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Home My WebLink About20042275.tiff RESOLUTION RE: APPROVE TASK ORDER FOR COLORADO WOMEN'S CANCER CONTROL INITIATIVE 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 Colorado Women's Cancer Control Initiative 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 June 30, 2004,and ending June 29,2005,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 Colorado Women's Cancer Control Initiative 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 4th day of August, A.D., 2004, nunc pro tunc June 30, 2004. BOARD OF COUNTY COMMISSIONERS E fie,e`•:� ilM WELD ' COLORADO isei {" � Robert D. Masden, Chair UW?Id•u rk to the 6•.rd Jt. / / William H. Jere , Pro-Tem �i �;.'/.i✓iii / Deputy Clerk to the Board M. ile EDAST • Davi . Lon County Atto4ney ,Q„/ilh Glenn Vaad Date of signature: 2004-2275 H L0031 DUI, 0 SS-19 -oy Memorandum 111 I TO: Robert D. Masden, Chair O Board of County Commissioners • From: Mark E. Wallace, MD, MPH, Director COLORADO Department of Public Health and Environment , / DATE: July 29,2004 J SUBJECT: Task Order for the Colorado Women's Cancer Control Initiative Enclosed for Board review and approval is a task order for the Colorado Women's Cancer Control Initiative (CWCCI). If approved, this task order will become part of the master contract between the Colorado Department of Public Health and Environment (CDPHE) and Weld County Department of Public Health and Environment (WCDPHE). The task order will provide funding for WCDPHE to improve the system of clinical and essential support services for breast and cervical cancer screening and diagnosis in eight northeastern Colorado counties including Weld, Larimer, Morgan, Logan, Sedgwick, Phillips, Washington, and Yuma. The goal is to increase screening and diagnosis among low income older women who are uninsured or under insured including those who are racial, ethnic, and cultural minorities. CDPHE will reimburse Weld County an amount not to exceed $64,934 for the initial time period of June 30, 2004 through June 29, 2005. This reimbursement, which is identified as Federal funding, will be for personnel expenses for a full-time Health Educator I, operating expenses including travel costs, and indirect costs. I recommend your approval of this task order. Enclosure 2004-2275 DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT DEPARTMENT OR AGENCY NUMBER FLA CONTRACT ROUTING NUMBER 0500253 TASK ORDER Colorado Women's Cancer Control Initiative Program This Task Order is made this 5th day of July,2004 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),for the use and benefit of the Weld County Department of Public Health and Environment,(a political subdivision of the state of Colorado),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("USDHHS"),through the Centers for Disease Control and Prevention("CDC")has awarded the State federal funds under Notice of Cooperative Agreement Award ("NCAA")number U55/CCU821947-01 for a project entitled the"Colorado Women's Cancer Control Initiative" (CWCCI), (see,Catalog of Federal Domestic Assistance("CFDA")number(93.283)to perform breast cancer screening,cervical cancer screening,and diagnostic services. The intent of the Cooperative Agreement is to increase screening and diagnosis among low income older women who are uninsured or under insured,including those who are racial, ethnic,and cultural minorities, such as American Indians,African Americans,Hispanics, Asian/Pacific Islanders, Lesbians, women with disabilities, and women who live in hard to reach communities in urban and rural areas; 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 7340 Appropriation Code 773, and Grant Budget Line Code HM5C under Contract encumbrance number PO FLA 0500253. All required approvals,clearances, and coordination have been accomplished from and with all appropriate agencies. Page 1 of 6 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 Contract is June 30,2004. 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. If the underlying NCAA authorizes the State to pay all allowable and allocable expenses of a contractor as of the effective date of that NCAA,then the State shall reimburse the Contractor for any allowable and allocable expenses of the Contractor that have been incurred since the proposed effective date of this Task Order. The initial term of this Task Order shall commence on its effective date and continue through and including June 29,2005. If the State receives additional federal funding for the purposes of this Task Order,then this Task Order shall automatically renew for the period covered by those additional federal funds. This Contract is funded entirely with federal funds. Therefore,the State's liability for payment for all services rendered, or goods supplied,under this Task Order 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 Task Order, then the State may immediately amend or terminate this Task Order without further liability to the State. 