HomeMy WebLinkAbout20073521.tiff RESOLUTION
RE: APPROVE 2007-2008 EMERGENCY PREPAREDNESS AND RESPONSE DIVISION PAN
FLU III FUNDING TASK ORDER CONTRACT AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a 2007-2008 Emergency Preparedness
and Response Division Pan Flu III Funding Task Order Contract 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 upon full execution, and ending August 9, 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 the 2007-2008 Emergency Preparedness and Response Division Pan Flu
III Funding Task Order Contract 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.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 19th day of November, A.D., 2007.
r R", 'C '� BOARD OF COUNTY COMMISSIONERS
'
('^y v 4z BOUNTY, COLORADO
ATTEST: ikel c
o vid E. Long, Chair
j
Weld County Clerk to the B "�
William . J r , Pro-em
BY:
De ty Cle to the Boar
William F. Garcia
'
APPROVES TO FOSIK.. EXCUSED
/ Robert D. Masden
C n Attorney gyp. LA,_,
Douglas maclemacher
Date of signature: 115'07
2007-3521
HL0034
f/� «� /,2-/0-1lo-1 l
(� ot
Memorandum
TO: David E. Long, Chair
Board of County Commissioners
ig
FROM: Mark E. Wallace, MD, MPH, Director
ODepartment of Public Health and ,, �f�j�n Environment e,"(fL, /L
COLORADO DATE: November 14, 2007
SUBJECT: Pan Flu III Task Order Contract
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 2007-2008
Emergency Preparedness and Response Division Pan Flu III funding.
This contract will provide continuation funding in the amount of$50,155 for the time period
November 1, 2007 through August 9, 2008. The funding is entirely from the federal government
and will be used for Public Health Preparedness activities in the area of pandemic influenza as
identified in the scope of work. The Weld County Department of Public Health and Environment
will collaborate with CDPHE and other regional and state partners to achieve these activities.
I recommend your approval of this contract.
Enclosure
2007-3521
STATE OF COLORADO
Bill Ritter,Jr.,Governor
James B.Martin, Executive Director -by•cotp\
Dedicated to protecting and improving the health and environment of the people of Colorado F`- o
4300 Cherry Creek Dr.S. Laboratory Services Division ` �
Denver,Colorado 80246-1530 8100 Lowry Blvd. 4,�
Phone(303)692-2000 Denver,Colorado 80230-6928 X876
TDD Line(303)691-7700 (303)692-3090
Located in Glendale,Colorado Colorado Department
of Public Health
http://www.cdphe.state.co.us and Environment
October 25,2007
Mark Wallace
Executive Director
Weld County Department of Public Health and Environment
1555 North 17h Avenue
Greeley,CO 80631
Dear Local Health Partner:
Thank you for your continued dedication to support emergency preparedness and response in Colorado.
Enclosed please find three copies of your 2007-2008 Emergency Preparedness and Response Division Pan Flu III
Funding Task Order,routing number 08 FHA 00098, (Contract#EPI0800098),with the Colorado Department of Public
Health and Environment for the term of November 1,2007—August 9,2008.
All three copies must be signed with the two appropriate signatures, one the designated authority binding the contractor to the
contract,and the other attesting to the authority of the first. If you have a seal,please affix it to the signature page of each
copy.
Please return all three copies of the task order at your earliest convenience to: Judy Yockey,Colorado Department of Public
Health and Environment,EPRD-A5,4300 Cherry Creek Drive South,Denver,Colorado 80246-1530.
Upon receipt of the signed documents,I will route them for approval by the proper authorities. Please be advised that is not
an official notification of funding award or authorization to begin performance and that these agreements shall not be deemed
valid until the State Controller authorizes it. Your verified copies will be returned to you as soon as possible.
Your assistance in expediting these agreements is greatly appreciated.Please feel free to contact me if you should have any
questions or concerns.
Sincerely,
Judy Yockey
Contract Administrator
Emergency Preparedness and Response Division
Phone: 303-692-2645
Fax: 303-691-7811
E-mail: judy.yockey(a,state.co.us
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
ROUTING NO.08 FHA 00098
APPROVED TASK ORDER CONTRACT-WAIVER#154
This Task Order Contract is issued pursuant to Master Contract made on 01/23/2007,with routing number 08 FAA 00052
SI'AIE: CONTRACTOR:
State of Colorado for the use& benefit of the Board of County Commissioners of Weld
Department of Public Health and County
Environment 915 10v11 Street
Emergency Preparedness and Response Greeley, Colorado 80632-0758
Division For the use and benefit of the
4300 Cherry Creek Drive South Weld County Department of Public Health
Denver, Colorado 80246-1530 and Environment
1555 North 176 Avenue
Greeley, Colorado 80631
TASK ORDER MADE DATE: CONTRACTOR ENTITY TYPE.
