HomeMy WebLinkAbout20002721.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR TOBACCO EDUCATION, PREVENTION, AND
CESSATION 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, Prevention, and Cessation 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 November 1, 2000, and ending June 30, 2001, 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, Prevention, and
Cessation 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 1st day of November, A.D., 2000.
BOARD OF COUNTY COMMISSIONERS
W D COUNTY, COLORAD
ATTEST:
Barbara J rkmeyer, Chair
Weld County Clerk to t C Bo: ' • :p�,
,1861 t*%g
r 1j '4n �I M. J. i , ro-Tem
BY: _ - .
Deputy Clerk to the '. %)UN�
r E. Baxter
JSBPR• i D AS O ORM:
' �I Dale I . Hal
Ce my Attorney
Glenn Vaad
2000-2721
HL0027
Kit ;
C� MEMORANDUM
COLORADO
TO: Barbara J. Kirkmeyer, Chair, Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director, Department of Public
Health and Environment
SUBJECT: Task Order for a Tobacco Education,Prevention and Cessation
Program
DATE: October 30, 2000
Enclosed for Board review and approval is a task order that, if approved, will become a part of
the master contract between the Colorado Department of Public Health and Environment
(CDPHE) and Weld County.
Funds from the Master Settlement Agreement between several states and certain tobacco
companies have been appropriated to the Colorado Department of Public Health and
Environment. This appropriation is for the implementation of a tobacco education, prevention,
and cessation grant program. Weld County Department of Public Health and Environment staff
members submitted a proposal and were awarded funding for such a program in our county. This
task order will permit hiring of 1.5 additional health education specialists, a .5 office technician,
as well as increasing the current field coordinator's position from .5 to 1.0 FTE. It will also fund
the purchase of two computers, software, and office furniture for the new staff.
As part of the work plan, WCDPHE staff members will identify and combine efforts with other
stakeholders to increase their impact on Weld County residents. They will provide training on a
comprehensive tobacco program to health professionals, teachers, parents, businesses, local
leaders, and law enforcement. Some of the goals of the work plan are to promote cessation
among youth and adults, prevent initiation of tobacco use among youth, and reduce exposure to
second-hand smoke.
For these efforts, Weld County will be paid a sum not to exceed $104,907 for the time period
November 1, 2000 through June 30, 2001. I recommend your approval of this task order.
Enc.
2000-2721
Department or Agency Name
COLORADO DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
Department or Agency Number
FLA
Contract Routing Number
01-00134
TASK ORDER
This TASK ORDER is made this 31st day of October.2000,by and between:the State of Colorado,for the use and
benefit of 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 Flobr,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".
WHEREAS,Section 29-1-201,9 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,and to this
end all State contracts with its political subdivisions are exempt from the State's personnel rules and the State
procurement code;
WHEREAS,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,and
Object Code 5781,under Contract Encumbrance Number FLA PPG0100134,Master Contract Routing Number 00-
00008
WHEREAS,tobacco use is the leading cause of premature death and disability in Colorado;
WHEREAS,the State of Colorado has received funds under a Master Settlement Agreement between several states,
including Colorado,and certain tobacco companies,
WHEREAS,a portion of these funds has been appropriated to the Department of Public Health and Environment to
implement a tobacco education,prevention and cessation grant program,to provide funding for community-based and
statewide tobacco education programs;
Page 1 of 6
WHEREAS,the contractor's funding request has been approved by the Board of Health to be funded from the
tobacco education,prevention and cessation grant program;
WHEREAS,as of the made date of this Contract,the State has a currently valid Group II purchasing delegation
agreement with the division of finance and procurement within the Colorado Department of Personnel;
WHEREAS,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 CONTRACT TERMINATION. The effective date of this Task
Order is November 15.2000, or on the date this Task Order is approved by the State Controller,whichever
is later. The term of this Task Order shall commence on November 15.2000,and continue through and
including June 30.2001,unless sooner terminated by the parties pursuant to the terms and conditions of
the Master Contract.
B. SCOPE OF WORM. The Contractor,in accordance with the terms and conditions of the Master Contract
and this Task Order, agrees as follows:
1. The Contractor agrees to build capacity for implementing a comprehensive tobacco control
program designed to prevent and reduce tobacco use. The Contractor shall perform and
complete, in a timely and satisfactory manner,all work items described in the"Scope of Work"
which is incorporated herein by this reference,made a part hereof,and attached hereto as
"Attachment A".