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 Task Order, including all automatic renewals, bilateral options to renew,and extensions,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. All money received by the Contractor from the State under this contract shall be used by the Contractor to promote and support recruitment and referral of rarely and never screened CWCCI eligible women to CWCCI service providers and to improve the system of clinical and essential support services for CWCCI enrolled women through the establishment,maintenance and/or strengthening of consortia/coalitions. The Budget, which is included in the Scope of Work,shall govern the expenditure of funds by the Contractor under this Task Order as well as subsequent reimbursement by the State. The Contractor may transfer funds between specific line items within a major budget category without prior approval up to ten percent(10%)of the total funds originally set forth in each major budget category(Personal Services, Operating,Travel,Contractual and Indirect)may be transferred to other categories without prior approval by the State. Proposed transfers that exceed ten(10%)of the original amount budgeted in a category must be approved in writing by the State prior to the transfer. In all instances, the Contractor shall submit a revised budget to the State that shows: the original amount(s),the modification(s)made, and the new amount(s) within thirty(30)calendar days of the modification(s). It is the expectation that the contractor maintain back up documentation for all reimbursement requests submitted to the State.The State shall have the authority to conduct program performance reviews or audits of all expenditures provided by the Contractor under this Contract. Financial records from the Contractor under this Contract shall be made available to the State for this purpose. The contractor shall perform the items described in the Statement of Work and Budget in the following counties: Larimer,Weld,Morgan, Logan, Sedgwick,Phillips,Washington,and Yuma. The Contractor shall provide data for the women screened to CWCCI in a format designated by CWCCI program for the activities set forth in Attachment A. Page 2 of 6 C. DUTIES AND OBLIGATIONS OF THE STATE. The Contractor shall be compensated in accordance with the rates set forth in 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 Sixty Four Thousand Nine Hundred and Thirty Four Dollars DOLLARS,f$64,934.00)for the initial term of this Task Order. Of the total financial obligation of the State referenced above, $64,934.00 are identified as attributable to a funding source of the United States government and, $0 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. The Contractor shall submit a signed,duplicate monthly Task Order Reimbursement Statement within sixty(60)calendar days of the end of the billing period for which services were rendered. A sample Task Order Reimbursement Statement is incorporated herein by reference,made a part hereof,and attached hereto as"Attachment B". Expenditures shall be in accordance with those items identified in Attachment A. These items may include,but are not limited to:the Contractor's salaries, fringe benefits,supplies,travel, operating,and indirect costs which are allowable and allocable expenses related to its performance under this Task Order. Each Task Order Reimbursement Statement shall reference the related Matter Contract by its contract routing number and this Task Order by their respective contract routing numbers. The contract routing numbers are located on page one of these documents. Each Task Order Reimbursement Statement shall also indicate the applicable performance dates,the names of payees; a brief description of the services performed during the relevant performance dates;all expenditures incurred; and, the total reimbursement requested. Reimbursement during the initial, or any renewal,term of this Task Order 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. Each Task Order Reimbursement Statement shall be sent to: Angie Villamaria Colorado Women's Cancer Control Initiative Program Colorado Department of Public Health and Environment PSD-CWCCI-A5 4300 Cherry Creek Drive South Denver,CO 80246 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 C". 