HomeMy WebLinkAbout20080595.tiff RESOLUTION
RE: APPROVE GRANT PROPOSAL FOR DENTAL,VISION,AND HEARING PROGRAM AND
AUTHORIZE CHAIR TO SIGN - UNITED WAY OF WELD COUNTY
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 Grant Proposal for the Dental,Vision,and
Hearing Program from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services,Area Agency on
Aging,to the United Way of Weld County, commencing upon full execution,with further terms and
conditions being as stated in said grant proposal, and
WHEREAS, after review, the Board deems it advisable to approve said grant proposal, 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 Grant Proposal for the Dental, Vision, and Hearing Program from the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County,on behalf of the Department of Human Services,Area Agency on Aging,to the United Way
of Weld County be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said grant proposal.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 13th day of February, A.D., 2008.
BOARD OF COUNTY COMMISSIONERS
�� ELD COUNTY, COLORADO
ATTEST: j • i. �� e7 ,
,,W11(hargi, . Jerke, Chair
Weld County Clerk to the Board Jc; e„Y
>'EXoU9 D
u � RobC f�j Ma , Pro-Tem
BY:
Deputy erk to the Board
WilliatGia
�ROV D O dv ( 6-:4
David E. Long
t orney
Douglas R demacher
Date of signature: a c?9 O5
2008-0595
c
HR0079
C' H Ct &u �, ..
MEMORANDUM
� o
COLORADO
Date: February 7, 2008
To: William H. Jerke, Chair, Weld County Board of Commissioners
From: Walter Speckman, Executive Director, Weld County Division of Human Services J
Subject: Weld County Area Agency on Aging application for Dental, Vision, and Hearing Program
funds from the United Way Safety Net Initiative
Enclosed for board approval is the Weld County Area Agency on Aging funding request of
$20,000.00 from the United Way Safety Net Initiative. The funds will be used to enhance the
WAAA Dental, Vision, and Hearing Program to seniors sixty years of age and older who reside in
Weld County.
If you have additional questions, please contact Eva Jewell, Director, Weld County Area Agency on
Aging at(970) 353-3800 extension 3331.
_ J
2008-0595
Safety Net
Request for Proposal Summary Sheet
Organization Name: Weld County Area Agency on Aging
Address: 1551 N 17th Ave. / PO Box 1805
Greeley, CO 80632
Phone: (970) 353-3800
Fax: (970) 304-6442
Email: hdarby@co.weld.co.us
Executive Director: Eva Jewell
Contact Person: Holly Darby
Program Areas: El basic needs Q Services for vulnerable populations
(Please mark all that apply)
Total Number to be served 50-70
Target population: Families x Individuals (counted as single individuals, not
(Approximate Numbers) part of a family)
Ethnic Distribution of 47 % Anglo 48 % Hispanic 2 %African American
Population to be
Served: (Approximate) 1 % Asian 2 % Other American Indian/Other
Total Project Budget: $ 168,812.37
United Way Amount $ 10,000.00 $ 10,000.00
Requested: Year: One Two
Total Amount Requested
from United Way $ 20,000.00
Is the program/agency
certified or monitored by an
outside agency? x Yes No
Certify that the agency
carries and is current with Executive Director will initial:
the stated insurance E>> Worker's Compensation Insurance t ,General Liability
coverage
Executive Director
Signature O hC2
Board Chair Signature „run (
William H. Jerke, Chair 02/13/2008
Received by United Way Signature Date Time
Cgs—
United Way of Weld County
Safety Net Initiative
Narrative Information
SECTION I: Program Narrative
1. How long has your agency been providing services in the community?
The Weld County Area Agency on Aging (WAAA) is one of sixteen in the state under the
Colorado Department of Human Services, Division of Aging and Adult Services. For over
thirty years, the Weld County Area Agency on Aging has been a support system for Weld
County residents 60 years of age and older and their caregivers. Our primary goal is to
help maintain an individual's independence and dignity in their home and community. The
WAAA supports services for seniors either through contracts with community agencies or
by providing the service directly. These services include adult day care, case
management, home delivered meals, legal assistance, nursing home and assisted living
ombudsman services, peer counseling, rural senior centers, senior nutrition programs,
Hispanic senior outreach, information and assistance.
