HomeMy WebLinkAbout20061292.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR FAMILY PLANNING SERVICES PROGRAM AND
AUTHORIZE CHAIR TO SIGN
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a Task Order for Family Planning Services
Program between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and the Colorado Department of Public Health and Environment, commencing
July 1, 2006, and ending June 30, 2007, with further terms and conditions being as stated in said
task order, and
WHEREAS,after review,the Board deems it advisable to approve said task order, 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 Task Order for Family Planning Services 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.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 8th day of May, A.D., 2006.
BOARD LD CO COUNTY T COMMISSIONERS
Y, COLORADO
ATTEST: / " 0'' �$ ,4s
/ st ! i ile, Chair
Weld County Clerk to the Boa r `'+i Y �` t
•
BY:
ltii � re, � �°\ id E. Long, Pro-Tem
D ty Clerk to the Board
Willi 4. Jerke
APPROVED AS TO FORM: V )eAt -
Robert D. Masden
���, unty rney .���.0AA r;, id;
Glenn Vaad
Date of signature: 5/26/0(c)
2006-1292
HL0033
('(3 '• Ni_— Cc. 0,Jc5) oL,--c} .-0C'
Memorandum
TO: M.J. Geile, Chair
Board of County Commissioners
' C FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health a/f 7 /o
Environment / G (0
COLORADO DATE: May 4, 2006 /
SUBJECT: Task Order for the Family Planning
Program
Enclosed for Board review and approval is a task order between the Colorado Department of
Public Health and Environment (CDPHE) and Weld County for continuation funding for the
Family Planning Program.
Under the provisions of this task order, Weld County Department of Public Health and
Environment will provide contraceptive services to both men and women in their reproductive
years. These services will include comprehensive health and social histories, physical
examinations, contraceptive information, and supplies. Education and counseling regarding
family planning, infertility, sterilization, nutrition, sexually transmitted diseases, and follow-up
and/or referral services will also be provided.
For the above services, Weld County will be reimbursed an amount not to exceed $165,526 for
the time period July 1, 2006 through June 30, 2007. Of this amount, $111,342 are federal pass
through funding and $53,914 are from the State of Colorado.
I recommend your approval of this task order.
Enclosure
2006-1292
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
07-FLA-00079
TASK ORDER
Family Planning Services Program
This Task Order is made this 17th day of April,2006,by and between:the state of Colorado,acting by and through
the COLORADO 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 the BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY(a political
subdivision of the state of Colorado),whose address or principal place of business is 915 10th Street,3rd Floor,
Greeley,Colorado 80631,for the use and benefit of WELD COUNTY DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT, whose address or principal place of business is 1555 North 17th Avenue,Greeley
Colorado 80631,hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The United State Department of Health and Human Services("DHHS"),through the Colorado General Assembly,
has awarded the State federal funds to conduct a comprehensive family planning program. See, Catalog of Federal
Domestic Assistance("CFDA")number 93.217. The State has formulated a comprehensive State plan,with
associated budgets,to disburse these funds throughout the state of Colorado. Under this comprehensive State plan,
the State shall allocate these funds to qualified entities to provide comprehensive family planning services to the
citizens of the state of Colorado on behalf of the State.
Section 29-1-201, C.R.S. as amended, encourages governments to make the most efficient and effective use of their
powers and responsibilities by cooperating and contracting with each other to the fullest extent possible to provide
any function, service, or facility lawfully authorized to each of the cooperating or contracting entities. Section 29-1-
201,C.R.S., as amended,further states that all state of Colorado contracts with its political subdivisions are exempt
from the state of Colorado's personnel rules and procurement code.
The Contractor is a political subdivision of the state of Colorado. The State and the Contractor mutually agree that
the most efficient and effective way to provide the above-described services is at the local level. The State and the
Contractor previously entered into a Master Contract with contract routing number 05-FAA-00054. This Task
Order is issued pursuant to the terms and conditions of that Master Contract.
As to the State,authority exists in the Law and Funds have been budgeted,appropriated,and otherwise made
available,and a sufficient uncommitted balance thereof remains available for subsequent encumbering and payment
in Fund Code 100,Organizational Unit Code 7500 Appropriation Code(s)625&624, Program Code 9011
Function Code(s)Flwt&Gfnd, and Grant Budget Line Code(s)JA5C under Contract encumbrance number PO
FLA FPP07000079. All required approvals,clearances, and coordination have been accomplished from and with
all appropriate agencies.