2. The Contractor shall not use funds provided under this contract to: supplant funding for any
existing programs/models; develop new cessation programs/models for youth or adults;
implement cessation programs that are not based upon Center for Disease Control(CDC)
guidelines; pay for individual cessation aids; nor fund capital improvements.
3. The Contractor shall submit a written program evaluation plan to the State Tobacco Education and
Prevention Partnership("STEPP")office,at the Colorado Department of Public Health and
Environment,within 30 days after approval of this contract. At a minimum the plan shall describe
how the grantee will measure the effects of the program against the goals it set out to accomplish
and determine how the results achieved by the program contribute to the overall achievement of
the program goals of Reducing Exposure to Environmental Tobacco Smoke,Promoting Cessation
Among Youth and Adults,and Preventing Initiation Among Youth.
4. The Contractor shall submit a monthly report describing key accomplishments related to
Page 2 of 6
measurable objectives written in the Contractor's Scope of Work within 15 days following the end
of each month during which services were rendered.
5. The Contractor shall submit an annual report describing key accomplishments related to
measurable objectives and overall achievement of the program goals within 30 days after of the
end of the contract period.
6. The Contractor shall participate in monthly conference calls,and meeting and trainings,conducted
by the State to inform and train contractors receiving tobacco settlement funds.
7. The Contractor shall notify the State in writing within 15 days of the Contractor's notification of
changes in the Field Coordinator position. The State Program Manager shall be provided with a
copy of the proposed candidate's resume prior to any Contractor filling a vacant Field
Coordinator's position.
8. The Contractor shall participate in State-level evaluation efforts as requested.
9. The Contractor agrees that the State of Colorado,specifically the Department of Public Health and
Environment,shall be the owner of all printed materials,graphic representations,education
materials,or other audiovisual products created under this contract.
10. The Contractor IS NOT required to provide matching funds in order to be eligible to receive
funding under this contract.
C. DUTIES AND OBLICATIONS OF THE STATE
The representative at the Colorado Department of Public Health and Environment for this Task Order
for matters pertaining to the scope of work,budget,total amount of funding available,and contractor staff
or budget changes is:
Karen DeLeeuw,Program Manager
STEPP, Mail Code EMSPD-A5 Phone: 303-692-2515
4300 Cherry Creek Drive South Fax: 303-758-3448
Denver, CO 80246
D. COMPENSATION. The State shall cause to be paid to the Contractor an amount not to exceed ONE
HUNDRED FOUR THOUSAND,NINE HUNDRED SEVEN DOLLARS($104,907.00)under this
Task Order. Of this total amount,$$=0--,are derived from a funding source of the Federal government and,
$104,907.00 are derived from a funding source of the State of Colorado.
The budget included with the Scope of Work,Attachment A, shall govern the expenditure of funds by the
contractor as well as the subsequent reimbursement by the State. The Contractor may transfer budget
between specific line items within the Program Operating category without prior approval. Up to 10%of
Page 3 of 6
the total funds originally set forth in each budget category(Personnel,Fringe,Travel, Staff Development
and Training,Consultants/Trainers,Program Operating,and Data Collection) may be rebudgeted into
other categories without prior approval by the State. Transfers exceeding 10%of the funds in a category
do require prior written approval by the State. In all instances,a revised budget showing the original
amounts,modifications made,and new amounts must be submitted within 30 days of the modifications(s).
The contractor shall submit a"Contract Reimbursement Statement",a copy of which is incorporated
herein by this reference,made a part hereof,and attached hereto as"Attachment B",requesting payment
from the State. All contract reimbursement statements:must reference the Master Contract's contract
routing number and this Task Order's 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 contract reimbursement
statement. The contractor shall maintain original documentation for all costs related to the contractor's
performance under this Task Order.
E. PAYMENT MECHANISM. Payments under this Task Order shall be made either through the Electronic
Payment System or,upon the contractor's monthly submission of duplicate invoices requesting
reimbursement for those services provided in the previous month.