2. What is your agency's mission?
The Weld County Area Agency on Aging maintains the mission adopted by the Colorado
Department of Human Services, Division of Aging and Adult Services to assist recipients
to live safely with maximum personal independence by planning and promoting an
effective, integrated, accessible delivery system under the Older Americans Act and Older
Coloradan Fund.
3. Describe the program for which you are requesting funding:
Since 1998, the Dental, Vision, and Hearing Program has provided financial assistance
for the eligible sixty and older low income and at risk senior residents of Weld County who
are in need of dental, vision, and/or hearing services.
Applicants submit an application; after approval and the selection of a provider of their
choice, authorization is sent to that provider. Once the services are complete, the
provider will bill WAAA at which time it is paid up to a maximum allowable amount. If the
recipient's need is complete and no other services are anticipated, any remaining funds
are reallocated back into the program for other potential recipients. The recipient is
responsible for any balance over the allotted amount and any service(s) rendered or paid
for prior to approval are not covered.
According to the Compass Weld County Assessment, affordable health care and the
availability of affordable providers is a major concern for aging seniors with difficult
choices due to costs. The Dental, Vision, and Hearing Program meets the United Way
Safety Net initiative outcomes of providing services to vulnerable populations before a
crises situation by providing aid to seniors experiencing difficulty accessing services. By
1
providing assistance prior to a crises situation, we are supporting recipients to assume
responsibility of their own health by becoming self-sufficient and begin preventive care.
The WAAA adheres to all of the Older American Act policies and regulations which
include serving a target population of adults sixty years of age and older with special
emphasis on those seniors who are in greatest economic and social need, low income,
minority, frail and rural. Targeting specific populations lead to program limitations such as
seniors who are denied assistance because of age or suggested income guidelines.
Other limitations include the lack of funds to cover the full cost of the needed service. For
example, currently the dental assistance can cover up to $600.00. However, this poses a
dilemma for the recipient who may be in need of full upper and lower dentures which
typically can cost between $1,200.00 and $2,200.00, thus requiring the client to pay
$600.00 or more out of pocket. This can be true also for recipients in need of specialized
lenses and frames or hearing aids. The WAAA has chosen to set such parameters in
order to serve more requests. Because of dire community need, funds are exhausted
prior to the fiscal cycle ending; therefore compelling WAAA to begin a waiting list for the
start of the next fiscal cycle. In addition, due to funding limitations and wait list needs a
policy has been set that recipients are only eligible every other year.
Thanks to the partnerships with the North Colorado Medical Center Foundation and Platte
Valley Medical Center, we have been able assist nearly 50% more individuals in Weld
County. In addition, the program works closely with each of the providers for services for
the recipients. Communication between WAAA and the provider comprises of the client's
need, appointment dates, and billing inquiries to name a few. Often a relationship is built
and as providers become more knowledgeable of the program, they frequently refer their
own clients to WAAA knowing they are in need and may not have otherwise known of the
assistance available, and on occasion will waive some costs if a particular client is
extremely indigent. Referrals from other community agencies such as case managers,
churches, adult protective services, Catholic Charities and other technicians remain the
programs greatest resource. Because of the flexibility of the program, we are able to
assist seniors in southern Weld County, for example, by working with providers in
Thornton or Northglenn. The same can be said for western residents using services in
Boulder County and northern residents in Larimer County to name a few. It is through this
community effort of working together with our partners and providers that Weld County
senior's benefit.
The need in the community is evident based on the funding being exhausted prior to the
end of the fiscal cycle; which in turn brings about the need for a waiting list. Along with
the inability to serve everyone because of lack of funds, the U.S. Census Bureau statistics
also suggest that society can anticipate a much greater need as the population increases.
According to the Bureau, in 2006, the estimated percent of all individuals in Weld County
below poverty level is 15.7% and persons 65 years and over below poverty level is 10.8%
that is 3.7% and 2.5% above the state's average respectively. Also according to
statistics, there were 32,985 individuals or 17.4% of Weld County residents that were
uninsured in 2000. The older adult population of Colorado is projected to grow by 51%
from 2000 to 2012 (NRC Inc. 2004). Weld County residents age 60 and over is estimated
to grow by over 9,977 or nearly 74% between 2006 and 2012 (Colorado Department of
2
Local Affairs; http://www.dola.state.co.us 2007). In September 2004, the Colorado
Department of Human Services, Division of Aging and Adult Services completed a
Strengths and Needs Assessment of Older Adults in the state of Colorado. Based on the
information obtained from the study, over 2,500 Weld County adults sixty or older stated
that they needed but could not afford eyeglasses, hearing aids or dentures. As the
population increases, the baby boomer segment continues to grow, and with programs
such as Medicaid not covering these types of services, we anticipate the need for our
program and others like it will also continue to expand.