NOW,THEREFORE, in consideration of their mutual promises to each other, stated below,the parties hereto
agree as follows:
A. PERIOD OF PERFORMANCE AND TERMINATION. The proposed effective date of this Task Order
is July 1,2006. However, in accordance with section 24-30-202(1), C.R.S., as amended,this Task Order is
not valid until it has been approved by the State Controller,or an authorized designee thereof. The
Contractor is not authorized to,and shall not,commence performance under this Task Order until this Task
Page 1 of 5
Order has been approved by the State Controller. 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. If the State Controller approves this Task Order on or before its
proposed effective date,then the Contractor shall commence performance under this Task Order on the
proposed effective date. If the State Controller approves this Task Order after its proposed effective date,
then the Contractor shall only commence performance under this Task Order on that later date. The initial
term of this Task Order shall commence on the effective date of this Task Order and continue through and
including June 30,2011,unless sooner terminated by the parties pursuant to the terms and conditions of
this Task Order. In accordance with section 24-103-503,C.R.S.,as amended, and Colorado Procurement
Rule R-24-103-503,the total term of this Contract, including any renewals or extensions hereof,may not
exceed five(5)years.
B. DUTIES AND OBLIGATIONS OF THE CONTRACTOR. 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 A".
C. DUTIES AND OBLIGATIONS OF THE STATE.
I. The Contractor shall be compensated for services provided in accordance with Attachment A
hereto. In consideration of those services satisfactorily and timely performed by the Contractor
under this Task Order the State shall cause to be paid to the Contractor a sum not to exceed ONE
HUNDRED SIXTY-FIVE THOUSAND TWO HUNDRED FIFTY-SIX DOLLARS,
($165,256.00)for the initial term of this Task Order. Of the total financial obligation of the State
referenced above,$111,342.00 are identified as attributable to a funding source of the United
States government and,$53,914.00 are identified as attributable to a funding source of the state of
Colorado.
2. Payments under this Task Order shall be made either through the State's Electronic Fund Transfer
system or,upon the Contractor's periodic submission of a duplicate"Task Order Reimbursement
Statement".
3. Reimbursement under this Task Order, and any renewal or extension hereof, shall be made to the
Contractor by the State on a monthly basis through automatic payment invoices prepared by the
State. The sample invoice,attached hereto as"Attachment B", is incorporated here by reference,
made a part hereof, and attached hereto,for the contract term. Accordingly,the Contractor shall be
paid one twelfth(1/12)of the State's financial obligation under this Task Order each month.
Upon affirmation by the State that the Contractor has satisfactorily and timely provided the
services described in this contract,the State shall pay the Contractor 116th of the total amount of
federal funding of$111,342.00 or$18,557.00 a month for the months of July through
December,and 1/6th of the total amount of state funding of$53,914.00 or$8,985.67 a month
for the months of January through June, inclusive.
4. The State may prospectively increase or decrease the amount payable under this Task Order
through a"Task Order Change Order Letter"that is substantially similar to the sample Task Order
Change Order Letter that is incorporated herein by this reference,made a part hereof,and attached
hereto as"Attachment E". To be effective,a Task Order Change Order Letter must be: signed by
the State and the Contractor; and, approved by the State Controller or an authorized designee
thereof. Additionally, a Task Order Change Order Letter shall include the following information:
A. Identification of the related Master Contract and this Task Order by their respective
contract routing numbers and affected paragraph number(s);
B. The type(s)of service(s)or program(s)increased or decreased and the new level of each
service or program;
Page 2 of 5
C. The amount of the increase or decrease in the level of funding for each service or
program and the new total financial obligation;
D. A provision stating that the Task Order Change Order Letter is effective upon approval
by the State Controller,or designee,or its proposed effective date,whichever is later.
Upon proper execution and approval,a Task Order Change Order Letter shall become an
amendment to this Task Order. Except for the General and Special Provisions of the Master
Contract,and the Additional Provisions of the Task Order,if any,the Task Order Change Order
Letter shall supersede this Task Order in the event of a conflict between the two. It is expressly
understood and agreed to by the parties that the task order change order letter process may be used
only for increased or decreased levels of funding,corresponding adjustments to service or program
levels, and any related budget line items. Any other changes to this Task Order,other than those
authorized by the task order option to renew letter process described below, shall be made by a
formal amendment to this Task Order executed in accordance with the Fiscal Rules of the state of
Colorado.