F. CHANGE ORDER LETTER. The state may prospectively increase or decrease the amount payable
under this Task Order through a"Task Order Change Order Letter",a sample of which is incorporated
herein by this reference,made a part hereof,and attached hereto as"Attachment C". To be effective,the
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,the Task Order Change Order letter shall
include the following information.
A. Identification of the Task Order by its routing number and affected paragraph number(s);
B. The type(s)of services(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 the
new total financial obligation;
D. The intended effective date of the renewal;and,
E. A provision stating that the Task Order Change Order Letter shall not be valid until approved by the
State Controller or such assistant as designated.
Upon proper execution and approval,the Task Order Change Letter shall become an amendment to this
Task Order. Except for the General and Special Provisions of the Master Contract,the Task Order Change
Order Letter shall supersede this Contract in the event of a conflict between the two. It is expressly
understood and agreed to by the parties that the Task Order Renewal Letter process may be only to:renew
this 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
this Task Order,other than those authorized by the Task Order Change Letter process described above,
shall be made by a formal amendment to this Task Order executed in accordance with the Fiscal Rules of
the State of Colorado.
Page 4 of 6
If the Contractor agrees to and accepts the proposed change,then the Contractor shall execute and return
the Task Order Change Order Letter to the State by the date indicated in the Task Order Change Order
Letter. If the Contractor does not agree to and accept the proposed change,or fails to timely return the
partially executed Task Order Change Letter,then the State may,upon written notice to the Contractor,
terminate this Task Order twenty(20)calendar days after the return date indicated in the Task Order
Change Order Letter has passed. In the event of termination under this clause,the parties shall not be
relieved of their respective duties and obligations under this Task Order until the effective date of
termination has occurred.
G. RENEWAL LETTER. The state may renew this Task Order through a"Task Order Renewal Letter",a
sample of which is incorporated herein by this reference,made a part hereof,and attached hereto as
"Attachment D".To be effective,the Task Order renewal Letter must be: signed by the State and the
Contractor;and,approved by the State Controller or an authorized designee thereof. Additionally,the
Task Order Renewal Letter shall include the following information:
A. Identification of this Task Order by its routing number and affected p0aragraph number(s);
B. The type(s)of services(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 the
new total financial obligation;
D. The intended effective date of the renewal;and,
E. A provision stating that the Task Order Renewal Letter shall not be valid until approved by the State
Controller or such assistant as designated.
Upon proper execution and approval,the Task Order Renewal Letter shall become an amendment to this
Task Order. Except for the General and Special Provisions of the Master Contract,the Task Order
Renewal Letter shall supersede this Contract in the event of a conflict between the two. It is expressly
understood and agreed to by the parties that the Task Order Renewal Letter process may be used only to:
renew this 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
this Task Order,other than those authorized by the Task Order Letter process described above,shall be
made by a formal amendment to this Task Order executed in accordance with the Fiscal Rules of the State
of Colorado.
H. ATTACHMENTS. All attachments are incorporated herein by this reference and made a part hereto as if
fully set forth herein. In the event of any conflict or inconsistency between the terms of this Task Order
and those of any attachment hereto,the terms and conditions of this Task Order shall control.
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 OF STATE OF COLORADO
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 vironment
By �v By:
Barbara J. K rkmeye or the Exe tive irector
Chair (11/01/2000) Colorado partmentof
FEIN: 84-6000813 Public Health and Environment
If Corp ,ption,.Iown1City/County,or Equivalent: PROGRAM APPROVAL:
iths f • ��,r E���, By:
oan�
Deputy Clerk to ®Bo
APPROVALS:
COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL
OFFICE OF THE AT ORNEY GENERAL OFFICE OF THE STATE CONTROLLER
Ken Salazar,Atto ey eneral Arthur L.Barnhart,/ State Controller
By. By. [dart (
'
WELD COUNTY DEPARTMENT OF
PUB ICS HEALTH AN ENVIR NM NT
BY:
Mark E. Wallace, MD, MPH-Director
Page 6 of 6
Attachment A
11. Provide a Scope of Work which details each measurable objective, provides a brief rational for the objective,
describes how the objective will be evaluated, and provides the projected costs under the appropriate Program Goal.
Program Goal: Increase capacity building for comprehensive tobacco control.