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 3 of 6 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 maybe 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, J. 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 D". 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 4 of 6 A. Identification of the related Master Contract and that Task Order by their respective contract routing numbers and affected paragraph number(s); 13. 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. State Division or Program Specific Requirements which are not covered by the General or Special Provisions of the Master Contract, e.g., 1. No federally appropriated funds have been paid or will be paid,by or on behalf of the Contractor, to any person to influence or attempt to influence an officer or employee of Congress,or an employee of a member of Congress: to award any federal contract,to make any federal grant,to make any federal loan,to enter into any cooperative agreement;or,to extend,continue,renew, amend,or modify any federal contract,grant,loan,or cooperative agreement. Page 5 of 6 IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written. CONTRACTOR: STATE: BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO OF WELD COUNTY(a political subdivision Bill Owens.Governor of the state of Colorado),for the use and benefit of the Weld County Department of Public Health and Environment (a political subdivision of the state of Colorado) By: Sabi. iftlIL By: � �{ Name: Robert D. Masden For the Executive Direc r Title: Chair DEPARTMENT OF P LIC HEALTH FE -as ; -.111-R1(ft AND ENVIRONME T .7# e._n tnna Date: s—`l't7 e t u1 1861 A . 1-6" �l, ATTE�% J/ROGRAM APPROVAL:Wet. Pi S ter..: . .,_ Ara �.�i By: City,City and ounty,Coun Special District,or Town Clerk or ivalent APPROVALS: 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: WELD COUNTY DEPARTMENT OF Leslie M.Shenefelt PU�LICHEALTH AND�ENVIR �ONMEN� By: /r�i' f - BY: Ir"N� �`1 'tote Date: Mark E. Wallace, MD, MPH-Director ?— to — o y Page 6 of 6 �ai9 &a 95 CONTRACT COMPLIANCE Attachment A Due Date Activity Documentation To State Objective: Coordinate and expand the scope of services for CWCCI enrolled women in each geographic breast and cervical cancer medical service catchment area. October 15,2004. Conduct inventory of breast and cervical cancer services for: Competed CWCCI Partners Inventory for each agency or • Public Education and awareness approved equivalent • Outreach • Recruitment/Navigation • CWCCI providers • DX services • Treatment • Support Include in quarterly Define CWCCI Partnership areas.Areas should be formed List Partnership Areas with counties or parts of counties narrative October 15, around diagnostic service areas. List geographic areas served. Explain any overlap or gaps. 2004 (counties or pans of counties) Include in quarterly Schedule or attend Partnership meetings. Each Partnership Schedule of meetings narratives due 15th day area must have at least 2 meeting per year. Meeting attendance by name and agency represented of 1"month of each Brief meeting minutes quarter Develop common MOUs between CWCCI providers and Include in quarterly service subcontractors. Proposed MOUs narratives Completed MOUs Include in quarterly Narrative report-Briefly document activities,provide specific narratives information on success and challenges with plan to address challenges. J:\CCP\CWCCI\CONTRACTS\2004-2005 Centracts Rccruitment\Contract requiremcnts.doc Activity Documentation To State Due Date Objective: Develop plans for public education and recruitment,with input from partners,to program-eligible women Use CWCCI Partnerships to plan and implement inreach Meeting agendas Include in quarterly activities,recruitment activities and special screening events. Action Plans for meeting input narratives due 15th day of 1"month of each quarter Communicate with CWCCI providers Meet with non-profit and for-profit agencies and businesses Monthly CAT submissions Monthly 15th day of that serve women who have rarely or never received breast or month cervical cancer screenings to develop potential collaborative Brief synopsis of success and challenges with actions to CWCCI marketing projects. address challenges Include in quarterly narratives Solicit input from partners on the development or revision of Submit new or modified materials Quarterly narrative recruitment materials Objective: Conduct marketing events in local communities, utilizing one-on-one recruitment,to reach and refer rarely CAT Monthly and never screened women. Distribute promotional materials at community locations that CAT Monthly serve women who are rarely/never screened. Objective: Utilize local print and broadcast media(paid and in kind) to reach program eligible rarely and never women