4. Describe the staffing and management of the program:
A designated staff person within WAAA manages the Dental, Vision, and Hearing
Program. This staff holds a Bachelor of Science degree in both Gerontology and
Community Health from the University of Northern Colorado. The staff has over eight
years experience in managing programs, including but not limited to collecting and
reporting data, budget oversight, and working with other staff and community partners.
The program is not currently utilizing volunteers due to the nature of the program. The
role of the staff in the Dental, Vision, and Hearing Program is to manage and market the
program to the target audience and other organizations, partners, and/or businesses in
order to encompass as wide a client base as possible. The WAAA director provides direct
supervision of the position.
5. Please identify how your program is considered a "best practices"based on research
you are following with your program or modeling it after
The Weld County Area Agency on Aging continues to model under the federal
government umbrella of the Administration on Aging (AoA). The AoA mission, as
embodied in the Older American Act, is to help elderly individuals maintain their dignity
and independence in their homes and communities through comprehensive, coordinated,
and cost-effective systems of long-term care, and livable communities across the United
States. As the aging of America creates new challenges and opportunities for our
Nation's system of care for older adults, WAAA follows the best practices and consumer
directed care approach set forth by AoA at a community level, to help strengthen and
promote the dignity and independence of older people by promoting more support for
community living; promoting consumer choice, control and independence; encouraging
people to take positive steps to maintain their health; and assisting people while they are
still healthy and able to plan ahead for their care.
3
SECTION II: Outcome and Evaluation Table
Describe how the outcome(s) of the proposed project relate(s) to the Safety Net Initiative
proposal guidelines. See also Outcome Evaluation Table Appendix A:
As mentioned previously, this program is directly impacting the respondents that reported
affordable healthcare as a moderate or major concern. An older adult's basic quality of
life and overall health is negatively impacted if he or she is unable to simply eat, see and
hear. These functions can have a ripple effect on a person's lifestyle by means of poor
nutrition which may lead to weight loss and isolation in turn leading to a damaging effect
on a chronic disease (currently, more than 80% of people 65 and older suffer from at least
one chronic illness) or harmful interaction with medication. Then when the individual does
seek medical attention, the devastating financial consequences on our nation's health
system are threefold.
As stated in Appendix A, if awarded, the funds will help an additional 50-70 Weld County
seniors at the end of the two year project. It is the agency's belief that if our Dental,
Vision, and Hearing Program can provide aid to those having difficulty accessing service
at an early stage, it will decrease the number of seniors that have waited until a moment
of crisis; thereby giving them control over their own preventive care with the expectation
the senior will be more independent and self-sufficient.
In addition, by administering a Client Satisfaction Survey, the Dental, Vision, and Hearing
Program will be able to identify problem areas and adjust to the client's needs. In doing
so, the program's improved efficiency will in turn create opportunity for them to achieve
better outcomes by being more accountable for their own health and preventive care.
4
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SECTION III: Budget Information
Budget Narrative:
In an effort to meet the growing needs of seniors, Weld County Area Agency on Aging is
requesting United Way of Weld County to fund $20,000 over the course of two years.
With an award from United Way, our goal would be to assist approximately 25-35
recipients with $10,000 the first and second year respectively through June 2010. Due to
the inability to predict which service seniors will need and the inflation of various dental,
vision, and hearing costs, an exact number cannot be calculated. All funds received from
United Way will be used for direct services for seniors; there will be no administrative
costs. For example, all funds would directly pay for frames, lenses, cleanings,
extractions, dentures, hearing aids, etc. All expenses, including personnel, supplies and
travel will be covered by monies received through the Older Coloradan Fund.