If the Contractor agrees to and accepts a proposed Task Order Change Order Letter,then the
Contractor shall execute and return that Task Order Change Order Letter to the State by the date
indicated in that Task Order Change Order Letter. If the Contractor does not agree to and accept a
proposed Task Order Change Order Letter,or fails to timely return a partially executed Task Order
Change Order Letter by the date indicated in that Task Order Change Order Letter,then the State
may,upon written notice to the Contractor,terminate this Task Order no sooner than thirty(30)
calendar days after the return date indicated in the Task Order Change Order Letter has passed.
This written notice shall specify the effective date of termination of that Task Order. If a Task
Order is terminated under this clause,then the parties shall not be relieved of their respective
duties and obligations under that Task Order until the effective date of termination has passed.
Increases or decreases in the level of contractual funding made through the task order change
order letter process during the initial,or renewal,term of a Task Order may only be made under
the following circumstances:
E. If necessary to fully utilize appropriations of the state of Colorado and/or non-
appropriated federal grant awards;
F. Adjustments to reflect current year expenditures;
G. Supplemental appropriations, or non-appropriated federal funding changes resulting in an
increase or decrease in the amounts originally budgeted and available for the purposes of
a Task Order;
H. Closure of programs and/or termination of related contracts or task orders;
I. Delay or difficulty in implementing new programs or services;and,
3. Other special circumstances as deemed appropriate by the State.
5. The State may renew a Task Order through a"Task Order Option to Renew Letter"substantially
similar to the sample Task Order Option to Renew Letter that is incorporated herein by this
reference,made a part hereof,and attached hereto as"Attachment F". To be effective, a Task
Order Option to Renew Letter must be: signed by the State and the Contractor; and,approved by
the State Controller or an authorized designee thereof. Additionally, a Task Order Option to
Renew Letter shall include the following information:
Page 3 of 5
A. Identification of the related Master Contract and that Task Order by their respective
contract routing numbers and affected paragraph number(s);
B. The type(s)of service(s)or program(s),if any, increased or decreased and the new level
of each service or program for the renewal term;
C. The amount of the increase or decrease, if any, in the level of funding for each service or
program and the new total financial obligation;
D. A provision stating that the Task Order Option to Renew Letter is effective upon
approval by the State Controller,or designee, or its proposed effective date,whichever is
later.
Upon proper execution and approval, a Task Order Option to Renew Letter shall become an
amendment to this Task Order. Except for the General and Special Provisions of the Master
Contract, and the Additional Provisions, if any of that Task Order, a Task Order Option to Renew
Letter shall supersede that Task Order in the event of a conflict between the two. It is expressly
understood and agreed to by the parties that the task order option to renew letter process may be
used only to: renew a Task Order;increase or decrease levels of funding related to that renewal;
make corresponding adjustments to service or program levels,and, adjust any related budget line
items. Any other changes to a Task Order,other than those authorized by the task order change
order letter process described above, shall be made by a formal amendment to a Task Order
executed in accordance with the Fiscal Rules of the state of Colorado.
If the Contractor agrees to and accepts a proposed Task Order Option to Renew Letter,then the
Contractor shall execute and return that Task Order Option to Renew Letter to the State by the
date indicated in that Task Order Option to Renew Letter. If the Contractor does not agree to and
accept the proposed renewal term, or fails to timely return a partially executed Task Order Option
to Renew Letter by the date indicated in that Task Order Option to Renew Letter,then the State
may,upon written notice to the Contractor,terminate this Task Order no sooner than thirty(30)
calendar days after the return date indicated in the Task Order Option to Renew Letter has passed.
This written notice shall specify the effective date of termination of that Task Order. If a Task
Order is terminated under this clause,then the parties shall not be relieved of their respective
duties and obligations under that Task Order until the effective date of termination has passed.
6. All attachments or exhibits to this Task Order are incorporated herein by this reference and made a
part hereof as if fully set forth herein. If a conflict or inconsistency is found to exist between the
terms and conditions of this Task Order and those of any attachment or exhibit hereto,then the
terms and conditions of this Task Order shall control.
D. ADDITIONAL PROVISIONS.
1. The Contractor shall comply with section 1001 of the federal Act and all applicable federal
regulations,as amended, contained in Title X,42 C.F.R., Subpart A,Part 59, as well as all
applicable state regulations.
Page 4 of 5
IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written.
