HomeMy WebLinkAbout20041549.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR TOBACCO EDUCATION AND PREVENTION
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 the Tobacco Education
and Prevention 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, 2004, and ending June 30, 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 the Tobacco Education and Prevention 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 2nd day of June, A.D., 2004.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
E.aa♦
.r �� �A/%/// EXCUSED
1861 l<\S Slf� Robert D. Masden, Chair
� _: o [ Jerk to the Board
' �4
®,? yyt6C2 / ' William H. rke, Pro-Tem
Deputy Clerk to the Board j
M. J. ei e
AP DAST CO
David . Long
ounty A orne
Glenn Vaad
Date of signature: ///i®V
2004-1549
HL0031
I
Memorandum
TO: Robert D. Masden, Chair
OBoard of County Commissioners
• From: Mark E. Wallace, MD, MPH, Director
COLORADO Department of Public Health and
Environment cN'`�v
\c. Cv i tiJ. ( _ May 28, 2004
- ;CT: Task Order for the Tobacco Education and
C k I .,l 1 Prevention Program
\ -Cc
Enclosed for l i task order for the Tobacco Education and
Prevention Pr order will become part of the master contract
between the Colorado Department or ruDuc Health and Environment (CDPHE) and Weld
County Department of Public Health and Environment(WCDPHE).
Funds from the Master Settlement Agreement between several states and certain tobacco
companies have been appropriated to the CDPHE. This appropriation is available for the
continued implementation of the tobacco education and prevention grant that has funded the
Tobacco-Free Weld County Program at the Weld County Department of Public Health and
Environment.
This task order will permit the continued efforts of 1.25 FTE Health Promotion staff members
who will work towards reducing initiation of tobacco use, reducing exposure to environmental
tobacco smoke, and promoting cessation of tobacco use among youth and adults in Weld County.
Community collaboration and capacity building around these tobacco prevention efforts will
continue in order to allow for the maximum outreach of the funds.
For these activities, WCDPHE will receive a sum not to exceed $99,925.00 for the time period
July 1,' through June 30, 2005. I recommend your approval of this task order.
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Enclosure
Enc.
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2004-1549
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
05-00071
TASK ORDER
Tobacco Education and Prevention Program
This Task Order is made this 28th day of April,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),whose address or principal place of business is 915 10th Street,
3rd Floor,Greeley,Colorado 80631,for the use and benefit of the 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
Tobacco use is the leading cause of premature death and disability in Colorado. The state of Colorado has received
funds under a Master Settlement Agreement between several states, including Colorado,and certain tobacco
companies. A portion of these funds has been appropriated to the State to implement a tobacco education,
prevention and cessation grant program,to provide funding for community-based and statewide tobacco education
programs. The Contractor has submitted a funding request which has been approved by the State Board of Health.
This funding request shall be funded from the tobacco education,prevention and cessation grant program.
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 Number 13V, Organizational Unit Code 7370 Appropriation Code 775 ,Program Code 9011,Function
Code XMPT,Object Code 5120, and Grant Budget Line Code 8A5G under Contract encumbrance number 05 FLA
00071. All required approvals,clearances,and coordination have been accomplished from and with all appropriate
agencies.
Page 1 of 7
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
July 1,2004. However, in accordance with section 24-30-202(1),C.R.S.,as amended,this Contract 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 Contract until this Contract 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 Contract. If the State Controller approves this Contract on or before its proposed effective date,then
the Contractor shall commence performance under this Contract on the proposed effective date. If the State
Controller approves this Contract after its proposed effective date,then the Contractor shall only commence
performance under this Contract on that later date. The initial term of this Contract shall commence on the
effective date of this Contract and continue through and including June 30,2005,unless sooner terminated
by the parties pursuant to the terms and conditions of this Contract. 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 items contained in its approved Annual Action Plan. This plan which is
required by the Request for Application and shall be submitted in writing to the STEPP office no later than
thirty(30)calendar days after approval of this Contract, is defined and referenced in the Statement of Work
and Budget,which are incorporated herein by this reference,made a part hereof and attached hereto as
"Attachment A".
