�J ( j____.
By
For Executive Director
846000813 B Department of Public Health and Environment
Social Security Number or FEIN
I{y---l'� Department Program Approval:
Signature of Authorized Officer JAN 1 4 2008
William H. Jerke, Chair By _ ^
Print Name&Title of Authorized Officer Ill
GOVERNMENTAL ENTITIES: _-1 j'
(An esta ' yya r,
�,
Gl/ r .i'r
Attest(Seal)B ' l /do( �. 4''�s
Town/Ci /Coun lerk" ot ✓ce,r
( tyEquivalent) (place seal here)
'N.\
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State
Controller,or such assistant as he may delegate,has signed it. The contractor is not authorized to begin performance until
the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be
obligated to pay for the goods and/or services provided.
STATE CONTROLLER:
Leslie M.Shenefelt
By
Date .1)- r O
WELD COUNTY DEPARTMENTj
F .
P LIC HEALT Aka NVIRON
E. T.
BYE Y-1I �r� ��1�_l(- C(
Mark Wallace, M MPH-Director
Page 4 of 4
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 01/04/2008- Contract Routing Number 08 FHA 00227
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
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.
2. This Task Order Contract contains federal funds(see Catalog of Federal Domestic Assistance(CFDA)
number 93.268)
3. The United State Department of Health and Human Services("USDHHS"),through the Center of Disease
Control("CDC")has awarded the State federal funds under Notice of Cooperation Agreement Award
("NCAA")number 2H23IP822564-06 to increase and enhance the availability of age appropriate
immunizations for vaccine preventable diseases. (See,Catalog of Federal Domestic Assistance("CFDA")
number 93.268.) 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 age appropriate immunizations for vaccine preventable diseases
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.
4. Reimbursement under this Task Order Contract shall be made to the Contractor by the State in four(4)
payments of$13,947.00 each. 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. The final payment for this Task Order Contract, is contingent upon the State's receipt of an
annual statement from the Contractor in the form attached hereto as Attachment A-1,which is
incorporated herein by this reference.
The Contractor shall submit an online Immunization Program progress report to the State. The progress
report is due within fifteen(15)calendar days of the end of the reporting period. This progress report shall
document the Contractor's progress towards completion of the activities described herein. The
Contractor's December payment shall not be reimbursed by the State until the requisite progress report is
submitted to the State by the Contractor. Reporting period and progress report due date is as follows:
Progress Period Due Date
February 1,2008—December 31,2008 January 15,2009
To be attached to CDPHE Page 1 of 2 Revised: 12/19/06
Task Order v1.0(11/05)contract template
EXHIBIT A
5. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have sixty(60)calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable,except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable,or is otherwise deficient,then the State shall notify
the Contractor of the failure or deficiencies, in writing,within sixty(60)calendar days of: 1)the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery;or 2)the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable,the Contractor shall have a reasonable period of time,not to exceed sixty(60)
calendar days,to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within(60)calendar days,the Contractor shall be in default of its obligations under this Task
Order Contract and the State, at its option,may elect to terminate this Task Order Contract or the
Master Contract and all Task Order Contracts entered into pursuant to the Master Contract.
d. Survivability Clause:Notwithstanding anything herein to the contrary,the parties understand and
agree that all terms and conditions of this contract and the exhibits and attachments hereto which
may require continued performance,compliance or effect beyond the termination date of this
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 Page 2 of 2 Revised: 12/19/06
Task Order v1.0(11/05)contract template
Attachment A-1
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
IMMUNIZATION PROGRAM
2008 CONTRACT REIMBURSEMENT CERTIFICATION FORM
Please return by January 15, 2009
RE: General Immunization Core Services Contract
TO: Colorado Department of Public Health and Environment—Immunization Program
4300 Cherry Creek Drive South, IMM-A3
Denver, Colorado 80246
Fax: 303-691-6118
FROM:
Tax ID#:
PROJECT PERIOD: February 1, 2008 through December 31, 2008
This is to certify that the contract services have been performed per Contract
Routing Number: for the period stated above.
SIGNATURE:
Contractor or Authorized Designee Date
.. ....... .
F CDP I or s H13 taff..to+cAm +ete . . � :.:
F ,.
I hereby..certify that all contract requirements.have been met and final payment of
$ -for contract services for the period February:t;2008
through December 31, 2008 is authorized.
SIGNATURE: : :
Program Director.or Autiorized Designee Date
EXHIBIT B
STATEMENT OF WORK
To Task Order Contract Dated 01/04/2008-Contract Routing Number 08 FHA 00227
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above.
1. The Contractor,in accordance with the terms and conditions of this contract,shall perform and complete,in
a timely and satisfactory manner,all activities described in the approved Scope of Work that is attached
hereto as Attachment B-1 and incorporated in accordance with the associated Budget which is attached
hereto as Attachment B-2 and incorporated herein.