in priority populations. Solicit input from partners on the development or revision of Submit new or modified materials or media outlets. Describe Quarterly narrative media messages. selection's ability to reach rarely and never screened women. Distribute CWCCI information to local media outlets CAT Monthly Describe selection's ability to reach rarely and never screened Quarterly narrative women l:\CCP\C WCCI\CONTRACTS12004.2005 Contracts'Recmitment\Contract requirements.doc Activity Documentation To State Due Date • Objective: Coordinate and maintain a system to allow easy access for women to obtain screening information and screening referrals. Document calls and referrals. Enter referrals in CAT CAT Monthly database. Brief synopsis of success and challenges with actions to Identify other community referral line(s)to which these call address challenges Quarterly narrative may be directed at some future time Objective: Meet with case managers and other appropriate staff at CWCCI service sites basis to collaborate recruitment of women into screening services Contact CWCCI providers to discuss provider's contractual Quarterly narrative Brief synopsis of success and challenges with actions to target#s;change in recruitment and training needs. address challenges Objective: Provide one-on-one follow-up(counseling, education and support)to women to overcoming barriers to screening. Within thirty(30) days of receipt of match log from CWCCI, CAT Monthly initiate contact with women who have not completed screening referral. This activity will NOT be initiated unless or until CWCCI provides a match log. Note: In the event of a discrepancy in due dates the Contract Compliance Attachment A document will supercede the work plan. J.\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\Contract requirements.doc CWCCI Community Coordinator Workplan, June 30, 2004 —June 29, 2005 NEW Performance Indicators Case Management Goal: 1. The number of established consortia who have consolidated MOUs in place between Improve system of clinical and essential support services for CWCCI clinical service providers and subcontractors. enrolled women 2. Number of consortia who have developed a MOU between other funding organizations and CWCCI Evaluation Objectives Activities Planned To Achieve This Data Timeframe for Team Members Objective Assessing Progress Responsible Coordinate and expand the 1. Define medical service catchment Service Inventory Quarterly Community scope of services for areas. MOUs June 30, 2005 Coordinators #Of completed CWCCI enrolled women List proposed consortium and MDE's Ongoing Nurse Consultant inventories in each geographic breast associated potential members. NBCCEDP Data Quarterly Clinical Services Case and cervical cancer (Consortium should he formed around See addendum 1 Management #Of attendance of medical service catchment diagnostic service catchment areas) Coordinator consortia meetings. area. i.e. providers and subcontractors. Nurse Consultant 2. Contact mammography centers to June 18,2004 #Of MOUs identify service areas. 3. Establish or strengthen existing June 18,2004 #Of new CWCCI consortia at central points i.e.Health contractors or District in Ft. Collins,Health Dept. in subcontractors. Greeley, and NEDPHE. 4. Motivate CWCCI providers to Ongoing regularly attend consortium meetings. (providers will be required by contract to attend at least 2 meeting/year) 5. Conduct meeting quarterly. Quarterly 6. Establish MOUs June 2005 7. Recruit new providers and Ongoing subcontractors in the consortium. J:\CCP\CWCCI\CONTRACTS\2004 -2005 Contracts\Recruitment\NE Weld\Community Coor Workplan 05 14 04.doc 1 Recruitment Recruitment Goal Performance Indicators MODIFIED To increase awareness among woman who have rarely or never been I. A minimum of 200 women will be reached will be those that are rarely or never screened screened for breast or cervical cancer, address barriers that prohibit 2. A maximum of 2000 women will be reached through coordinator recruitment efforts. Since the target screening, recruit women for these services and support completion of population is the rarely and never screened,activities should limit the number of other women screening. Objective will be met by developing and implementing an encountered. appropriate mix of broad-based awareness-raising,narrow cast education 3. A minimum of 50%of these program-eligible women reached will be referred to screening and one-on-one recruitment strategies through partnerships with agencies 4. A minimum of 50%of program-eligible women referred to screening will have a completed breast and/or or organizations providing other services to the same target