CONTRACTOR: STATE:
BOARD OF COUNTY COMMISSIONERS
OF WELD COUNTY STATE OF COLORADO
(a political subdivision of the state of Colorado) Bill Owens. Governor
for the use and benefit of WELD COUNTY
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
a.) L-A-Th
By: ✓/i lip By:
Name: M. J. Geile For the Executive Director
Title: Chair DEPARTMENT OF PUBLIC HEALTH
FEIN: 84-6000813$lg AND ENVIRONMENT
Date: MAY 0 8 2006 Date:
ttihd
EL^ ATTE � 111 ��' / PROGRAM APPROVAL:
J���
1161 lfj f�
eel
ate♦
Deputy Clerk to the Board WELD COUNTY DEPARTMENT OF
p y PU C HHEALT4 AC' NV] E
APPROVALS: BY: If EIS
Mark E. Wallace, MD, MP� (/
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: `O
Revised:11/5/04
Page 5 of 5
Attachment A
STATEMENT OF WORK FOR FAMILY PLANNING SERVICES
The Contractor shall conduct a comprehensive family planning program("the program")in Weld
County. This program shall comply with section 1001 of the federal Act and all applicable
federal regulations,as amended,contained in Title X, 42 C.F.R., Subpart A, Part 59, as well as all
applicable state regulations. (Federal funding from HHS,CFDA#93.217 FP Services).
2. The Contractor shall make its program available to men and women in their reproductive years and
shall offer the following services,as appropriate:
A. Outreach services and/or other program efforts designed to improve client recruitment;
B. Nursing and medical services, which shall include a comprehensive health and social
history and physical examination administered in accordance with all applicable Title X
regulations and, all applicable nursing-medical policies or procedures which have been,
or may be,established by the State's Women's Health Section("WHS");
C. Contraceptive information, education, and supplies regarding all family planning
methods;
D. Education and counseling services regarding family planning, family planning methods,
child spacing, infertility,sterilization,nutrition,sexually transmitted diseases, HIV/AIDS,
adolescent counseling and other related health issues, as outlined in the Nursing and
Administrative Manual;
E. Follow-up and/or referral services,as appropriate.
3. The services provided by the Contractor must be deemed acceptable, in good faith, by the WHS.
For a service to be "acceptable" it must comply with all applicable: Title X regulations, WHS
nursing-medical policies and procedures, and any applicable fiscal and administrative policies and
procedures of the State and Federal government All applicable Title X regulations, WHS
nursing-medical policies and procedures, and all applicable fiscal or administrative policies of the
State have been provided to the Contractor by the State as of the effective date of this Contract.
4. The Contractor shall provide the State's family planning program consultants and administrators
with reasonable access to its operations to perform: periodic site reviews, data reviews, fiscal
reviews or other evaluations of the Contractor's family planning program. Evaluations of the
Contractor's program shall be based on established standards and policies of the State or the
Federal government. The Contractor shall cooperate during all periodic site visits, data reviews,
fiscal reviews or other evaluations conducted by the State.
5. If necessary, the Contractor shall comply with all recommendations made by the State's family
planning program consultants and/or administrators after a periodic site visit, data review, fiscal
review or other evaluations that are necessary to bring its program into compliance with all
applicable federal and state laws, policies and regulations. The Contractor shall be in full
compliance with a recommendation, if any,within three (3)months of the date a recommendation
is made by the State. If the Contractor cannot obtain full compliance within this three (3) month
period, then on or before the expiration date of that three (3) month period the Contractor shall
present sufficient written evidence to the State: to show that continuing progress is being made
towards full compliance; and, the date when full compliance shall occur. In no event, however,
Attachment A—Statement of Work Page 1 of 3
shall full compliance with a recommendation occur any later than six(6)months after the date that
a recommendation was initially made by the State.
6. On a monthly basis, the Contractor shall collect and provide to the State, by the fifteenth calendar
day of the following month, all pertinent data regarding all services offered, and all family
planning clients served, by its program during the preceding month, submitted through the IRIS
data system. This data shall be verified on a monthly basis to help assure accuracy. The
Contractor must adhere to the Data Security,Use and Confidentiality Agreement attached hereto in
a form substantially equivalent to Attachment D.
7. Within thirty(30) calendar days of receipt of a written request from the State, the Contractor shall
submit nursing-medical chart audits to the State.