October 23, 2007 Colorado Political Subdivision
PO/SC ENCUMBRANCE NUMBER: CONTRACTOR REIN OR SOCIAI.SECURITY NUMBER:
PO FHA EPI0800098 846000813
TERM: BILLING STATEMENTS RECEIVED:
This Task Order shall be effective upon Monthly
approval by the State Controller, or designee,
or on 11/01/2007,whichever is later. The STATUTORY AUTHORITY:
Task Order shall end on 08/09/2008. Not Applicable
PRICE STRUCTURE: CONTRACT PRICE NOT TO EXCEED:
Cost Reimbursement $50,155.00
PROCUREMENT METI 1OO: FEDERAL FUNDING DOLLARS: $50,155.00 ..
Exempt REATE FUNDING DOLLARS:
$P
BID/REP/LIST PRICE AGREEMENT NUMBER: MAXIMUM AMOUNT AVAILABLE PER FISCAL.YEAR:
Not Applicable FY08: $50,155.00
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESEN'TAT'IVE: CONTRACTOR REPRESENTATIVE:
Judy Yockey Mark Wallace
Department of Public Health and Environment Executive Director
Emergency Preparedness and Response Division 1555 North 17th Avenue
4300 Cherry Creek Drive South Greeley,CO 80631
Denver,CO 80246-1530
SCOPE OF WORK:
Contractor shall work with and through state,regional and local partnerships to achieve the activities - —-
identified under the attached Scope of Work. Contractor shall ensure collaboration with the Colorado
Department of Public Health and Environment (CDPHE),local public health agencies and regional
Epidemiologist, Planner and Trainer staff members within the designated All-Hazards Region.
Page 1 of 4
EXI IIBIT.
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 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.
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
exhibits/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 3 of 4
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 Weld County BILL RITTER,JR. GOVERNOR
for the use and benefit of the Weld County
Department of Public Health and Environmentd.----.14:4J
glee___,y/'//�glee___,Legal Name of Contracting Entity
By
•
For Executive Director
846000813 Department of Public Health and Environment
Social Security Number or FEIN
r
E` d, Department Program Approval:
Signature of Authorized Officer NOV 19 2007
David E. Long, Chair B
Print Name&Title of Authorized Officer
alaratip
GOVERNMENTAL TITLES: 1� `%
(An attestation and)e+I ar r e )i !/ �J
I
/
(I at. fli
Attest(Seal)By )r_....--6--"S")C!`/�i SJztc j a
, . `T
(Town/City/County Clerk or Equivalent) - r t seal here) _
� : \ �;-
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:
1 Leslie ;Shenefelt
_ By LI — a — - - . . .
Date / ']-
WELD COUNTY DEPARTMENT OF
PU�LLIIC_HrEALTIH A U NV�IR�ONNMEE7NT
BY: " Q` 1/ - GU a ' euj
Mark E. Wallace, MD, MPH-Director
Page 4 of 4
&OC7- 35,a/
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 10/23/2007 - Contract Routing Number 08 FHA 00098
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
This Task Order Contract contains federal funds(see Catalog of Federal Domestic Assistance(CFDA)
number 93.283).
2. The United State Department of Health and Human Services("USHHS"), through the Centers for Disease
Control and Preventions("CDC")has awarded federal funds under Award number U90/CCU816827,
hereinafter"Award",to develop emergency-ready public health departments by upgrading, integrating and
evaluating state and local public health jurisdictions' preparedness for and response to terrorism,pandemic
influenza, and other public health emergencies.
The State has formulated a comprehensive State plan, with associated budgets,to disburse these funds
throughout the state of Colorado. Within this cooperative agreement, the State has been awarded
supplemental funding for pandemic influenza preparedness activities specifically intended to foster
developing and exercising pandemic influenza plans. This funding supports key elements of the National
Strategy for Pandemic Influenza,the Implementation Plan for the National Strategy and the USHHS
Pandemic Influenza Plan.
If the underlying Award authorizes the State to pay all allowable and allocable expenses of a contractor as
of the effective date of that Award,then the State shall reimburse the Contractor for any allowable and
allocable expenses of the Contractor that have been incurred by the Contractor since the proposed effective
date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable
and allocable expenses of a contractor as of the effective date of that Award,then the State shall only
reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by
the Contractor on or after the effective date of this Task Order Contract, with such effective date being the
later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the
State Controller or delegee.