population. cervical cancer screening exam Objectives Activities Planned To Achieve This Data Timeframe for Team Members Evaluation Objective Assessing Responsible Progress Develop plans for public I. Identify existing breast and cervical See Addendum 2 BBP Community Coordinators Review of meeting education and recruitment, cancer groups in local communities, Ongoing Clinical Services Case minutes,including with input from partners,to i.e.ACS,Komen„and Greeley X-ray Management Coordinator Participant attendance program-eligible women Group. Nurse Consultant 2. Collaborate with service provider staff See Addendum I Recruitment Coordinator Results of evaluations to plan and implement inreach Program Manager activities,recruitment activities and Numbers of meetings special screening events. A minimum of three 3. Communicate with service providers, See Addendum 1 & statewide meetings will coalition members/volunteers and other partnering agencies to identify Addendum 2 be held, with advisory committees, local opportunities for marketing recruitment and one-on-one interactions with businesses,provider eligible women. See Addendum 3 staff, community agencies,as a part of 4. Meet with non-profit and for-profit larger conferences agencies and businesses to discuss potential collaborative projects. 5. Solicit input from partners on the development or revision of recruitment materials and strategies. J:\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\Community Coor Workplan 05 14 04.doc Objectives Activities Planned To Achieve This Data Timeframe for Team Members Evaluation Objective Assessing Responsible Progress Conduct marketing events in 1. With input from partners, identify Lists of special Ongoing Recruitment Coordinator Coordinator Contact local communities, utilizing opportunities for non-traditional calendar events Community Coordinators Logs(#of local one-on- one-on-one recruitment,to marketing recruitment. See Addendum 4 one recruitment activities y 2. Distributepromotional materials at will be conducted) reach and refer 100 rare] See Addendum 5 and never screened women. community locations that serve women who are rarely/never screened, such as Quarterly Hotline Call Summary correctional facilities,mental health (#Received as a result facilities, substance abuse agencies, of one-on-one domestic violence agencies,homeless recruitment efforts) shelters, mobile home parks, agencies who serve non-English speaking Screening Referrals women,migrant ands tribal groups. (#Referrals made as a Priority populations are ethnic and result of one-on-one racial minorities, women who partner recruitment efforts) with women and women with disabilities. Personal History Forms See Addendum 3 (15%of responses to 3. Mail brochures,posters, and free screening certificates to human "how did you hear?"will be from one-on-one services and other agencies/organizations that marketing efforts) communicate with rarely and never screened women. Quarterly Utilize local print and 1. Identify potential media sources and NCI-CHP Data Ongoing Community Coordinators Coordinator Contact broadcast media(paid and in channels for rarely/never screened Target Eligibility Logs(#of local one-on- kind)to reach program women, i.e. Dept. Social Services Case Data one recruitment activities eligible rarely and never Workers. will be conducted) screened' women in priority 2. Establish and maintain collaborative See Addendum 6 populations. relationships with local media sources Hotline Call Summary (#Received as a result 3. Review and revise existing media or of one develop new media to include electronic public service recruitment efforts) e announcements,camera-ready ads, print public service messages,news Screening Referrals (#Referrals made as a releases and feature stories. result of one-on-one J:\CCP\CWCCI\CONTRACTS\2004 -2005 Contracts\Recruitment\NE Weld\Community Coor Workplan 05 14 04.doc Objectives Activities Planned To Achieve This Data Timeframe for Team Members Evaluation Objective Assessing Responsible Progress 4. Distribute CWCCI information to local See Addendum 6 Quarterly recruitment efforts) newspapers, community publications, church bulletins,television/radio Personal History Forms stations, cable channels and electronic (15%of responses to bulletin boards. "how did you hear?"will be from one-on-one marketing efforts) Copies of print and/or electronic media will be reviewed when available. Coordinate and maintain a 1. Identify other community referral Hotline call logs Ongoing Community Coordinators Coordinator Contact system to allow easy access line(s)to contract with to take calls Community Recruitment Coordinator Logs(#of local one-on- for women to obtain directed at some future time, i.e. 1211 Coordinator logs one recruitment activities screening information and thru United Way. will be conducted) screening referrals. 