Measurable Objective 1: By December 15, 2000 increase number of Tobacco Free Weld County
Project staff by increasing the field coordinators position from .5 to 1.0 FTE, hiring 1.0 and .5
FTE Health Educators, and a .5 office technician.
Rationale for the Objective: The increase in staff is needed to implement a comprehensive tobacco
control program in Weld County.
Desired Outcome: Adequate staff to support a comprehensive tobacco control program in Weld County.
Evaluation of the Objective: Record of personnel hired.
Program Goal: Increase capacity building for comprehensive tobacco control.
Measurable Objective 2: By November 30, 2000 purchase 2 computers,2 Microsoft Office 2000
software, and office furniture for new staff.
Rationale for the Objective: The health department has office space but not enough computers/software
or office furniture to support additional staff. This will provide resources needed for project
implementation and communication with CDPHE, STEPP coordinators, coalition members, and
community partners.
Desired Outcome: Adequate work space and technical support equipment for the TFWC staff and
coordinator.
Evaluation of the Objective: Receipts of purchase.
Program Goal: Increase capacity building for comprehensive tobacco control.
Measurable Objective 3: By January 31,2001 identify and meet with stakeholders to present and
discuss the Tobacco Settlement funding and the comprehensive tobacco plan for Weld County,
and recruit 5 additional partners from these stakeholder meetings to participate in the TFWC
coalition.
Rationale for the Objective: By identifying additional Weld County stakeholders and combining our
efforts with theirs, Tobacco Free Weld County Project will increase our impact on Weld county
residents.
Desired Outcome: To build a stronger, more comprehensive program by partnering with all agencies and
organizations committed to decreasing tobacco use in Weld County.
Evaluation of the Objective: A list of stakeholders in the community; documentation of attendance at
meetings; addition of 5 new names to the coalition list.
Program Goal: Increase capacity building for comprehensive tobacco control.
7
Measurable Objective 4: Provide training on what a comprehensive control tobacco programs for
the Tobacco Free Weld County staff, coalition, stakeholders, health department staff, Weld
County schools and parents, and community leaders and members by April 30,2001.
Rationale for the Objective: Provide training for the staff and Coalition on a comprehensive tobacco
program. Once trained,they can educate health department administration and staff, health
professionals, teachers, parents, local businesses, and law enforcement, local leaders, etc.
Desired Outcome: Increased awareness of what a comprehensive program encompasses and how all
community partners can participate.
Evaluation of the Objective: Training for staff and Coalition documented. Schedules of all
presentations on file with attendance documented.
Program Goal: Increase capacity building for comprehensive tobacco control.
Measurable Objective 5: Provide professional and technical assistance for strategic planning by
contracting with a consultant to assist the Tobacco Free Weld County Project staff, coalition and
stakeholders in reviewing and revising the 5 year comprehensive plan by March 31,2001.
Rationale for the Objective: Strategic planning is an ongoing process. We will improve the 5 year
comprehensive plan and goals by assisting staff, coalition, and stakeholders with the process of strategic
planning.
Desired Outcome: A collaboration of informed staff, coalition, and stakeholders that are motivated to
implement a comprehensive plan.
Evaluation of the Objective: Hire a consultant. Documentation of the planning process in Coalition
meeting minutes.
Program Goal: Increase capacity building for comprehensive tobacco control.
Measurable Objective 6: Provide Tobacco Free Weld County s' staff and coalition members skills
in collaborative leadership by contracting with a professional leadership consultant for training
by April 30,2001.
Rationale for the Objective: Strong community leadership skills are needed to implement a
comprehensive program.
Desired Outcome: Improve and enhance the leadership skills of each individual on the Tobacco Free
Weld County staff and Coalition.
Evaluation of the Objective: Hire a consultant and schedule a presentation time and place.
Documentation of attendance at the presentation.
Program Goal: Reduce Exposure to ETS
Measurable Objective 7: Determine attitudes and beliefs surrounding clean in-door air in Ault,
Johnstown, and Windsor through 1 survey in each community by May 31,2001.
8
Rationale for the Objective: Cigarette smoking, second-hand smoke, and lack of smoke-free restaurants
would effect Clean in-door air. By surveying these communities, we can determine the readiness of
each to work towards having cleaner indoor air.