1. The Contractor shall implement tobacco control program activities in Weld County,Colorado,
designed to prevent and reduce tobacco use.
2. The Contractor shall not use funds provided under this Task Order to: supplant funding for any
existing and future programs/models;develop new cessation programs/models or curricula for
youth or adults;pay for individual cessation aids or nicotine replacement therapy;fund capital
improvements,substitute funding for events previously funded by tobacco companies,or fund
costs of enforcement of state or local laws and ordinances.
3. If the Contractor intends to subcontract any or all of its performance obligations under this Task
Order,then the Contractor shall provide to the State, for the State's prior review and written
approval,a copy of any proposed subcontract between the Contractor and a subcontractor. All
subcontractors are subject to all the terms and conditions of this Task Order and the related
Master Contract. The Contractor remains ultimately responsible for any work performed by a
subcontractor.
4. The State shall be the owner of all printed materials,graphic representations,educational
materials,audio-visual products, or any other media,in whatever form,created by the Contractor
under this Task Order.
5. The Contractor shall ensure that its staff is trained in the field of tobacco control. Newly hired
staff of the Contractor who will perform work under this Task Order shall participate in an
Page 2 of 7
orientation training conducted by the State and complete the STEPP learning modules within six
(6)months of the commencement date of employment
6. The Contractor shall participate in state-level evaluation efforts as requested by the State to
include,but not be limited to:quarterly reports, due fifteen(15)calendar days after the end of
each calendar quarter. Calendar quarters shall be July-September,October-December,January-
March and April-June.
7. Within thirty(30)calendar days after the expiration of the term of this Task Order,the Contractor
shall submit a written report to the State which describes its key accomplishments in
implementing Attachment A to this Task Order. The written report shall also describe all
measurable objectives and the Contractor's overall achievement of its plan.
8. The Contractor IS NOT required to provide matching funds in order to be eligible to receive
funding under this Task Order.
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
NINETY-NINE THOUSAND NINE HUNDRED TWENTY-FIVE DOLLARS,($99,925.00)
for the initial term of this Task Order. Of the total financial obligation of the State referenced
above, $0_00 are identified as attributable to a funding source of the United States government
and,$99,925.00 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 "Task Order Reimbursement
Statement".
3. If this Task Order requires the Contractor submit a"Task Order Reimbursement Statement",then
the Contractor shall submit a signed monthly Task Order Reimbursement Statement within sixty
(60)calendar days of the end of the billing period for which services were rendered in a format
either provided by or approved by the State.
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).
Page 3 of 7
All task order reimbursement statements: shall reference the Master Contract's contract routing
number and this Task Order's contract routing number;shall be based upon the costs of the work
and services performed during the term of this Task Order;and,shall be supplemented or
accompanied by supporting data and subcontractor invoices, if any,covering the work shown on
the Task Order reimbursement statement upon request of the State. The Contractor shall maintain
original documentation for all costs related to the Contractor's performance under this Task Order.
The Contractor shall not be reimbursed unless and until the State has received any and all
quarterly reports then due from the Contractor. Each Task Order Reimbursement Statement shall
be sent to:
David Smith
Prevention Services Division
Colorado Department of Public Health and Environment
Mail Code PSD-STEPP-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 B". 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;
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
Page 4 of 7
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 C". 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:
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 finding 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
Page 5 of 7
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. ATTACHMENTS.
All attachments to this Task Order are incorporated herein by this reference and made a part hereof as
if fully set forth herein. In the event of any conflict or inconsistency between the terms and conditions
of this Task Order and those of any attachment hereto,the terms and conditions of this Task Order
shall control.