8. The Contractor shall only use program income generated from client fee collections and donations
for family planning purposes that further the objectives of the legislation under which this Contract
is entered into. In accordance with Title X guidelines,the Contractor shall not charge for any Title
X required services provided to clients who are at or below 100% of the official poverty line as
defined by the Office of Management and Budget (OMB). A copy of this guideline has been
provided to the Contractor by the State as of the effective date of this Contract. If the State
receives new poverty guidelines from the OMB during the term of this Contract, then the State
shall immediately forward those new poverty guidelines to the Contractor. The Contractor shall
use these new poverty guidelines, if any,upon receipt thereof from the State.
9. The Contractor's charges for services to clients who are above 100% of poverty level shall be
based on a sliding fee scale that takes into account a client's family size and/or individual income.
These charges and the sliding fee scale shall be made available to all clients of the Contractor, the
general public, and the State. This most current version of this document is available on the
Family Planning website (http://www.cdohe.state.co.us/pp/womens/FederalPovertvGuidelines.htm).
Charges shall be based upon the Contractor's actual costs to provide these services as determined
by a cost analysis. The Contractor and the State shall review these costs annually. The Contractor
shall insure that all clients understand that they will not be denied services because of an inability
to pay any of the Contractor's sliding fee charges.
10. All money received by the Contractor from the State under this Contract shall be used by the
Contractor to provide contraceptive services to approximately 1,787 target family planning
clients(fertile clients receiving contraceptive services).
11. The Contractor shall either use a cytology laboratory chosen by the State or, a laboratory proposed
by the Contractor and approved by the State.
12. During the term of this Contract, the Contractor agrees to provide the State with the semi-annual
Family Planning Expenditure/Revenue Reports. The required report is incorporated herein by this
reference, made part hereof, and attached hereto in a form substantially equivalent to
Attachment C. The first report is for the months of July through December will be due no later
than February 7; the second report is for the months of January through June and will be due no
later than August 7.
13. The Contractor shall protect the confidentiality of all client records and other materials that are
obtained, created, or maintained by the Contractor under this contract. Except for purposes
directly related to the administration of this contract, no information about, or obtained from, any
client shall be disclosed by the Contractor in any form that would identify that client without the
prior written consent of that client. As of the acceptance date of this contract by the Contractor,
the Contractor shall have written policies governing the access to and, the duplication and
Attachment A—Statement of Work Page 2 of 3
dissemination of, all such information. The Contractor shall advise its directors, officers,
employees, agents, servants, and subcontractors, if any, that they are subject to these
confidentiality requirements.
Attachment A—Statement of Work Page 3 of 3
Attachment A-1
07-FLA-00079
Title X federal funding from the United States government(HHS CFDA#93.217 FP Services) provides:
$ 101,322.00 for ROUTINE FAMILY PLANNING services
$0 for STERILIZATION services
$ 10,020.00 for CHLAMYDIA TESTING services
$ 111,342.00 Total Title X Funding
p. All federal funds must be fully expended by December 31, 2006.
State of Colorado funding provides:
$ 53,914.00 for ROUTINE FAMILY PLANNING services
$0 for STERILIZATION services
$ 53,914.00 Total State of Colorado Funding
ilk All State funds must be fully expended by June 30, 2007.
$ 165,256.00 Total Current Award
Family planning services target clients: 1,787
Attachment A-1 Page 1 of 1
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COLORADO DEPARTMENT of PUBLIC HEALTH and ENVIRONMENT
FAMILY PLANNING EXPENDITURE/REVENUE REPORT
Attachment C
AGENCY NAME:
PERIOD:
COMPLETED BY:
DATE:
EXPENDITURES
Column(A) I Column (B) Column (C)
Family Planning
CDPHE-WHS Program-(Non-
Funding CDPHE funding) Combined Total
Personal Services _
Salary _ $ - I $ - $ -
Fringe @ a/o #DIV/0! - - -
Subtotal Personal Services h$I(i, „- +•.yq ," -,r `ter '' ,-
Contractual Services
Clinician $ - $ - $ -
Lab&X-ray - - -
_ Other --- - - -
Subtotal Contractual Services
Operating Expenses
Supplies - $ -1 $ - $ -
- Training _-- - - -
Other - - -
Travel ----__ - - l -
Equipment -
_ Subtotal Operating Expenses
Total Direct Costs „ .' _ °''' "` - - '-
Indirect Costs @% Ir$ - $ - I $ -
TOTAL EXPENDITURES
Inkind $ --- - $ - $ -
TOTAL COSTS i..6' �Y. ra'C'i„ ?"s +rL-ci''$';''- „ '.. I `iri .d'S ,vi:•..