Desired Outcome: Determine the needs of each community and focus our efforts for clean indoor air
education and assistance toward the most receptive community.
Evaluation of the Objective: Documentation of the results of a random mail survey in each of the three
locations.
Program Goal: Promote Cessation among Youth and Adults
Measurable Objective 8: By May 31, 2001, Increase by 10% the number of youth at Adelante
Alternative School who report they have contemplated quitting or attempted to quit after
participating in a smoking cessation program as evidenced by a pre and post test of youth at the
school.
Rationale for the Objective: In February 2000, from the Weld County jury pool, 21 of the 117 persons
surveyed also identified youth tobacco prevention programs as an equal concern.
Desired Outcome: Decrease the number of youths that smoke at the Adelante School.
Evaluation of the Objective: Show increase from baseline number by 10% of youth who report they
have contemplated quitting or attempted quitting smoking after participating in the smoking cessation
program.
Program Goal: Prevent Initiation of Tobacco Use among Youth.
Measurable Objective 9: Provide one presentation to school athletic directors and coaches in
Weld County at the monthly district meeting on strategies to enforce youth possession ordinances
and to discourage the use of spit tobacco by January 31, 2001.
Rationale for the Objective: In February 2000, from the Weld County jury pool, 69 of the 117 persons
surveyed identified at least one of the following as a top concern surrounding youth and smokeless
tobacco. Addressing youth tobacco prevention programs,youth tobacco possession, and smokeless
tobacco use among young men in grades 9-12 would be incorporated in a program directed at the high
school athletic departments.
Desired Outcome: Raise awareness of dangers associated with spit tobacco use in athletic directors and
coaches and encourage them to implement a no-acceptance policy on their teams.
Evaluation of the Objective: Documentation of presentation outline, overheads, and handouts.
Attendance records.
Program Goal: Increase capacity building for comprehensive tobacco control.
Measurable Objective 10: Create a written evaluation plan for the Tobacco Free Weld County
program by December 1,2000, by hiring an evaluation consultant to assist the staff/coalition with
the development.
Rationale for the Objective: To establish a baseline and create program accountability.
Desired Outcome: A complete tracking system for the comprehensive program.
9
Evaluation of the Objective: Documentation of the written plan submitted to STEPP coordinators in
Denver.
10
Attachment 2: Preferred Budget Format
LOCAL HEALTH DEPARTMENT: Weld County Health Department
TIME PERIOD:_11/15/00 thru 6/30/01
FISCAL OFFICER/CONTACT PERSON:_Judy Nero PHONE: _(970)304-6420 Ext.2122
CATEGORY AND ANNUAL TIME ON PROGRAM COST FOR PERIOD
LINE-ITEM SALARY PROJECT
No.of Hrs./Week
Months
A. PERSONNEL
Position Titles'
1.Field Coordinator(H.E.II) 17,229.95 8 20/week 12,747.76
2.Health Educator 1 29,088.34 8 40/week 19,392.23
3.Health Educator I 14,544.00 8 20/week 9696.00
4.O111ce Technician 6,297.16
9,445.74 8 20/week
Subtotal Personnel 48,133.15
FRINGE @ 25 3 �4�r f ,i {`��`�r�{F3 I {r '�{; {E{r''Ij(� �. I} { fth
1.Field Coordinator(H.E.II) 4,482.19
2.Health Educator I 4,848.06
3.Health Educator 1 2,424.03
4.Office Technician 1,889.15
Total Personnel 61,77638
C. TRAVEL @ .305 /Mile
In-State 1,000.00
Out-of-State 1,650.00
Total Travel 2,650.00
D STAFF DEVELOPMENT&inTR
{{{ate fi I13 4i
I.Leadership Training Materials 500.00
2.Comprehensive Tobacco Training& Presentation 3,000.00
Total Staff Development 3,500.00
E. CONSULTANTS/TRIOERSh
I.Evaluation Specialist 6,250.00
2.Leadership Trainer 3,500.00
3.Stratigic Planning facilitator 1.000.00
20hours @ 850.00/hour Total Consultants 10,750.00
PROGRAM COST FOR
PERIOD
;;i i n'�`' .,111'13'
:: g, (i i�i,. �tII I iI9}' tldi i i'.Ii� dt vIE!€i�t f A i!((i( !r l itifit'�,lo} f�j��jii !i tt i.�..',3 e,Ct; n'I d4x:,.I �' �� fie f,�t�,°1i 1, i�I II, iI tutty it 0 i;
{�i i .01(i ' 1, i I t (�E�! ° lE�! a � I loll
gg9it'i I EtittlttE I i (z d l d lit �+•
iI � .�i t t.�zii ti 17 � iiii �ifl!Iz , Iliad!. l{l.,,
1. Educational Materials 2,000.00
dlip02. Printing 2,000.00
3. Postage 500.00
4. Meeting Expenses 2,000.00
5. Office Supplies 500.00
6. Equipment 2 computers,2 microsoft office word,desk, 2 chairs 4,650.00
7. Phone in-kind
8.