Page 6 of 7
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 Bill Owens,Governor
(a political subdivision of the state of Colorado)
for the use and benefit of the Weld County Department
of Public Health and Environment
By: l v.-•—Q By:
Name: William H._Jerke For the xecutiv Di ctor
Title: Chair, Pro-Tem(06/02/2004) DEPARTMENT OF UBLIC HEALTH
, 000813 B AND ENVIRON E
, _ 4�
�tabt I,
e. ATTEM 0Ltt PROGRAM APPROVAL:
' By: ,4 /. IaZcO(Gf/J
'svi �i',.; , , ,>•��� . ��� ounty, -�Q
Deputy Clerk to the Board
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:
Arthur L. Barnhisrt
By:
`/ WELD COUNTY DEPARTMENT OF
Date: 7 PU IC HEALTfri op ENVI E,T
Revised:11/30/02 BY: k /�VC
Mark E. Wallace, Ml D, MPH•Director
Page 7 of 7
V—,A y
Attachment A
STATEMENT OF WORK
Tobacco Control Program
1. The Contractor will implement a tobacco control program designed to prevent and
reduce tobacco use in the county or counties named in its grant application. The program
will employ those community-level activities described in The Guide to Community
Preventive Services: Tobacco Use Prevention and Control as key activities to accomplish
its goals.
2. Within thirty (30) calendar days from the approval of the Contract, the Contractor
shall develop and submit an "Annual Action Plan and Budget"to the State that describes
the projects and activities the Contractor will complete in any or all of the following
areas:
INFRASTRUCTURE
Maintaining the program infrastructure to sustain coalition involvement and staff
to lead the program. Infrastructure includes annual objectives to sustain the
program related to coalition building and maintenance, training for staff and
coalition members, attendance at State meetings and trainings, reporting to
STEPP, and other basic activities the Contractor will conduct to sustain its
program.
CESSATION
Support and promote the statewide Quitline, QuitNet, and research—based
community cessation services that are already in place.
COALITIONS
Develop and sustain community-based coalitions dedicated to planning and
carrying out tobacco reduction strategies.
Establish and maintain relationships with a broad-based set of partners, including
but not limited to: law enforcement, alcohol and drug abuse providers, schools,
health care providers and community-based organizations.
Conduct an annual satisfaction survey among coalition members and implement
strategies to improve the satisfaction and effectiveness of the coalition.
ELIMINATING DISPARITIES
Identify and address the disparities related to tobacco prevention and education
through specific activities.
ENFORCEMENT OF LOCAL ORDINANCES
Coordinate with the Colorado Department of Revenue and local law enforcement
agencies to identify instances of illegal sales of tobacco to minors.
MEDIA ADVOCACY AND PLACEMENT OF PAID MEDIA
Develop media plans and media advocacy activities. Coordinate media plans and
activities with STEPP and neighboring counties and cities as necessary.
POLICY RELATED ACTIVITIES
Consistent with State law and local health agency protocols and practices, focus
on policy interventions within each program goal. Policy development may be a
long-term objective spanning more than one funding period.
SCHOOL-BASED ACTIVITIES
In conducting these activities, the purchase of educational curricula or cessation
programs for public or private schools or the direct funding of staff support for
school-based prevention and cessation programs are not allowed.
TRAINING
Participate in state and regional trainings, statewide and regional youth summits
and meetings and conference calls provided by STEPP.
YOUTH COALITIONS AND YOUTH EMPOWERMENT
Provide support to local "Get R!EAL" youth coalitions through the provision of
technical assistance and resources.
Involve Get R!EAL youth, where appropriate, in local tobacco control efforts.
Attend Get REAL regional and statewide summits to support of local Get R!EAL
coalitions.
If a Get R!EAL youth coalitions does not exist in the Contractor's service area,
then the Contractor will develop partnerships with youth organizations to
collaborate on projects that contribute to youth empowerment and reduction of
tobacco use.
3. Submit all revisions to the Contractor's approved Annual Action Plan and Budget for
approval by STEPP as necessary during the contract term. Revisions must be submitted
and approved at least thirty(30) calendar days before the Contractor conducts any new
activities that were not contained in the previously, approved Annual Action Plan and
Budget. Upon approval by STEPP, the revised Annual Action Plan and Budget will
become the approved Annual Action Plan and Budget.