To be attached to CDPHE Page 1 of 1 Revised: 12/19/06
Task Order v1.0(11/05)contract template
•
Attachment B-1
IMMUNIZATION SERVICE DELIVERY PROGRAM
SCOPE OF WORK
To best meet the immunization needs of the citizens of Colorado and to ensure immunization best practices are
provided around the state,the contractor shall use the funding provided by this Contract to augment any of the
following activities:
• Meet with community leaders to work towards formulating policies designed to solve local immunization
access issues.
• Follow the Standards for Child and Adolescent Immunization Practices(CDC, 2006)to assure all
populations have access to appropriate immunization services and evaluate the effectiveness of the services
provided.
• Promote,educate and support providers regarding the value of active participation in reminder/recall
activities.
• Conduct onsite clinical services with optimal access such as non-traditional clinic access,"express lane"or
drop-in appointments,and use incentives to encourage completion of children's primary immunization
schedule.
• Develop and follow appropriate procedures for vaccine storage and handling with appropriate clinic
equipment and implement written policies and procedures for vaccine storage,vaccine ordering and
emergency response. Utilize up-to-date written protocols and have them readily accessible at all locations
where vaccines are administered,and ensure all persons who administer vaccines and staff who manage or
support vaccine administration are knowledgeable and receive ongoing education.
• Provide support for immunization initiatives through the Colorado Supplemental Nutrition Program-
Women,Infants,and Children(WIC)by providing vaccinations on site,assessing immunization histories
and referring children appropriately and/or distributing educational materials regarding immunizations and
locally available services.
The Contractor shall submit an online Immunization Program progress report to the State. The progress report is
due within fifteen (15) calendar days of the end of the reporting period. This progress report shall document the
Contractor's progress towards completion of the activities described herein. The Contractor's December payment
shall not be reimbursed by the State until the required progress report is received by the State from the Contractor.
Reporting periods and progress report due dates are as follows:
Reporting Period Due Date
February 1,2008 through June 30,2008 July 15,2008
July 1,2008 through December 31,2008 January 15,2009
Throughout the 2008 funding period,the CDPHE Immunization Program will conduct ongoing project monitoring
and provide technical assistance as needed. If after the State receives and reviews the progress report for the period
of February 1,2008 through June 30,2008 it appears the Contractor is not progressing towards the completion of
any activity a follow-up work plan may be requested and additional technical assistance shall be provided. In an
extreme situation,and in consultation with the Contractor,the CDPHE Immunization Program reserves the right to
reduce or withhold quarterly payments due to poor project performance.
Page 1 of 1
ATTACHMENT B-2
BUDGET
CONTRACTOR: Board of County Commissioners of Weld County
PROJECT: Immunization Program
FOR THE PERIOD: February 1, 2008 through December 31, 2008
Funded
by
CDPHE
Budget for Current Term $55,786
TOTAL AMOUNT $55,786
EXHIBrr C
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
(ADD PROGRAM NAME HERE)
DEPARTMENT OR AGENCY NUMBER
***
CONTRACT ROUTING NUMBER
** *****
ELIMINATE ALL INFORMATION APPEARING IN RED
LIMITED AMENDMENT FOR TASK ORDERS #*
This Limited Amendment is made this **** day of*********, 200*, by and between the State
of Colorado, acting by and through the DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT, whose address or principal place of business is 4300 Cherry Creek Drive
South,Denver, Colorado 80246,hereinafter referred to as the"State"; and, LEGAL NAME
OF ENTITY, (legal type of entity), whose address or principal place of business is Street
Address, City, State & Zip Code, hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract, dated ******** **, ****, with contract routing
number** *** ***** "the Master Contract").
Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order
Contract, dated ******** **, ****, with contract encumbrance number PO *** **********
and contract routing number ** *** *****, [insert the following if previous amendment(s),
change order(s), renewal(s) have been processed: as amended by] [include all previous
amendment(s), change order(s), renewal(s) and their routing numbers], [insert the
following if previous amendment(s), change order(s), renewal(s) have been processed:
collectively] referred to herein as the"Original Task Order Contract, whereby the Contractor was
to provide to the State the following:
[Briefly describe what the Contractor was to do under the Original Task Order
Contract—indent this paragraph]
[Please choose one of the following four options and delete the other three options not
selected]
The State promises to [choose one and delete the other] increase/decrease the amount of funds
to be paid to the Contractor by ********** Dollars, ($*.**) during the current term of the
Original Task Order Contract in exchange for the promise of the Contractor to perform the
[choose one and delete the other] increased/decreased work under the Original Task Order
Contract.
Page 1 of 5
The State promises to pay the Contractor the sum of********** Dollars, ($*.**)in exchange
for the promise of the Contractor to continue to perform the work identified in the Original Task
Order Contract for the renewal term of****years/months, ending on ******** **, ****.
The State promises to [choose one and delete the other] increase/decrease the amount of funds
to be paid to the Contractor by ********** Dollars, ($*.**) for the renewal term of****
[choose one and delete the other] years/months, ending on ******** **, ****, in exchange
for the promise of the Contractor to perform the [choose one and delete the other]
increased/decreased work described herein.