During this current fiscal year 2007-2008 the Dental, Vision, and Hearing Program
receives the majority of its funding from the Older Coloradan Fund. The Platte Valley
Medical Center in Brighton, Colorado through their Community Health Investment
Program (CHIP) provides 20% of funding and 8% is provided from the North Colorado
Medical Center Foundation in Greeley, Colorado. In the event funding from United Way,
CHIP, and/or NCMC Foundation is not granted to the full amount, the Dental, Vision, and
Hearing Program will still be offered to Weld County residents under the Older Coloradan
fund. However, the program may be forced to decrease the amount of funds awarded to
recipients (i.e., $600.00 for dental assistance may be decreased to $450.00 per client)
and the number of seniors receiving help will be drastically reduced. We fear the impact
that would occur on the older citizens of the community would be detrimental.
1. These funds will be used to continue and/or expand services provided for Weld County
seniors. Per notification of the CHIP Committee and North Colorado Medical Center
Foundation, due to their budgetary restraints these funds may not be available on a
continuous basis or at a significantly reduced amount. If the full amount of funding is
received from aforementioned partners, the impact on the number of Weld County
seniors benefiting from the program will increase.
2. Since the program is set up to provide direct services only, there would be no other
portions of the program that could be funded fully as a substitute. If United Way
cannot meet the full request of funds, then the number of seniors WAAA could assist
would decrease. As mentioned previously, an exact number that would be affected
cannot be calculated due to the inability to predict which service seniors will need and
the rise or fall of various dental, vision, and hearing costs. We could assume that
those older adults not able to receive assistance may experience more isolation
caused by the inability to hear and communicate with others, their driving could be
compromised by poor vision and their nutritional status may decline if they are unable
to properly chew food.
6
3. During the 2006-2007 fiscal year, the Dental, Vision, and Hearing Program was able to
commit up to $600.00 for dental services and $350.00 for vision and hearing services
respectively. The average cost per client was $400.00 for fiscal year 2006-2007 from
state funding. This is calculated by dividing the total service dollars by the number of
clients served.
4. As a governmental agency, WAAA is well established and has received steady funding
from the Older Coloradan Fund on a yearly basis, as well as a successful history with
other foundations and grants. Because of state regulations, the funds received for the
Dental, Vision, and Hearing Program from the Older Coloradan Fund are not permitted
to be carried over from one year to the next; therefore there are no state reserves.
Federal monies from the Older Americans Act may be carried over from one year to
the next within a limited time frame. For the last two years the Older Coloradan Fund
has increased and the program remains successful in finding smaller grants to support
additional direct services for seniors.
5. Various dental, vision, and hearing providers throughout northern Colorado remain our
best in-kind contributors. Often these providers will grant discounted services or waive
balances not covered by the program. In doing so, this donation deters the occasional
client from requesting additional assistance and therefore allowing more funds to be
available to more recipients.
6. Weld County Government follows generally accepted accounting principles and has an
annual outside independent audit. This audit is conducted in accordance with the
standards applicable to financial audits contained in Government Auditing Standards.
7
Safety Net Initiative
Project Budget Year 1
Applicant: Weld County Area Agency on Aging
Project: Dental, Vision, and Hearing Program
Total Amount Other Funding Requested from
BUDGET EXPENDITURES: Required for In-kind/Cash Match United Way of
Project Specific Status Weld County
PERSONNEL EXPENSES:
Older
Staff and Director time $18,011.25 Coloradan Received $ 0.00
Fund
SUPPLY EXPENSES:
Postage $125.00 Older
Brochures $215.00 $555.00 Coloradan Received $ 0.00
Paper, envelopes, folders $215.00 Fund
OPERATING EXPENSES:
Direct program expense: client
services such as exams, frames, United
lenses, hearing aid, dental $10,000.00 Way Applying $10,000.00
extractions, cleanings, partials, Safety Net
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames, Older
lenses, hearing aid, dental $35,000.00 Coloradan Received $ 0.00
extractions, cleanings, partials, Fund
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames,
lenses, hearing aid, dental $10,000.00 CHIP Will Apply $ 0.00
extractions, cleanings, partials,
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames, NCMC
lenses, hearing aid, dental $10,000.00 Foundation Will Apply $ 0.00
extractions, cleanings, partials,
upper/lower dentures, etc.