3. In consideration for those services timely and satisfactorily performed by the Contractor under this
Contract,the State shall cause to be paid to the Contractor a total sum not to exceed FIFTY THOUSAND
ONE HUNDRED FIFTY FIVE DOLLARS($50,155.00)for the initial term of this Contract from
November 1,2007,through and including August 9,2008. Of this total amount, $50.155.00 is identified
as attributable to a funding source of the federal government.
4. This Contract is funded entirely with federal funds. Therefore,the State's liability for payment for all
services rendered, or goods supplied,under this Contract is contingent upon the State's receipt of those
federal funds. If the State does not receive all, or any part,of the federal funds necessary to pay its
obligations under this Contract,then the State may immediately amend or terminate this Contract without
further liability to the State.
5. To receive compensation under this Contract,the Contractor shall submit a signed monthly Emergency
Preparedness and Response Division Reimbursement Statement in accordance with the 2007-2008
• Emergency Preparedness and Response Division ReimburseritentReghirements.A sample Emergency
Preparedness and Response Division Reimbursement Statement is attached hereto as"Attachment A-1"
and incorporated herein by this reference. The Emergency Preparedness and Response Division
Reimbursement Requirements is attached hereto as"Attachment A-2" and incorporated herein by this
reference. An Emergency Preparedness and Response Division Reimbursement Statement must be
submitted within thirty(30)calendar days of the end of the billing period for which services were rendered.
To be attached to CDPHE Page 1 of 2 Revised: 12/19/06
Task Order v1.0(11/05)contract template
EXHIBIT A
Final billings under this Contract must be received by the State within a reasonable time after the expiration
or termination of this Contract;but in no event no later than thirty(30)calendar days from the effective
expiration or termination date of this Task Order Contract. Expenditures shall be in accordance with the
Statement of Work and Budget attached hereto as Exhibit B and incorporated herein, and in accordance
with the work requirements outlined in"Attachment B-1". Contractor shall be paid on a cost
reimbursement basis only. All items requested for reimbursement must be allowable and directly related to
activities identified under the Scope of Work. These items may include, but are not limited to,the
Contractor's salaries, fringe benefits, supplies,travel,operating, indirect costs which are allowable,and
other allocable expenses related to its performance under this Task Order Contract.
The State has the option to reduce the budget and the scope of work if the Contractor fails to submit
monthly invoice/cost reimbursement statements within thirty(30)calendar days. The monthly billing
performance shall also be used as a basis for calculating the Contractor's future funding levels, if any.
The State will notify the Contractor of the potential need to decrease the budget and scope of work. The
Contractor may supply the monthly invoice,back up documentation and request a re-determination,which
shall take place within fifteen(15)calendar days of the receipt of a written request. If no dispute is
received by the CDPHE within fifteen(15)calendar days,the State will take action and modify the contract
to reduce the budget and scope of work.
Invoice/Cost Reimbursement Statements shall: 1)reference this Task Order Contract by its contract routing
number, which number is located on page one of this Task Order Contract;2)state the applicable
performance dates; 3)state the names of payees;4)include a brief description of the services performed
during the relevant performance dates; 5)describe the incurred expenditures if reimbursement is allowed
and requested; and, 6)show the total requested payment. Payment during the initial, and any renewal or
extension,term of this Task Order Contract shall be conditioned upon affirmation by the State that all
services were rendered by the Contractor in accordance with the terms of this Task Order Contract.
Invoice/Cost Reimbursement Statements shall be sent to:
Sonia Gonzales
Emergency Preparedness and Response Division
Colorado Department of Public Health and Environment
EPRD-A-5-3650
4300 Cherry Creek Drive South - -
Denver,CO 80246
Unless otherwise provided for in this Task Order Contract,"Local Match", if any,shall be included on all
billing statements as required by the funding source.
The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
6. The State has determined that this contract does not constitute a Business Associate relationship under
HIPPA.
To be attached to CDPHE Page 2 of 2 Revised: 12/19/06
Task Order vl.0(11/05)contract template
ATTACHMENT A
r�ergeney ' rep es a ndRespo l>►�Isio. .0. uubn semen t semen ' ,
o: Colorado Dept.of Public Health&Environment From:
Address: 4300 Cherry Creek Drive South,A-5 Address:
Denver,CO 80246
Attn: Sonia Gonzales Fax: 303-691-7811 Contact: Phone:
From:
Program: Public Health Emergency Preparedness&Response Date of Expenditure:
To:
Contract/PO Number:
Final Invoice Yes No FEIN:
' iai •*� r,ae r S` ' f • t Qaa = •₹ x +
>< -A1::214444 ;141:).
r i s c...n-' =S { -r- {.y 4 n t Lien
I �$ „titer11i + ,14
I I i 1 1 A:
Job Title
Name of Employee Hours or % `ksa3' 8 a,ra'
Personnel:
k�6 2#:<<i� '4z
tl` itett i]CPeU9ens S• $0.00
Equipment:
t k •.• eTS R14 i '.