9.
Total Operating Expense 11,650.00
di', 'k+�;�3�I �I'!!Ij 7; Er(fa'T+i: >> ';io „t 9 '6 �"�i: mir ei E,tiE,i.I(IEEI!i ,� i in y,g(fiE1,ino in I't₹i, ttli t{ .t :fr i t t i
( E ii,t i , I iiliI5 i r:?3IE ph ! I , ('ii'� 1(n ff'i= kill tl (!!i(:I Ill, l?Ilia ;EsE utE, i ti� i :! `_ ..
�F�: ."! �i ° I i � E I�E` II I,(,. ',it, Il�,1i, M, � lvi=3 I kill
th '�'jj'it I i;��gp71 in.�,,;I 14 i 1 i i
i E i�il� i-°�i!S!3Ii. wi�st ,. .. � 3 � ! I# i f I ii of th,.a ��l ids t�i �#f+. i �& iu��lobo!,!j�i�IEjiji{iI�hn3i h�ti.."g:06 00 III!itNt ii!R.t{ t.t.::..
Total Data Collection 5,000.00
1414043i i itlt�.( ii'?`i'If{6V, ,ttiF i! i(3i, v�It�;lllf3+((jj� P(+i : lit°'�,i 7 it (ii{.,+p:� tllii III Ii it 'o]�idnl,qop ! ii{ m 3t aE p It ai„
V.;wilai$ .E 0.1 +�; II I, i !i {t f ( I� I,6,I. 4 titttallV�4i3I9�fII�iif itl pE(94'I'IIL,E1 �3 {,,�il ,.:l I�,I! lt Ei i
E! I I-i?r fieti l {§p:(i,I!I, t< �y ,uE E ,(E Eii,Rt ,aa pp6ibyiltll, iiili�I(• 'Il3�j�"L p ji} lei l Ii�:I�Eilplil, 000P0ii 0 8 6 �, '!( I•li`! i! i± 444413= ,l i or+l L(3
ii( .o! DWI;31!'? 7�� I i I {tI,Ii I°i ilii' Iiq i,i; (t f "g i ! ,j(i! p u ilt' ,!i i!I ii! 1. I i!y EIi l y i( ¢ : 3lTl 3 4044441444444444
E :
...,,Fi4�::; ul l(H ';4,i�1, 0 :t31 aI f,I,,:,!d;EE�i�Plil$11 i111b.,, 3 :{ 1 ,1'#r ,,,Y.hli q�t.iJLF .,iii1f71.EbE.v 8i....vl�. iih.i?..:,N.f !i 4f4.iEi
1.(Please See Narrative) 9,580.32
2.
Total Indirect Costs 9,580.32
104,906.90
TOTAL PROGRAM COSTS
Budget Narrative:
Personnel:
Salary: Fringe:
Field Coordinator $12,748.00 20 hours/week $4,483.00 *
Health Educator $19,392.00 40 hours/week $4,848.00
Health Educator $9,696.00 20 hours/week $2,424.00
Office Technician $6,297.00 20 hours/week $1,889.00
Total $48,133.00 + $13,644.00 = $61,777.00
• The variation in the field coordinator's fringe is due to adjustments made for the difference between benefits received
by a.5 grade 31 FTE to the benefits received by a 1.0 grade 34 FTE.
Travel :
In-state travel includes: $1,000.00 travel @ .305/mile. 1280 miles for fulltime HE & 640 miles for part-time HE,
implementation of presentations, workshops and training sessions in town. 600 miles for staff trainings,
comprehensive programming, leadership, and cultural competency trainings. 730 miles for outreach with in
Weld County.