TRAVEL EXPENSES:
Older
65 miles x 12 months x $.485 $378.30 Coloradan Received $ 0.00
Fund
EQUIPMENT EXPENSES:
Older
n/a $ 0.00 Coloradan Received $ 0.00
Fund
TOTAL PROJECT COSTS: $83,944.55 $10,000.00
8
Safety Net Initiative
Project Budget Year 2
Applicant: Weld County Area Agency on Aging
Project: Dental, Vision, and Hearing Program
Total Amount Other Funding Requested from
BUDGET EXPENDITURES: Required for In-kind/Cash Match United Way of
Project Specific Status Weld County
PERSONNEL EXPENSES:
Older
Staff and Director time $18,705.52 Coloradan Received $ 0.00
Fund
SUPPLY EXPENSES:
Postage $175.00 Older
Brochures $285.00 $745.00 Coloradan Received $ 0.00
Paper, envelopes, folders $285.00 Fund
OPERATING EXPENSES:
Direct program expense: client
services such as exams, frames, United
lenses, hearing aid, dental $10,000.00 Way Applying $10,000.00
extractions, cleanings, partials, Safety Net
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames, Older
lenses, hearing aid, dental $35,000.00 Coloradan Received $ 0.00
extractions, cleanings, partials, Fund
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames,
lenses, hearing aid, dental $10,000.00 CHIP Will Apply $ 0.00
extractions, cleanings, partials,
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames, NCMC
lenses, hearing aid, dental $10,000.00 Foundation Will Apply $ 0.00
extractions, cleanings, partials,
upper/lower dentures, etc.
TRAVEL EXPENSES:
Older
65 miles x 12 months x $.535 $417.30 Coloradan Received $ 0.00
Fund
EQUIPMENT EXPENSES:
Older
n/a $ 0.00 Coloradan Received $ 0.00
Fund
TOTAL PROJECT COSTS: $84,867.82 $10,000.00
9
Safety Net Initiative
Cumulative Project Budget
Applicant: Weld County Area Agency on Aging
Project: Dental, Vision, and Hearing Program
Total Amount Other Funding Requested from
BUDGET EXPENDITURES: Required for In-kind/Cash Match United Way of
Project Specific Status Weld County
PERSONNEL EXPENSES:
Older
Staff and Director time $36,716.76 Coloradan Received $ 0.00
Fund
SUPPLY EXPENSES:
Postage $300.00 Older
Brochures $500.00 $1,300.00 Coloradan Received $ 0.00
Paper, envelopes, folders $500.00 Fund
OPERATING EXPENSES:
Direct program expense: client
services such as exams, frames, United
lenses, hearing aid, dental $20,000.00 Way Applying $20,000.00
extractions, cleanings, partials, Safety Net
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames, Older
lenses, hearing aid, dental $70,000.00 Coloradan Received $ 0.00
extractions, cleanings, partials, Fund
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames,
lenses, hearing aid, dental $20,000.00 CHIP Will Apply $ 0.00
extractions, cleanings, partials,
upper/lower dentures, etc.
Direct program expense: client
services such as exams, frames, NCMC
lenses, hearing aid, dental $20,000.00 Foundation Will Apply $ 0.00
extractions, cleanings, partials,
upper/lower dentures, etc.
TRAVEL EXPENSES:
See detail in Budget Year 1 and Older
Budget Year 2 $795.60 Coloradan Received $ 0.00
Fund
EQUIPMENT EXPENSES:
Older
n/a $ 0.00 Coloradan Received $ 0.00
Fund
TOTAL PROJECT COSTS: $168,812.37 $20,000.00
10
SECTION IV: Supporting Documentation
✓ Copy of most recent Audit. Weld County Government does not keep year-to-date
Financial Statements.
✓ Copy of Program Budget for 2008 (per Elizabeth Barber).
✓ Copy of current Board of Directors.
✓ Copy of non-profit status.
✓ Copy of anti-discrimination statement.