REVENUES
Family Planning
CDPHE-WHS Program-(Non-
Funding CDPHE funding) , Combined Total
CDPHE-Women's Health family planning contracts $ - $ - $ -
Patient Fees - - -
Patient Donations - - -
Medicaid - -
State Children's Health Ins(CHP+) - - -
Local government-County and City grants and contracts - - J -
Inkind(Other Donations) - - -
Other public health insurance(TRICARE/CHAMPUS,CHAMPVA) - - -
Private Health Insurance - - -
Temporary Assistance for Needy Families(TANF) - - -
Other(specify private grants,fundraising,MCH,Social Service Block grant,Medicare, - - -
TOTAL
Unspent Funds-This Period I $ - $ $ -
Unspent Funds-Prior Periods - -
Balance Unspent Funds I$ s-, .
J:\Fiscal\contracts\FY06\Attachment C-Family Planning Expendenditure-Revenue Report
Maggie Leiman 303-692-2485
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Agassr ar t)t�>iniratintr .. . ___ _ ..__._.__._.___...�. _......_..__..__ , .._ ._..m___._ �i
Street Adti rex*0444 P.Q.Bat) I 10
22 ^,tape Suits Floor or Bid M = � 1O
014,Statr and lap Cady
Applicant Signature M Title Dote
Supct am Signature Title Doer
ii von
Attachment 0
i • Page 1 of 4
I
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Data Security, Iii and Confidentiality Agreement Renewal User ID
!�auocsideratIon of qty stenst to the Cn srsttu Deparlment+of T'tah&Health and Environment(CDPH gl wore
rtrrl•tite amid information..1 aver at to the following.(hrltirl*Fills atareenent end sign below.)
•1 understand that I am raotptatatbk to make every effort to prevent urtuuiro4,ed users linen tinning
•
Atti:Vt.li 1St or siWil`MY Vitt II)and p;atsword. I also epee Ittr;italic every reasonable effort to prevent use
of a ctirnputer for iliiegal or unethical purposes by a#.I users:atunonerder nt L
_.. _•t agree to intatle itaitiy rt:pori arty xuyxeted Of 141utd un aiibtarai+ d sear&to the Colortrda Deportment
of Public Health and 1~:n,truttment point of contact iha t=nava the tnfonitmhm.
•1 x tit riot;ittarc toy password with airy caner pertain. I will trot least taw coos xt►rrl art»d mny eMptitet
or where it might be easily located by another:Krum I will change toy password periodically and if I
suite art it ban,been compromised.I will,t:f up my patatwonis according to CIIPHE guidelines fur length
nil content.
•t understand that ibis is a";t,arod fate"environment. M►y fclk►w users god patients mos be omitted of
confidentiality ct iproints ti by the activities ofDolor gam, Preventing such zielAtly is the shared
restrerttcrrrbillty°fail wooers:
_. ►I agree Mamma;Italy the information I need to do my Oh,and not tq amens or attempt to:marts flies I
an nut authonzed to u.*. I wilt sail"rrCrwac"or otherwise use files or programs that ettceeti what is the
minimum necessary to Jo my Mb. Isly use and distlooms of information will be..rams-nit-tit with dune
permitted by the federal Health.insurance Portability and Aecunatahility Alt of I9% l anti other
applicable loon.
.#avee not in dtacum confidential mi'trrm:ttion or prit t*k copies of confidant-4 reports.:corniest of
bow of where setionc d.to family inc.inlaers,friends,prolcssiunn.l colleague*,either employees,toiler
climb Of arty utiser p opt unk. a+t•Kh pier itwi hat horn autbtmtctl.to have seettut to that information. It
oats ore who la autitikri:rod to at:;t:C:t+s the intfwmit.:.at,t will check with my stupct'ta+ttt Of dm t;;DPI•1E point
of contact who Marmites the infi*rntanci .
•I uodersta id that arty access is granted for the purposes of public tteihh arid enviiaprtgtcnt:tl protection, I
will elm iota:rte tliwlaae any 103 foe:my p u pour or red toc'on rotten with the pats'rm iert of the symordst
fire whiol 44.4.-O.s::i gr:tnurl.. iY I;tier unsure irony'tee or dos lcrwc►tx .ts pcinittaa3.I will discuss the iwsu:
with my tatperilSOr updur oenttlet upprirprisuc CIWFIE pr+.grrnm staff for further elarilloutet.