2. Provide eligibility and screening information to all callers. Hotline Call Summary (#Received as a result 3. Educate callers about the importance of of one-on-one regular screening and the availability of recruitment efforts) free exams every year if women qualify Screening Referrals 4. Assess each caller's need for assistance (#Referrals made as a with making appointments, arranging result of one-on-one transportation,etc. recruitment efforts) 5. Ensure all marketing/media materials list the hotline number. Personal History Forms (15%of responses to "how did you hear?"will be from one-on-one marketing efforts) Client Satisfaction Survey JACCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\Community Coor Workplan 05 14 04.doc Objectives Activities Planned To Achieve This Data Timeframe for Team Members Evaluation Objective Assessing Responsible Progress 1. Contact new case managers and/or Service delivery Ongoing Community Coordinators Documentation of case Meet with case managers clinic staff at service delivery agencies case manager list Clinical Services Case manager visits and in- and other appropriate staff at to learn process for providing services. Management Coordinator service presentations CWCCI service sites basis 2. Identify appropriate referral contacts Nurse Consultant to collaborate recruitment of 3. Conduct in-services for new provider Review of provider women into screening staff screening data services Provider evaluation of CWCCI staff/ coordinators Provide one-on-one follow- 1. Identify women referred for services Referral logs Ongoing Data Coordinator Screening Referral up(counseling, education who have not completed screening Coordinator/ Yearly site visit Community Coordinators Follow-up(a minimum and support)to women to exams. Recruitment Recruitment Coordinator of 50%referred women overcoming barriers to 2. Contact women to determine what Summary Reports Clinical Services Case will complete their screening barriers they faced. Encourage women Screening Data Management Coordinator screening exam within 6 to be screened and assist with removal Nurse Consultant months) of barriers as needed. 3. Visit contract agencies to address Screening Data barriers and identify strategies to reduce barriers. Client Satisfaction Survey Feedback to contractors J:\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\Community Coor Workplan 05 14 04.doc CWCCI Budget Request And Matching Funds for Outreach Contractors July 1, 2001 June 3O, 2OO5 List the budget request from CWCCI, CDPH&E and calculate all private and public (local, state, and federal) matching funds that will support this project. Weld County Department of Public Health & Environment—Health Promotions Name of Agency : Budget Category Dollar Amount Requested Dollar Amount of from CDPH&E Matching Funds Personnel/fringe 52,961.88 Travel 1,545 Equipment 400 Supplies 174 500 Contractual 0 Operating 2,085 1,000 Total Direct 56,765.88 Indirect Cost 8,168.61 Total Request 64,934.49 1,900 Budget Detail: Complete the following budget request and justification template (personnel and fringe, travel, equipment, supplies, operating, indirect charges). Line Item Totals should match those above. n � _ #: r¢, J� 'E ,] ��^6a.t,r 1r, `e1dn'1 $J4Allra J:\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\CWCCI Budget Fn 04- 05.doc • a x{� 't�'�`' —'-'.'1,y scw 4I e #ce 4 i" i?w 41":" '.h" PPfIIO V' . •5. M. + ' YfY°' ns. i^;c...� 3. _ im, Cy Y�� `Nat'' ' - Trtle'' 1 t, 'Base Salax #t,rFringe r Percent�o€ f: a D: .ter c., n '' ,x,.,�if t # i 4;.t.„.7_t 3 C�` rY& -r rc �LCY,:. ci. . Olivia Martinez Health Education 40,131.76 12,830.12 FTE 52,961.88 Specialist II Total Personnel 52961.88 b� �,Y 44, . . ,, _ '. H 3--,-.4-A---- "ti gr3 ,'-§ t»x, w , 4, . s <` s" er{ ... 5,. t Description f , ,LA..-Hl."' $t. ` R g` St 'k .: °� f. Mileage Mileage Northeastern Region for outreach, marketing, 3,000 .355 1,065 attend consortium meetings and State conference Total Mileage 1 065 Lodging 3 Required Regional Consortium Meetings 3 night 90 270 Statewide Comprehensive Cancer Conference I night 90 90 --' Total Lodging 36�` Per Diem 6 15 90 Meals overnight stay Meals—Cancer Conference 2 15 30 J:\CCP\CWCCI\CONTRACTS\2004-2005 COntracts\Recruitment\NE Weld\CWCCI Budget FTE 04- 05.doc r � �j, d±.lase b y-- - bfr/mts Umt Cost s r f � llol . Total Per Diem $120 Total Travel $1,545 a� .s ' .K x ti` .,;. 5 Yt le. ti :-.Biatt& :l t z c ;•q stir" ofUnits�.•Cost • t ' o o Equipment (TV,VCR,flip chart,etc.) $ Total Equipment gt w . x nt" s u. .