Out of state travel includes: $1,650.00 For accommodations and travel to and from educational tobacco workshops
for all staff.
Staff Development:
Leadership training materials: $500.00 Meeting supplies and training materials, marketing of the leadership
workshop to coalition members and stakeholders.
Comprehensive Tobacco Training and Presentations: $3,000.00 For Meeting supplies, office supplies, marketing of
the comprehensive tobacco training to coalition members, stakeholders, and the community and to hire a
training facilitator for the staff and coalition.
Consultants/Trainers:
Evaluation specialist: $6,250.00 Consultant fees for development and implementation of a comprehensive
evaluation.
Leadership trainer: $3,500.00 For implementation of a multi-day collaborative leadership training session by a
professional leadership consultant for the coalition.
Strategic Planning facilitator: $1,000.00 For a professional strategic planning consultant to provide 20 hours of
strategic planning training at $50 an hour.
Program Operating Expense:
Educational Materials: $2,000.00 For marketing materials, office supplies and incentives. For the presentations to
Athletic Directors and the cessation program at Adelante Alternative School.
Printing: $2,000.00 For design work and creation of marketing materials .
Postage: $500.00 For invitations to training sessions and stakeholder meetings, community presentations
Meeting Expenses: $2,000.00 For training sessions and meetings with stakeholders, staff, coalition, community
leaders.
Office Supplies: $500.00 For desk "set-ups" for new personnel and program supplies.
Equipment: $4,650.00: For office equipment and furniture for the new personnel Data collection.
Data Collection:
$5,000.00 TFWC will contract an evaluation specialist to facilitate focus groups, contribute their expertise in
13
question creation for various types of evaluations and for assessment of attitudes in Ault,Johnstown and
Windsor. Including purchase of mailing addresses, phone numbers, postage and materials for survey.
Indirect Cost:
$9,580.00 Accounting, budgeting,office space and related costs, data processing,management services,office machines and equipment
maintenance and repairs, office supplies,personnel services, freight,purchasing services,telephone.
14
Attachment B
CONTRACT REIMBURSEMENT STATEMENT
TO: EMS and Prevention Division FROM:
Tobacco Use Prevention&Reduction
Mail Code: PPD - STEPP - A5
4300 Cherry Creek Drive South
Denver CO 80222-1530
Attn: Karen DeLeeuw,Program Manager
Federal Tax ID #
TOBACCO EDUCATION, PREVENTION AND CESSATION GRANT
Time Period Covered by this Statement From: To:
Final Billing?_Yes _No
EXPENDITURES Reimbursement Requested Match Provided
Personnel(Name): $ $
Fringe Benefits @(%): $ $
Travel- local and in-state $ $
Travel- out-of-state $ $
Program Supplies and Operations $ $
Staff Development $ $
Other:
Consultants/Trainers $ $
Data Collection $ $
Media Purchase $ $
$ $
$ $
$ $
Total Direct Costs: $ $
Indirect Costs @(%): $ $
Total Reimbursement Requested $
This is to certify that the above expenses were incurred per Contract# during the time period
stated above.
CONTRACTOR SIGNATURE: DATE:
I hereby certify that all contract requirements have been met and the amounts billed are correct. Payment is authorized.
CDPHE Program Director
or Authorized Designee: Date:
STATE OF COLORADO
Bill Owens,Governor 0p::_.• .