•I will laic ptecatsttottt to protect:rip!lt natal data doplayttd►m my stxccn Ir.tnt stewing by others 'rites
mat'MOM re-positioning my computer scrim.adding a device to limit other's view.fuming oft tie
compute *hot leasing Mc area or enabling password•ponccten screen i weir. I *ill take rrtaunairk
and.ppmpriic'op*taking litho act:omit the staff and public acact;vs ut nor arras anti the nature.of the
data on the ryt:teta.
•I ittkteo*tnd titan files I acsacxs may he protected from distribution by copynght or other applarublc laws.
.~�.._ t DPNIF rt,u .selu.ttie copyrights in all in-snot roan ofattrhwrssbip created b•:n t etrtpkr±t.a ar
contraCt+m. T"hie applies to both published and urpubtihht:d works,seed nselucles,but is not binned to,
written doennienta,duxes,t?xaphst.imagery and maps, Other cables'eopyrtestcd+wtorrka truly alio he
ctccti;'iifitc tin ibis.•.Moir., I will nix reproduce,distribute or titsplair these works without penni>ar10o
from CDPHE or another copyright owner,.
•t understand that for audit or.system Security mimosa,C"DPHE may rnnttitor all my computer.system
.. w •1,undo:;horrid that COME may revoke my seems at any time,with or without cause. I understand tits
ans.*i la.i nt of federal,state,local or the mango's confidentiality requirements or this Agreement will
lac tinsidetted a'Mach of my t+bli ;onions anti forty rt auto to disctplittary,,;Coin,tip to and including
icmttrtattott at ctttphtyment.termination or tenlnietual tcltttinnihip and hitter retrx dies allowed by law
dung at alter my ctrtplaymc,tt or work with these data sy iitcnts.
•1 tioderstand that Information t,attained in the COME information .interns is highly ennftailcntiaal anti is
protected cteri from improper one and disclosure by applicable federal anti sate Inns. I agree not to dutcknsc
confidential ittfornutior in violation of C DPIiI..policy and applicable ctrrt1identiality limit. have read
and a ever to comply with the CflPHE's policies and pnwetturet r oncvm;inp'information security'.secure
weir etc SCUlt14 arid tafttlenualtty,u,t miry be revised and updated.
4pptrt:asu situ?Oat a'C....-.. .... amount t Stytmtare Date
$;IticTi uttr Nam r ftiptirtfra Date
Attachment Q
P age 2 of 4
Applicant Name ... Aerno.Mur
3"rognagt(3i applicant rectum*craw for(r g.Special Noah.Corannosaraists biaratc. nil i si dny. *a a Atop c
d _ COPED.:Prosrnm like Only
Application I COPH~.Authorizing Staff Name Date 1 Phony Etter
�l4sltsle Cllr .1
i Print
�Rok: Mw a E
IPrint., -�---�- t
Rafe•
I Sign:
Punt �..._ � i.
Role: I i
Sign,
CDPIII.Authorizing Pragmatist Only(Instruction*to ITS and'C raining Notes)
ITS Staff Pcr+inn completing ilia Set Up: _.
IAnigntii User ID:
Confirmation Emailed to
CDPIIE Program Staff: Date:
Canitrnuninn ONLY by Email
Signature t7'S Staff Title
nt*
Attachment 0
Page 3 of 4
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User Agency Letterhead
Colorado Department of Public Health and Environment
Program Name and Mail Code
4 tX)Cherry Creek Drwe South
Denver.CO ROB=6153() (use for multiple users, one program)
Date
•To Whom It flay Concert:
User Nantes(Ifat all) arc employees teontracitrr. volunteer,intern,tn,etc)at Agency Name
As their supervisor I am.requc Ling L'.aer Names be eiven,access to Colorado
Department of Public Health and Environment nment(C_DPME)information systems. £men
system name hero'. This access to incccaxary in order for the above lasted individuals to be
cable to do their work for Agency Name,
I understand that,if any of the above individuals lcaties the Agenda:,or no tramper nccds
arceipi to the: above CDPRE inform ition systems, I will request that unneeded acres will
be disabled immediately. I also understand that if I have c an questions about the status
of the;cccss.. I can contact the owner of the above information systcrrt at the Department
ofPublic Health and Environment at(at31;692-N00or I-it0tl-046.7 t9lln:-stag; )
Sincerely
Name
Tuk
Attachment D
Page 4 of 4 lwl;rcx►
Attachment E
TASK ORDER CHANGE ORDER LETTER
[Date]
Task Order Change Order Letter Number**, Contract Routing Number** *** *****
State Fiscal Year 20** -20**, *************** Program
This Task Order Change Order Letter is issued pursuant to paragraph*_*.of the Master Contract identified as
contract routing number** *** ***** and paragraph*. *. of the Task Order identified as contract routing number