.••, 9uipidentlelpted Pe fs tt -Tb 000
Travel:
' s�€}�0.O, - r ' �ti' iltp ' '+'�C Iik8 UI1'of I: i , .' :k .,'„.". 4}t1
Operating/
Supplies:
b e rippi��kell ed Ezpeiises Sub-tou•t $0.00
Indirect:
' 'h ist'"47-''''f s „� "ssry` r-ps,"',fi-'s"sra�ey
l9v y n t . t Z:" Y . uh k.� ,r t=l•- C r
t t� yt4 `" , 't r 'x`17 i+ �� iilt @ t°' t g o-v ,� p F i �• �, f f , I I h
aitebte(%, ,� st ..t �..
1 certify the expenses listed above were incurred by our agency;are true and just in all respects and are In compliance with the above referenced Contract/
Purchase Order
Signature tcourancroac Date:
As a State designee,/hereby certt that all contract requirements have been met,the requested amounts are correct and the payment is authorized
Signature(cop '. Date:
ta
Page 1 of
ATTACHMENT A-2
Emergency Preparedness and Response Division
2007 - 2008 Reimbursement Requirements
� u �5
.i.q � PL
., . : 0 DOS ,isH.:�O F `i
PERSONNEL > Breakout of actual amounts for salary, fringe
benefits and indirect rates
John Doe, EPR Planner, 100%of FTE $5,000.00 > Documentation of EPR activities and
projects for employees and time periods
Jane Black,EPR Admin Support, 15 Hours $1,000.00
listed on invoice
Fringe $1,236.00 > Activities must be directly related to EPR
Invoice for actual time spent on EPR > All of above information is needed even if
grant
• personnel time is contracted out
• Include Name,Title and Percent of FTE or Hours Worked
EQUIPMENT > Original receipts
30Actual equipment being used appropriately to
2 Computers $5,000.00
accomplish EPR activities
2 Pagers $1,000.00
3 800 Mhz Radios $3,500.00 > Documented check-out system if equipment
1 Fax Machine $500.00 is loaned out to other programs to track and
verify location and availability of all
equipment purchased with EPR funds
TRAVEL > Signed mileage expense forms with
itemized list of travel related expenses for
Jane Dough,NIMS Training $1,000.00 each traveler(including applicable receipts
John Smith,NDMS Conference $500.00 for hotel, parking,per diem etc.)
➢ Meeting/conference(reason for travel)
who traveled separate documentation, i.e.registration
• List each employee
P confirmation,meeting minutes/attendance
list etc.
OPERATING/SUPPLIES ➢ Original Receipts
Copies$100.00 > Actual existence of supplies
Office supplies $23.46 Postage $10.34 > Documentation of operating expenses
(phone records,rental agreements, etc.)
Telephone service(Cell and Main Line) $200.00
Rent $300.00 > Documented formula for expenses that are
Equipment Maintenance $250.00 billed against multiple grants or programs
AV Equipment Rental $40.00
Task based funding for online course $1,000.00
• Itemize by type of expense(i.e. copies,office supplies)
• * LABORTORY: Itemize separately by type of expense&item
• A copy of the receipt for any single item with a value of $1,000
or greater must be submitted with the invoice
Page 1 of 2
ATTACHMENT A-2
Emergency Preparedness and Response Division
2007 - 2008 Reimbursement Requirements
te i °r ' S. Yg i f T v B t ' 6 't&' ffi ! a 0 S' 1 ' a ° tiF ` 6
'on it.Errt"SWMP- Otwerif,9e reetirlitVgtii51:4641r
INDIRECT ➢ Documentation of approved%of indirect
LPHA Approved Indirect Rate 10% ➢ Specific documentation may be required and
of Direct Salaries&Wages $1,243.00 will be identified on an individual basis
• List approved percentage,or requested percentage if less
• Indirect costs that exceed the approved contractual amount
will not be reimbursed
• Approved indirect rats are effect for the entire term of the
contractual agreement
• Per Capita is not an allowable category for expense reimbursement.
• All expenses must be directly related to specific Emergency Preparedness and Response activities as identified in the
Scope of Work.