Jane E.Norton,Executive Director rsc•-r
Dedicated to protecting and improving the health and environment of the people of Colorado u f r • n
4300 Cheny Creek Dr.S. laboratory and Radiation Services Division ♦ • .: +/
Denver,Colorado 80246-1530 8100 Lowry Blvd. •ttt76
Phone(303)692-2000 Denver CO 80230-6928
TDD Line(303)691-7700 (303)692-3090 Colorado Department
located in Glendale,Colorado of Public Health
and Environment
http://www.cdphe.state.co.us
[Date] Sample Task Order Change Order Letter Attachment C
State Fiscal Year 19**-**, Task Order Change Order Letter Number**,
Task Order Change Order Letter Contract Routing Number**-*****
This Task Order Change Order Letter is issued pursuant to paragraph** of the Task Order with contract routing number***-
***** and contract encumbrance number***********,(as amended by Task Order Change Order Letter'*,contract routing
number**-*****,and/or Task Order Renewal Letter**,contract routing number**!'****, if any),hereinafter referred to as
the"Original Task Order"(a copy of which is incorporated herein by this reference,made a part hereof,and attached hereto as
"Attachment A")between the State of Colorado,Department of Public Health and Environment and Contractor's Leeal
Name. The parties agree that the maximum amount payable by the State for the eligible services referenced in paragraph** of
the Original Task Order is increased/decreased by dollar amount DOLLARS,($*.**)for a new,total fmancial obligation of
the State of dollar amount DOLLARS,($*.**). The revised work plan,which is attached hereto as"Attachment 1",and the
revised budget,which is attached hereto as"Attachment 2",are incorporated herein by this reference and made a part hereof.
The first sentence in paragraph**of the Original Task Order is hereby modified accordingly. All other terms and conditions
of the Original Task Order are hereby reaffirmed. This amendment to the Original Task Order is intended to be effective as of
********* **.****. However,in no event shall this amendment he deemed valid until it shall have been approved by the
State Controller or such assistant as he may designate.
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,Denver,Colorado 80246,Mail Code: *****-**. One original of this Task Order Change Order Letter will be
returned to you when fully approved.
CONTRACTOR'S LEGAL.NAMF STATE OF COLORADO
(legal type of entity) Bill Owens,Governor
By: By:
Print Name: For the Executive Director
Title: DEPARTMENT OF PUBLIC HEALTH
FEIN: AND ENVIRONMENT
APPROVALS:
STATE CONTROLLER: PROGRAM:
By: By:
Arthur L. Barnhart
State ControlleR
STATE OF COLORADO
Bill Owens,Governor
Jane E.Nonon,Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado *
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division
�*
Denver,Colorado 80246-1530 8100 Lowry Blvd. *1876
Phone(303)692-2000 Denver CO 80230-6928
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
and Environment
help://www.cdphestate.co.us
[Date] Sample Task Order Renewal Letter Attachment D
State Fiscal Year 19** -**, Task Order Renewal Letter Number*,
Task Order Renewal Letter Contract Routing Number*******
This Task Order Renewal Letter is issued pursuant to paragraph**of the Task Order with contract routing number*******
and contract encumbrance number***********,(as amended by Task Order Change Order Letter**,contract routing
number**-*****,and/or Task Order Renewal Letter**,contract routing number**-*****,if any),hereinafter referred to as
the"Original Task Order"(a copy of which is attached hereto and by this reference incorporated herein and made a part
hereof)between the State of Colorado,Department of Public Health and Environment and Contractor's Legal Name. The
parties agree that for the renewal term from ********* **.**** through********* ** **** the maximum amount payable
by the State for the eligible services referenced in paragraph** of the Original Task Order is increased/decreased by dollar
amount DOLLARS,($*.**)for a new,total financial obligation of the State of dollar amount DOLLARS,($*.**). The
revised work plan,which is attached hereto as"Attachment 1",and the revised budget,which is attached hereto as
"Attachment 2",are incorporated herein by this reference and made a part hereof. The first sentence in paragraph** of the
Original Task Order is hereby modified accordingly. All other terms and conditions of the Original Task Order are hereby
reaffirmed. This amendment to the Original Task Order is intended to be effective as of********* **.****. However, in no
event shall this amendment he deemed valid until it shall have been approved by the State Controller or such assistant as he
may designate.
Please sign,date,and return all**originals of this Task Order Renewal Letter by********* **.****,to the attention of:
************ ************,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive
South,Denver,Colorado 80246,Mail Code: *****-**. One original of this Task Order Renewal Letter will be returned to
you when fully approved.
CONTRACTOR'S LEGAL NAME STATE OF COLORADO
(legal type of entity) Bill Owens,Governor
By: By:
Print Name: For the Executive Director
Title: DEPARTMENT OF PUBLIC HEALTH
FEIN: AND ENVIRONMENT
APPROVALS:
STATE CONTROLLER: PROGRAM:
By: By:
Arthur L. Barnhart
State Controller
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