11
Dental, Vision, and Hearing Budget
July 1, 2008 -June 30, 2010
July 1,2008-June 30,2009 July 1,2009-June 30,2010 Cummulative
Revenue:
OCF(State)-Admin $18,944.55 $19,867.82 $38,812.37
OCF(State) $35,000.00 $35,000.00 $70,000.00
United Way* $10,000.00 $10,000.00 $20,000.00
NCMC* $10,000.00 $10,000.00 $20,000.00
CHIP* $10,000.00 $10,000.00 $20,000.00
Total Revenue: $83,944.55 $84,867.82 $168,812.37
Expenses:
Personnel $18,011.25 $18,705.52 $36,716.77
Supplies $555.00 $745.00 $1,300.00
Operating $65,000.00 $65,000.00 $130,000.00
Travel $378.30 $417.30 $795.60
Total Expenses: $83,944.55 $84,867.82 $168,812.37
*Contingent upon grant funding
Weld County Area Agency on Aging
Board Membership List
Adella Andrijeski, Retired Tom Gordon, Retired
26416 Range View Dr. 4639 21St St. Cir.
Kersey, CO 80644 Greeley, CO 80634
H: 970.350.0447 H: 970.339.3778
Email: Email:
adel26416@netzero.net Tg339@aol.com
Susan Bromley, Nancy Meek, Retired
Akerman & Associates 4267 W 15th St. Ln.
1621 13th Ave. Greeley, CO 80634
Greeley, CO 80631 H: 970.353.2850
H: 970.352.8750 C: 970.396.3657
W: 970.353.3373 Email: cobuilder@comcast.net
Email:
ssbromley@hotmail.com Marcia Osborn, Retired
2536 22nd Ave.
Don Beierbach, Retired Greeley, CO 80631
4292 W 14th St. Dr. H: 970.352.4668
Greeley, CO 80634 Email:
H: 970.352.5952 xlarxmar@comcast.net
Email:
dndbeierbach@juno.com Josie Sanchez,
Mary Pat Eastwood, University of Northern Colorado
5151 W 29thSt., Unit 1203
Eastwood Insurance
3609 Marigold St. Greeley, CO 80634
Evans, CO 80620 H. 970.330.5805
W: 970.346.1446 W: 970.351.2829
H: 970.330.3436 Email:
Email: josephine.sanchez@unco.edu
eastmary65@aol.com
Jerry Weil, Retired
Dave Long, Commissioner 7521 Plateau Rd.
Centennial Complex Greeley, CO 80634
Greeley, CO 80631 H: 970.353.2630
W: 970.356.4000 ext. 4208 Email:
Email: jerweil@comcast.net
dlong@co.weld.co.us
Ken Whitney,
Jacque Crick, Retired Anderson & Whitney
1103 3rd St. 1357 43rd Ave. #18
Ft. Lupton, CO 80621 Greeley, CO 80634
H: 303.857.1450 H: 970.353.8416
Email: W: 970.352.7990
topm@aol.com Email:
ken@awhitney.com
Revised 2/08
POLITICAL SUBDIVISION SALES TAX EXEMPTION CERTIFICATE
(For use by States, Territories, or Political
Subdivision thereof,or the District 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
FEDERAL TAX EXEMPTION NUMBER-84-6000813
STATE TAX IDENTIFICATION NUMBER- 14-02101
By 01142
Controller
Colorado statute exempts from state and state-collected sales tax all sales to the United States government and the State of
Co/orado,its departments and institutions,and its political subdivisions(county and local governments,school districts and special
districts)in their governmental capacities only.(C.R.S.39-26-114)1)(a)(I)].
Some governmental entities have a Colorado-issued tax-exemption number,although they are not required to have one. Following
is a copy of Weld County Government's most recent Colorado-issued Certificate of Exemption for Sales and Use Tax Only.
DR 100(,,e„ State of Colorado
'DEPARTMENT OF REVENUE
1375 SHERMAN STREET
DENVER.COLORADO 1 CERTIFICATE OF EXEMPTION
THIS LICENSE IS NOT TRANSFERABLE
FOR SALES AND USE TAX ONLY
WELD COUNTY
915 10TH S7 s1F C1)��
6REELEY CO' 8 0632-1 11 7 �� "'•'•••••,eG
18 t 1 761
. . oFi ' t
LIABILRY INFORMATION
ACCOUNT NUMBER ISSUE DATE �rNF1T OF.R�
98-03551 03 057 5999 9 010181 OCT 14 1988
E><xu1NeOF.aor
915 10TH ST 6REELEY CO )BExeRwRw Revenuetor
Weld County Employee
Policies
Ott And
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COLORADO
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