• Contractor shall be paid on a cost reimbursement basis only.
• All expenses must be invoiced under the appropriate budget categories of Personal Services,Equipment,Travel,
Operating/Supplies or Indirect and in accordance with the above criteria.
• Cooperative agreement funds under this program may not be used to purchase vehicles or supplant any current state or
local expenditures. Supplantation means using Federal funds to replace local funds. The Public Health Service Act,
title I, Section 319(c)specifically states: SUPPLEMENT NOT SUPPLANT.Funds appropriated under this section
shall be used to supplement and not supplant other Federal, State,and local public funds provided for activities under
this section. Therefore,the law strictly and expressly prohibits supplanting.
• Department of Public Health&Environment,Emergency Preparedness and Response Section may request additional
back up information including copies of receipts on any item at any time.
• All Expenses must be encumbered by the grant end date,and all invoices must be submitted no later than 45 days after
the grant end date.
Page 2 of 2
EXHIBIT B
STATEMENT OF WORK
To Task Order Contract Dated 10/23/2007-Contract Routing Number 08 FHA 00098
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above.
I. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order,
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"Attachment B-1" and incorporated herein.
To be attached to CDPHE Page 1 of I Revised: 12/19/06
Task Order v1.0(11/05)contract template
ATTACHMENT B-I
Emergency Preparedness and Response Division
2007—2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
Contract Term: November 1,2007 through August 9,2008
Background: The State of Colorado,through the Colorado Department of Public Health and
Environment(CDPHE), was awarded $2,775,801 for pandemic influenza preparedness activities
under the Centers for Disease Control and Prevention(CDC)Public Health Emergency
Preparedness Cooperative Agreement(PHEPCA). This funding supports key elements of the
2006 Pandemic and All-Hazards Preparedness Act(PAHPA)designed to improve the nation's
public health and medical preparedness and response capabilities for all emergencies, whether
natural or man-made, with public health consequences.
In April 2007, CDC required all states to submit a pandemic influenza operational plan. CDC
asked states to report on 24 thematic areas, six of which were deemed Priority Thematic Areas:
Mass Vaccination, Continuity of Operations Planning, Surveillance/Laboratory,
Communications, Community Containment and Antiviral Distribution. Deliverables under this
contract will relate to one or more of these Priority Thematic Areas. For continuity, each of the
Priority Thematic Areas has been linked to one or more target Capabilities.
Purpose: This document provides Pandemic Influenza Phase III criteria for Colorado's LPHAs
supported by CDC PHEPCA funding for the purpose of furthering pandemic influenza
preparedness and response.
Contract Objective: Pandemic Influenza Phase III activities under this Scope of Work are for
the purpose of furthering pandemic influenza preparedness and response. Any successful
response to a pandemic influenza must include an effective response at the State and local
levels. This will require pre-established partnerships and collaborative planning by public health
officials, law enforcement officials, hospital administrators, and community leaders, who have
considered a broad range of scenarios and participated in realistic response exercises. These
planning and response exercises should enable public health and law enforcement officials to
establish procedures and locations for quarantine, surge capacity, diagnostics, and
communication. Local public health agencies supported by this cooperative agreement should be
fully prepared to respond to and control a pandemic influenza outbreak by the end of three years,
beginning with Phase I funding, but accelerated if epidemiologic information suggests the need to
implement a cohesive response prior to that time. CDC endorses capabilities-based disaster
planning and exercising consistent with the Homeland Security Exercise and Evaluation Program
(HSEEP)—a national exercise program coordinated by the Department of Homeland Security
(DHS).
As with the core 2007-2008 Public Health Emergency Preparedness and Response funding, this
- - -- supplement organizes Critical Tasks under a series of Target Capabilities. Target Capabilities are
defined as combinations of people, equipment, and supplies which, through proper planning,
equipping, training, organizing, and exercising, can perform Critical Tasks at expected levels of
proficiency to achieve desired outcomes in response to disasters.
Page 1 of 8
ATTACHMENT B-1
Emergency Preparedness and Response Division
2007 — 2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
The Colorado Department of Public Health and Environment(CDPHE)shall be responsible for
setting any precedents for actual response to a disease outbreak or emergency over the activity
requirements of this contractual agreement. The Contractor shall be responsible for the
accomplishment of all Agency Work Plan activities through State, Regional and Local
partnerships and shall comply with Colorado Revised Statute 25-1.5-102.