The State hereby exercises a"no cost"change to the [choose those that apply and delete those
that don't apply] budget, specifications within the Statement of Work, project
management/manager identification, notice address or notification personnel, or
performance period within the [choose one and delete the other] current term of the
Original Task Order Contract or renewal term of the Original Task Order Contract.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the
parties hereto agree as follows:
1. Consideration for this Limited Amendment to the Original Task Order Contract consists
of the payments and services that shall be made pursuant to this Limited Amendment,
and promises and agreements herein set forth.
2. It is expressly agreed to by the parties that this Limited Amendment is supplemental to
the Original Task Order Contract, contract routing number ** *** *****, [insert the
following language here if previous amendment(s), change order(s), renewal(s) have
been processed] as amended by [include all previous amendment(s), change
order(s), renewal(s) and their routing numbers], [insert the following word if
previous amendment(s), change order(s), renewal(s) have been processed, otherwise
delete"collectively"lcollectively 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 Limited 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:
[Please choose one of the following three options and delete the two options not
selected]
A. [Use this paragraph when changes to the funding level of the Original Task
Order Contract occur during the current term of the Original Task Order
Contract] This Limited Amendment is issued pursuant to paragraph 5 of the
Original Task Order Contract identified by contract routing number** ***
*****. This Limited Amendment is for the current term of********* **
Page 2 of 5
EXHlnrr C
****, through and including ********* ** ****. The maximum amount
payable by the State for the work to be performed by the Contractor during this
current term is [choose one and delete the other] increased/decreased by
********** Dollars, ($*.**) for an amended total financial obligation of the
State of********** DOLLARS, ($*.**). [Delete the following sentence if not
applicable in your situation] The revised Statement of Work is incorporated
herein by this reference and identified as "Attachment *". [Delete the following
sentence if not applicable in your situation[ The revised Budget is incorporated
herein by this reference and identified as "Attachment *". The Original Task
Order Contract is modified accordingly. All other terms and conditions of the
Original Task Order Contract are reaffirmed.
A. [Use this paragraph when the Original Task Order Contract will be renewed
for another term] This Limited Amendment is issued pursuant to paragraph 5 of
the Original Task Order Contract identified by contract routing number ** ***
*****. This Limited Amendment is for the renewal term of********* **
****, through and including********* **, ****. The maximum amount
payable by the State for the work to be performed by the Contractor during this
renewal term is ********** Dollars, ($*.**) for an amended total financial
obligation of the State of********** DOLLARS, ($*.**). [Delete the
following sentence if not applicable in your situation] The revised Statement of
Work is incorporated herein by this reference and identified as "Attachment *".
[Delete the following sentence if not applicable in your situation[ The revised
Budget is incorporated herein by this reference and identified as "Attachment*".
The Original Task Order Contract is modified accordingly. All other terms and
conditions of the Original Task Order Contract are reaffirmed.
A. Use this paragraph when there are "no cost changes" to the Budget, the
specifications within the original Statement of Work, allowable contract
provisions as noted, or performance period.] This Limited Amendment is
issued pursuant to paragraph 5 of the Original Task Order Contract identified by
contract routing number ** *** *****. This Limited Amendment Ichoose those
that apply and delete those that don't] modifies the Budget in [identify
location in contract], modifies the Statement of Work in [identify location in
contract], modifies the project management/manager identification in
[identify location in contract], modifies the notice address or notification
personnel in identify location in contract[, modifies the period of
performance in [identify location in contract] of the Original Task Order
Contract. The revised [choose those that apply and delete those that don't]
Budget, Statement of Work, project management/manager identification,
notice address or notification personnel, or period of performance is
incorporated by this reference and identified as. All other terms and conditions of
the Original Task Order Contract are reaffirmed.
4. The effective date of this Limited Amendment is **/**/****, or upon approval of the
State Controller, or an authorized delegate thereof, whichever is later.
Page 3 of 5
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 Limited Amendment and any of the terms and provisions of the Original Task Order
Contract, the terms and provisions of this Limited 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 4 of 5
N,XH1BuI C
IN WITNESS WHEREOF, the parties hereto have executed this Limited Amendment on the
day first above written.
CONTRACTOR: STATE:
[LEGAL NAME OF CONTRACTOR] STATE OF COLORADO
(a political subdivision of the State of Colorado) Bill Ritter,Jr. Governor
By: By:
Name: For the Executive Director
Title: DEPARTMENT OF PUBLIC
HEALTH
FEIN: AND ENVIRONMENT
ATTEST: PROGRAM APPROVAL:
Because the Contractor is a governmental
entity, an attestation is required By:
(Seal, required)
By:
City, City and County, County,
Special District, or Town Clerk or Equivalent
[Delete inapplicable language.]
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS 24-30-202 requires that the State Controller approve all state contracts. This limited
amendment is not valid until the State Controller, or such assistant as he may delegate, has
signed it. The contractor is not authorized to begin performance until the contract is
signed and dated below. If performance begins prior to the date below, the State of
Colorado may not be obligated to pay for goods and/or services provided.
STATE CONTROLLER
Leslie M. Shenefelt
By:
Date:
Page 5 of 5
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