& z f a • �y o- "s Sf� Z rygg r�"..ektriht ta£ "` -- 'fit^ "'�" �T. t. .y� i. Si• rY.F 1'r t-T"p�'z- '('.S, ' , P' :' a �.fAt A :if- 9 1 ,•••••• "•:-•- ( s,,. -z!' 1 t ' •y i �i al.)- ,3/44-44-',.O-$),‘,-..- i aStil{p••lhar�� Cvii 8 € 7 1v zs li'3 i 1 'Si�tr- ?F •a u i:. "c:' c fix' d i - , r: h rd'FtA r y &* x pie ,-.1 .' .4 �_...,.zsy...., ).�..,�� '"s?-81..4, a c.-: .. � a Office Supplies(paper,pens,notebooks,tablets,flip chart paper,markers,etc.) Paper for reports,letters, minutes 3 reams 8 24 Copies for marketing 5000 copies .03 150 1* :, ; ..".k.1.--,''''' _ ,47:7441,44-..r, ' 7« Total Ofice Suppj x Bore' Total Supplies - - . - J:\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\CWCCI Budget FTE 04- 05.doc ?' s - ; 141::;•; - , ,p i.-� k , 't'.,Sts:..- "t of U t3 i Unit Cost .! © fifi.. 'j „� t r I:: ' Marketing(promotional materials,booth space,etc.) Total Marketing,. $ Media Advertising(television,radio,newspaper,etc.) Thrifty nicle, Radio ads 3 100 300 Total Media $300 Postage Mailings to service providers,cervical cancer groups, 500 .37 185 volunteers and partnering agencies Total Postage . $185 Honoraria,incentives,refreshments Meals for community consortium attendees 135 10 1,350 a -.� n+-* V. ''re,';'1`otat Hoinoraria,items�., re3 {g.: `-h�' Staff Training Statewide Comprehensive Cancer Conference—2 days 1 250 250 J:\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\CWCCI Budget FTE 04- 05.doc 3".µf {+ 9f4 3 .0.[. Etc , Yy{� te X g, '�' '1, 'CSt st e ,'"4- "i c' s! i i `1• `ya ra a a ti in , Milt Costa x mil' ° l • s, 4"- '� en, Total Staff Training.; $250 Total Operating $2,085• iT,m Lt`7"4, kz t „�, i xk & 3� `1-"i n �. n - +.*"t t 'k '✓E`t"'. 3 il:t9`; : .i6 w,t..... o..H t}o, _ r i ..r.Sr w i5.e ✓; ,r§ `.E"t ........-LiczFzei f'� � ` :wi 5t�^X�s � �v t� .. � tel .� ® a 9� a e a _ K .= € a tie jr a r '" ® a � 43 tic � 1£C. d $' .7 c ° .xx .7 ,:>,? ' xxk tS Indirect Charges (legal fees, rent, utilities, cleaning supplies, audit cost,interest payments, liability insurance, general postage, general office equipment,building maintenance, etc.) 14.39%of all direct costs 8,165.16 TOTAL INDIRECT $8,165.16 J:\CCP\CWCCI\CONTRACTS\2004-2005 Contracts\Recruitment\NE Weld\CWCCI Budget FTE 04- 05.doc CWCCI Budget Justification for July 1,2004—June 30, 2005 1. Personnel salary for one FTE to coordinate and oversee the Regional Coordinator position. 2. Fringe benefits for one FTE for the Regional Coordinator position 3. Equipment to purchase a cell phone and pay monthly charges. 4. Supplies for promotion and education to reach rarely and never screened women. 5. Contractual none 6. Travel for mileage to cover northeastern region of Colorado, attend consortium meetings and recruit never/rarely screened. 7. Other—operating expense to purchase marketing/promotional materials, for media coverage, for mailings, refreshments and meals for consortium participants and registration fee for statewide conference. 8. Indirect for legal fees, utilities, cleaning supplies, audit cost, interest payments, liability insurance, general postage, general office equipment, building maintenance, etc. J:\CCP\CWCCI\CONTRACTS\2004 -2005 Contracts\Recruitment\NE Weld\CWCCI Budget Justification 04-05.doc Attachment B Task Order Reimbursement Statement CWCCI Program July 1,2004 -June 30, 2005 Contractor Date Submitted: Address: Contract Number: Billing Month: Budget Category Approved Budget Totals Requested Reimbursement Totals Personnel/fringe Travel Equipment Supplies Contractual Operating Other Indirect Cost(supervisory) Total Request This is to certify that the above expenses were incurred per contract number With the State and we,the contractor,are requesting reimbursement for the same. Is this the final payment reimbursement request for this contract order? YES NO Contractor Signature Date Phone For State Use Only: Fiscal Officer Approval Date A:\ACS BUDCET.doc 1 (Date] SAMPLE TASK ORDER CHANGE ORDER LETTER Attachment C 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,f$*.**) 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 (Seal) ATTEST: PROGRAM APPROVAL: By: 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: Arthur L.Barnhart By: Date: Revised:08/30/02 ]Date] SAMPLE TASK ORDER OPTION TO RENEW LETTER Attachment D Task Order Option to Renew Letter Number**, Contract Routing Number** *** ***** State Fiscal Year 20**-20** *************** Pro¢ram 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,f*.**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 (Seal) ATTEST: PROGRAM APPROVAL: By: 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: Arthur L.Barnhart By: Date: Revised:08/30/02 Hello