Contractor shall work with and through state, regional and local partnerships to achieve the
activities identified under this Scope of Work. Contractor shall ensure collaboration with
CDPHE, local public health agencies and regional Epidemiologist, Planner and Trainer staff
members within the designated All-Hazards Region. Contractor shall ensure agency
representation at the requested meetings, training sessions and conference calls.
Contractor understands and agrees that no amount of funding made available pursuant to this
contractual agreement can be used for any work or project other than that specified in this Scope
of Work. Contractor further understands that Contractor is not to include any work not related to
the Scope of Work on any reimbursement statements to the State. If Contractor mistakenly
includes any unrelated work on an reimbursement statement submitted pursuant to this
contractual agreement, then Contractor hereby agrees to return this amount of money to the State
immediately upon becoming or being made aware.
Page 2 of 8
ATTACHMENT B-1
Emergency Preparedness and Response Division
2007— 2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
Contract Budget: Contractor's total award shall not exceed $50,155.00.
Contractor shall ensure compliance with the 2007-2008 Emergency Preparedness and Response
Division Reimbursement Requirements and shall have the liberty to allocate funds across and in
accordance with the following budget categories:
Personnel: Contractor shall dedicate the necessary funds to support salary and fringe for any
staff member devoting time and effort towards the accomplishment of any activities
identified under this Scope of Work.
Equipment: Contractor shall dedicate the necessary funds to purchase equipment, as well as
maintain the working order of any existing equipment, required to meet any activity
identified under this Scope of Work. This shall include, but is not limited to, personal and
portable computers, communication radios, cellular telephones, facsimile machines,
laboratory equipment, training equipment, public information kits, etc.
Travel: Contractor shall dedicate the necessary funds to support travel related costs to ensure
accomplishment of activities identified under this Scope of Work. This shall include, but is
not limited to, regional planning meetings, local partner planning meetings, attendance at
training sessions, conferences, agency representation at the Emergency Preparedness and
Response conference calls and annual strategic planning meetings.
Operating and Supplies: Contractor shall dedicate the necessary funds for operating and
supply costs directly associated with any activities identified under this Scope of Work. This
shall include, but is not limited to, high-speed Internet connections, notification systems,
telephone and communication systems, office supplies, copying, printing, postage, room
rental, software purchase and upgrades, laboratory supplies, etc.
Indirect: The allowable indirect rate charged to this contractual agreement may be lower but
shall not exceed 13.96% of Total Direct Costs.
This indirect rate shall be in effect for the entire term of this contractual agreement.
Contractor may request a modification if a different indirect rate is negotiated within this
term. Contractor must provide written documentation identifying a significant financial
impact in order to justify the contractual agreement modification. All contractual agreement
modifications will be reviewed on an individual basis.
Contractor shall establish a process to track all obligations and expenditures related to this
contractual agreement separately from other funds awarded through the Public Health
Preparedness and Response Cooperative Agreement. - _ - - -
Contractor shall ensure that all service related expenses will be completed and all goods related
expenses committed by August 9, 2008.
Page 3 of 8
ATTACHMENT B-1
Emergency Preparedness and Response Division
2007 — 2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
The Contractor shall maintain a complete file of all records, documents, communications, and
other materials that pertain to the operation of the activities under this contractual agreement.
Such files shall be sufficient to properly reflect all direct and indirect costs of labor, materials,
equipment, supplies and services, and other costs of whatever nature for which a reimbursement
was made. These records shall be maintained according to generally accepted accounting
principles and shall be easily separable from other Contractor records. Contactor's auditor shall
perform audits in accordance with the requirements of the OMB Circulars A-87 (Cost Principles
for State, Local, and Tribal Governments), A-122 (Cost Principles for Non-Profit Organizations)
and A-133 (Audits of States, Local Governments, and Non-ProfitOrganizations), as applicable.
Contractor shall ensure that reimbursement requests are not duplicated under any other Public
Health Emergency Preparedness funding or utilized to supplant non-related activities or
programs. Contractor shall ensure appropriate distribution of costs in direct relation to the
activities performed.
Supplantation: Cooperative agreement funds cannot supplant any current state or local
expenditures. Supplantation refers to the replacement of non-federal funds with federal fund
intended to support the same activities. The Public Health Service Act, Title I, Section 319(c)
specifically States: "SUPPLEMENT NOT SUPPLANT. -- Funds appropriated under this section
shall be used to supplement and not supplant other federal, state, and local public funds provided
for activities under this section." Therefore, the law strictly and expressly prohibits
supplantation.