•
STATE TOBACCO EDUCATION AND PREVENTION PARTNERSHIP
APPLICATION BUDGET AND/OR EXPENDITURE REPORT FORM
FOR THE PERIOD: July 1,2004-June 30,2005
AGENCY: Weld County Department of Public Health&Environment
Annual #of FIE/ Total SOURCE OF FUNDS
Fringe/ Requested I
Salary months Ind Amount Received
Rate Budget Pct Required OTHER' from CDPHE
PERSONAL SERVICES:
Megan Martinez,Program Coordinator 43,322.18 12 75.00% $32,492.00 $32,492.00
26,726.10 12 50.00% $13,364.00 $13,364.00
Fringe Benefits:(Rate:31.97%) $14,660.00 $14,660.00
Total Personal Services $60,516.00 $60,516.00
DIRECT OPERATING EXPENSES
Printing/Copying $727.00 $727.00
Postage/Shipping $1,432.00 $1,432.00
Rent/Utilities
Telephone,Fax,Internet Access
Office Supplies $2,457.00 $2,457.00
Office Equipment
Computer Equipment
Meeting Expense $3,675.00 $3,675.00
Media Expense(Program Cost) $9,633.00 $9,633.00
Staff Development-Registrations $300.00 $300.00
Staff Development-Memberships/Subscriptions $150.00 $150.00
Educational Materials(Program Cost) $3,600.00 $3,600.00
Miscellaneous Expense $185.00 $185.00
Total Operating $22,159.00 $22,159.00
TRAVEL
In-State $1,626.00 $1,626.00
Out of State $1,104.00 $1,104.00
Total Travel $2,730.00 $2,730.00
CONTRACTUAL
Consultant Costs
Contract Trainers/Speakers
Data Collection $500.00 $500.00
Total Contractual $500.00 $500.00
Total Direct Costs(Personal Services+Operating+Travel+Contractual) $85,905.00 $85,905.00
ADMINISTRATIVE INDIRECT COSTS Pct
Indirect Percentage(applied to all direct costs) 16.32% $14,020.00 $14,020.00
Indirect Percentage(applied to salary and fringe costs only)
Indirect Percentage(applied to salary costs only)
Total Indirect Costs $14,020.00 $14,020.00
TOTAL PROJECT COST $99,925.00 $99,925.00
"'Other"Funding Sources(Matching Funds). Funds supplementing the STEPP award.
TOTAL $99,925.00
Dr.Mark E.Wallace,MD,MPH Executive Director,WCDPHE 3/24/2004
Signature of Authorized Representative Date
i'ASTEPP1Lcmmunilke of EocelkngknprcMeeeePaudge,Form 2004-2005revised May
Reu:L212pW
DSmilh
Pate] SAMPLE TASK ORDER CHANGE ORDER LETTER Attachment B
Task Order Change Order Letter Number**, Contract Routing Number** *** *****
State Fiscal Year 20**-20**, ***************Program
This Task Order Change Order Letter is issued pursuant to paragraph *_*.of the Master Contract identified as
contract routing number** *** ***** and paragraph*. *. of the Task Order identified as contract routing number
** *** ***** and contract encumbrance number** *** ********** This Task Order Change Order Letter is
between the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT and JLEGAL
NAME OF CONTRACTOR). The Task Order has been amended by Task Order Option to Renew Letter**
contract routing number** *** *****,and/or Task Order Change Order Letter**,contract routing number** ***
*****, if any. The Task Order,as amended,if applicable, is referred to as the"Original Task Order". This Task
Order Change Order Letter is for the current term of********* ** ****,through ********* **,****. The
maximum amount payable by the State for the work to be performed by the Contractor during this current term is
increased/decreased by********** Dollars,($*.**)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
(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 C
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!LEGAL
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,(*.**)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
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