** *** ***** and contract encumbrance number** *** **********. This Task Order Change Order Letter is
between the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT and JLEGAL
NAME OF CONTRACTOR'. The Task Order has been amended by Task Order Option to Renew Letter
contract routing number** *** *****,and/or Task Order Change Order Letter", contract routing number** ***
*****, if any. The Task Order,as amended, if applicable, is referred to as the"Original Task Order". This Task
Order Change Order Letter is for the current term of********* ** ****,through********* **, ****. The
maximum amount payable by the State for the work to be performed by the Contractor during this current term is
increased/decreased by********** Dollars,($*.**)for an amended total financial obligation of the State of
********** DOLLARS,($*.**). The revised specifications to the original Scope of Work and the revised Budget
are incorporated herein by this reference,made a part hereof,and attached hereto as"Attachment*" and
"Attachment*". The first sentence in paragraph*_*.of the Original Task Order is modified accordingly. All
other terms and conditions of the Original Task Order are reaffirmed. This change to the Task Order shall be
effective upon approval by the State controller, or designee, or on ********* **,****, whichever is later.
Please sign, date, and return all** originals of this Task Order Change Order Letter by ********* **,****,to the
attention of: ************ ************ Colorado Department of Public Health and Environment,4300
Cherry Creek Drive South, Mail Code ***-***-**,Denver,Colorado 80246. One original of this Task Order
Change Order Letter will be returned to you when fully approved.
]LEGAL NAME OF CONTRACTOR] STATE OF COLORADO
(a political subdivision of the state of Colorado) Bill Owens,Governor
By: By:
Name: For the Executive Director
Title: DEPARTMENT OF PUBLIC HEALTH
FEIN: AND ENVIRONMENT
PROGRAM APPROVAL:
(Seal-Required)
By:
ATTEST(required):
By:
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:
Revised:11/5/04
Attachment F
TASK ORDER OPTION TO RENEW LETTER
[Date]
Task Order Option to Renew Letter Number**, Contract Routing Number** *** *****
State Fiscal Year 20**-20** ***************Program
This Task Order Option to Renew Letter is issued pursuant to paragraph_*. of the Master Contract identified by
contract routing number** *** ***** and paragraph*. *. of the Task Order identified by contract routing number
** *** ***** and contract encumbrance number** *** **********. This Task Order Option to Renew Letter is
between the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT and JLEGAL
NAME OF CONTRACTOR]. The Task Order has been amended by Task Order Change Order Letter**,contract
routing number** *** *****,and/or Task Order Option to Renew Letter**,contract routing number** ***
*****, if any. The Task Order,as amended, if applicable, is referred to as the"Original Task Order". This Task
Order Option to Renew Letter is for the renewal term of********* ** ****,through********* **,****. The
maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is
********** Dollars,1*.**1 for an amended total financial obligation of the State of********** DOLLARS, This
is an increase/decrease of($*.**)of the amount payable from the previous term. The Budget for this renewal term
is incorporated herein by this reference,made a part hereof,and attached hereto as"Attachment*". The first
sentence in paragraph*_*. of the Original Task Order is modified accordingly. All other terms and conditions of
the Original Task Order are reaffirmed. This Task Order Option to Renew Letter is effective upon approval by the
State Controller,or designee, or on********* **,****,whichever is later.
Please sign, date,and return all** originals of this Task Order Option to Renew Letter by********* **, ****,to
the attention of: ************ ************,Colorado Department of Public Health and Environment,Mail
Code********,4300 Cherry Creek Drive South,Denver,Colorado 80246. One original of this Task Order
Option to Renew Letter will be returned to you when fully approved.
[LEGAL NAME OF CONTRACTOR] STATE OF COLORADO
(a political subdivision of the state of Colorado) Bill Owens,Governor
By: By:
Name: For the Executive Director
Title: DEPARTMENT OF PUBLIC HEALTH
FEIN: AND ENVIRONMENT
PROGRAM APPROVAL:
(Seal-required)
By:
ATTEST(required):
By:
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:
Revised:11/5/04
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