Unallowable Costs:
• Purchase of antiviral drugs, seasonal influenza vaccine, or pneumococcal vaccine
• Funds may not be used for research
• Funds under this program can not be used to purchase vehicles of any kind
• Funds may not be used to purchase incentive items
• Salaries for back filling of personnel
• Construction or major renovations
• Fund raising activities
• Political lobbying.
Progress Reporting: Information on progress made with the following deliverables will be
collected biannually through CDPHE's Preparedness Reporting System on February 29, 2008 and
August 8, 2008.
Page 4 of 8
• ATTACHMENT B-1
Emergency Preparedness and Response Division
2007-2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
Pandemic Influenza Priority Thematic Areas &Associated Target Capabilities
rTarget Capabilities: Planning&Mass Prophylaxis
Priority Thematic Area: Mass Vaccination
Agency Activity CDPHE Performance Measure
PAN! Participate in the CDPHE"Pod Squad"full- PAN Ia. For LPHAs opening a POD: Based
scale exercise. on CDPHE's and your LPHA's After Action
Report(AAR)and Improvement Plan(IP),
implement corrective actions and update
agency's POD Plan by June 1,2008.
PAN/b. Document participation by
appropriate agency personnel in at least one
training on updated components of the
agency's POD Plan by August 8, 2008.
PANI c. For LPHAs not opening a POD:
Provide constructive feedback during the
"POD Squad"Hotwash to CDPHE and LPHA
who's POD your agency was assigned to
support AAR/IP development.
Target Capability:Planning
Priority Thematic Area:Continuity of Operations Plaw(COOP)
Agency Activity
CDPHE Performance Measure
� �
PAN2. Update Continuity of Operations Plan(COOP) PAN2a. Identify gaps in the agency's current
Annex to incorporate how agency will maintain COOP Annex and revise to include bulleted
essential functions during a pandemic and return to items by June 1,2008.
routine public health functions:
o Identify essential functions and other critical PAN2b. Document participation by
activities appropriate agency personnel in at least one
o Identification of alternate operating facilities training on updated components of the
o Vital records, databases and systems and agency's COOP Annex by August 8, 2008.
where/how they are stored;
o Orders of succession for key organizational
leadership positions
_ _ _ _o Delegation of authorities
o Decision process for determining appropriate
actions in implementing COOP plans and
procedures
o Responsibilities of the individuals who have
COOP roles(leadership, planners,COOP
_personnel);
Page 5 of 8
•
ATTACHMENT B-1
Emergency Preparedness and Response Division
2007—2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
.: o Interoperable communications systems and
contact lists;
o Flexible workplace issues/teleworking
o Process to reconstitute/resume routine public
health functions
Target Capability: Epidemiological Surveillance and Investigation
Priority Thematic Area: Surveillance/Laboratory
Agency Activity . .. ...
CDPHE Performance Mea�are
PANS.Regional Epis ONLY: Update and/or develop a PAN3a. Regional Epis ONLY: Submit the plan
plan for active disease surveillance and reporting at electronically to the CDPHE Communicable
hospitals in the region/jurisdiction during an event Disease Epidemiology Program by August 8,
such as pandemic influenza,using the CDPHE 2008.
"Surveillance for Pandemic Influenza Hospitalization
and Hospital Deaths" as a guide. PAN3.Ia. Regional Epis ONLY: Provide am
electronic list of hospitals participating in the
PAN3.1.Regional Epis ONLY: Solicit hospitals within exercise to the CDPHE Communicable
your region to participate in the pandemic surveillance Disease Epidemiology Program by August 8,
and reporting exercise to be held in the fall of 2008. 2008.
Target Capability: Communications
Priority Thematic Area: Communications
Agency Activity CDPHE Performance Measure
PAN4.Public Information Officers Only: Participate PAN4a. LPHA Public Information Officer
in biannual CDPHE-sponsored communications/ will attend two CDPHE-sponsored
public information meetings led by CDPHE's Office communications meetings.Attendance
of Communications. Dates/locations to be verified by sign-in roster. This deliverable is
determined. optional for any LPHA who does not have a
Public Information Officer.
Target Capability: Isolation and Quarantine
.
Priority Thematic Area: Community Containment .
Agency Activity CDPHE Performance Measure
- - PANS:Review-Colorado's Pandemic-Influenza Triage PANSa: Send comments electronically to . . - . .
Guidance document developed by CDPHE and CDPHE within 30 days of initial release of
provide recommendations for improvement,if document for review.
appropriate.
Page 6 of 8
• ATTACHMENT B-1
Emergency Preparedness and Response Division
2007 — 2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
Target Capability: Medical Surge
Priority Thematic Area: Antiviral Drug Distribution
Agency Activity' J CDPHE Performance Measure
PAN6. Participate in one CDPHE-sponsored"Medical PAN6a. Participate in one"Medical Surge
Surge Seminar/Tabletop" Seminar/Tabletop".Attendance verified by
o All Regional Staff must attend. CO.TRA IN sign-in roster. Regional staff
o At least one senior staff person from each participation does not count toward LPHA
LPHA must attend. participation.
PAN6.I Develop a Medical Assets Distribution annex
for Treatment Centers within the jurisdiction. The PAN6.1a. Medical Assets Distribution Annex
Division of Strategic National Stockpile defines must be posted to COHAN, in the appropriate
"Treatment Centers"as: All-Hazards Regional folder,by August 8,
o Hospitals: In-patient Care 2008.
o Alternative Care Sites such as:
Community/Rural Health Clinics: Out-patient PAN6.1 b. SNS request/receipt protocol must
Care include approval signatures from the local
public health agency, local emergency
Annex must address the following: management,hospitals,community health,
o Identification of ESF-8 lead agency tasked rural health and Kaiser Pennanente(if
with coordinating SNS medical requests at applicable)and posted to COHAN, in the
the regional/county level appropriate All-Hazards Regional folder, by
o Annex must address the allocation,and August 8, 2008.
transport of antivirals,controlled substances
and medical materiel to hospitals and other
healthcare entities such as community and
rural health clinics within the jurisdiction_
o Per CDPHE,develop protocols for the
request and receipt of Strategic National
Stockpile(SNS)assets that are agreed upon
by local emergency management, hospitals,
community and rural health clinics.
o NCR/CR1 Only—Kaiser Permanente
must be included in this protocol.
PAN6.2 Work with local emergency management and
hospitals within the jurisdiction for alternate care site PAN6.2a Alternate Care Site(ACS) Annex
(ACS)planning. The following must be addressed: must be posted to COHAN, in the appropriate
o Using AHRQ's Alternate Care Site Selection All-Hazards Regional folder,by August 8,
Tool to identify at least one alternate care site 2008.
must be identified for each hospital,hospital
system or healthcare system.At least one PAN6.2b Document name, location and
ACS should be identified for.the region. contact information for the identified - .
o Confirm protocol for coordination and Alternate Care Sites for the region or
activation of alternate care site exists through jurisdiction in the agency's PHEOP by August
local emergency management; provide 8,2008.
technical support to develop if one does not
exist. PAN6.2c Document the protocol for
coordination and activation of the Alternate
Page 7 of 8
ATTACHMENT B-1
Emergency Preparedness and Response Division
2007 — 2008 Local Public Health Agency
Phase III Pandemic Influenza Scope of Work
Centers for Disease Control and Prevention
Public Health Emergency Preparedness Cooperative Agreement
Care Sites for the region or jurisdiction in the
agency's PHEOP by August 8,2008
Cross-Cutting
Training and Exercise Strategy
Agency Activity
PANT Participate in electronic statewide training and PAN7a. Complete electronic statewide
exercise needs assessment training and exercise needs assessment by
o All agency directors must complete the August 8, 2008.
assessment Attendance verified by Zoomerang Survey
o All emergency preparedness regional staff tool. Regional staff participation does not
must complete the assessment count toward LPHA participation.
o At least 25%of organized health department
staff must complete the assessment
•
•
Page 8 of 8
EXHIBIT C
It 4,
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 ** *** *****, f 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 I of 5
4 t
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"]collectively referred to herein as the Original Contract, which is by
this reference incorporated herein. All terms, conditions, dnd 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
EXHIBIT C
r
****, 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 [choose 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
t
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
EXHIBIT 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
STATE OF COLORADO
Bill Ritter,Jr.,Governor � pp co4o�F�
James B. Martin, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado " .,%
4300 Cherry Creek Dr.S. Laboratory Services Division '� .
Denver,Colorado 80246-1530 8100 Lowry Blvd. +e7b
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
December 21, 2007
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
Attn: Mark Wallace
Dear Contractor,
Enclosed please find your fully approved 2007-2008 Phase III Pandemic Influenza Funding Task
Order Contract, PO FHA EPI0800098, (contract routing number 08 FHA 00098), with the Colorado
Department of Public Health and Environment, Emergency Preparedness and Response Division.
Please keep these original documents for your records.
If you have any questions or require further information, please feel free to contact me.
Sincerely,
Jud Yockey
Contract Administrator
Emergency Preparedness and Response Division
Phone: (303) 692-2645
Fax: (303) 691-7811
E-mail:judy.yockeystate.co.us
Attachments
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