HomeMy WebLinkAbout20001761.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR CANCER PREVENTION OUTREACH 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 Cancer Prevention
Outreach 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 August 15, 2000, and ending August 14, 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 Cancer Prevention Outreach 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 26th day of July, A.D., 2000.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
n �c
ATTEST: it/�, �wv.'s j1 /�, EXCUSED DA E OF SIGNING (AYE)
<� arbara J. meyer, Chair
Weld ;ntY Clerk to the er r n �" 9
s1
•• F lIV - , Geile, ro-T em
BY: n_
Deputy Clerk to the Bo f rtirc ,::7' --, 7 -7
7-1-77-71George Baxter
APPROVEI AS TO FORM; EXCUSED DATE OF SIGNING (AYE)
Dale Hall
tGoriyfyttor� --
Glenn Vaad G'
2000-1761
ie NZ HL0027
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COI„ R MEMORANDUM
TO: Barbara I. Kirkut iet f h :. Boar:, of County Commissioners
FROM FROMe Mark E. Walks MD ` P€ . Department of Public Health and
Environment :.
SUBJECT: Cancer Prevent,'> t i.ii t cn Task Order
D s TEt July 24, 2000
Enclosed r_a ' ...and approval is, a t>sti Oder lvtwera ..ne Colorado Department of
Public Health or< .•s <:.t and Weld County 3-: n.: outreach program of the Colorado
Women's Cancer:t < :g Ittittative.
Under the prof tw. ..-::f ;.k '<'sk order, Weld Gnettxtr Etn trim .:t of Public Health and
Environment .W CPF I . wilt s•.:>pur. t <...,;::c tya-and tttutteach activities to recru r worn(n
for breast and_.tr>s< ,:c.t.:,nit.ati screenttat.t ser i <. ,•iz are age 40 ',ears and <'3er, vihose
household incomn ts insit t".;,.: or equal to t > .>3 is ...:.>≥federal poverty guideline,. who co
not have health :ntu: ti : :1.:Vi would cover s.�s< ,.c and us men who have rot had a
mammogram Or Pap W!:3 >3 the past twelve: Moiatitt . Tint tt.CSe se r"icees WCDPHE wi H i kt..
reimbursed a, =03:1X l':::-:.: V.>,cxceed :323,19e-ter :.>' s M period h vg xst 15, 2000 through
August 1.4,200!
I recommend ymt7 apip3--oi:',>. is this task order
Enc.
Department or Agency Name
COLORADO DEPARTMENT NT erPuil_ r
HEALTH AND ENVIRONMENT
Department or Agency Number
FLA
Contract Routing Number
01-00030
TASK ORDER
This TASK ORDER is made this 2th day of ante,WOO,by and between:the State of Colorado, for the use and
benefit of the COLORADO JHEPARTMENIDEMILIC HEALTH AN))ENVIRONMENT,whose,address
or principal place of bus necs ibusiters.is 4mt?.t r:ry Creek rive SSatbakenver,Colorado..?f;246,hereinafter referred
to as"the State", :nd,the O 1 1Y QF COUNTY COMI!LSS1ONFBs_(}1 D COUNTY,(ate;:tka!
sttl?dintion of th- s"atese C n St..),whose address or principal place of business is 93.$ t0`°i Weer.3'Floo
GreeiCis_Coloridtsli431, for the useend benefit of the Weld Cotatillent of Palle Health and
Eatvire.nment,whose address or principal place of business is 1555 North 17th Avenue,.CEr elev>_C ando
80631;hereinafter referred to as"the Contractor".
FACTUAL RECITALS
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 personne roles and the
State procurement code;
Funding for such services is to be allocated through task orders with local health agencies.
The State has received funding through a grant from the Centers for Disease Control and Prevention (CDC) to
implement a comprehensive breast and cervical cancer control project, titled the Colorado Women's Cancer
Control Initiative (CWCCI).
The CDC requires the State to facilitate the design, implementation and evaluation of outreach activities directed
toward women who are eligible for screening and diagnostic services through the project.
Special efforts are to be made to increase screening and diagnosis among women who are racial, ethnic and
cultural minorities such as American Indians, African Americans, Hispanics, Asian/Pacific Islanders: lesbian!_
women with disabilities; and women who live in hard to reach communities in urban and rura. areas.
As of the made date of this Contract, the State has a currently valid Group It purchasing delegation agreement
with the Division of Purchasing within the Colorado Department of Personnel.
Page 1 of 6
? J_, -/%t- (
This is a sole source procurement made in accordance with the applicable provisions of section 24-103-205, 7
C.R.S., as amended,and Colorado Procurement Rule R-24-103-205-01];.].
All required approvals,clearances, and coordination have been accomplished from and with all appropriate
agencies.
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 1tT's.,Organizational Unit Code 734Q,Appropriation.Code 773, Program Code 9O1,
and Object Code 1920,under Contract Encumbrance Number FLA PPG010030, Master Contract Routing
Number 00-0000@,
Ail 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 PERI.QD,OF PERFORMANCE AND CONTRACT TERMINATION. The effective date of this
Task Order is 4ligj.st 1,5,209Q,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 August 15.2000,and continue
through and including August 14,2001,unless sooner terminated by the parties pursuant to the terms and
conditions of the Master Contract.
B. SCOPE OF WORK. The Contractor, in accordance with the terms and conditions of the Master
Contract and this Task Order, agrees to:
1. 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. Within 15 days following the month during which services were rendered,submit monthly
reports describing the progress accomplished. Copies of documentation of progress towards the
goals set forth in the Statement of Work shall be maintained by the Contractor and made
available to the state upon request.
C, DUTIES AND OBLIGATIONS OF THE STATE
1. The State shall produce a limited number of CWCCI promotional materials,training and
technical assistance for the Contractor's personnel in conducting public education and outreach
activities. The State shall distribute statewide media releases to complement local med;iia
activities in Contractor's region. The Contractor is encouraged to develop and utilize specific
materials and strategies that are targeted for women in their community.
2. The State shall schedule and originate two(2)conference calls for the Contractor staff The
State shall also schedule, convene and reimburse the Contractor for its reasonable travel
expenses for two(2)training meetings. One meeting will be held in Denver,Colorado and the
second one will be a regional meeting to include local service providers.
Page 2 of 6
3. The State shall provide a list of women referred by the Contractor who have not received
recommended screen%:;g exams so that Contractor can conduct follow up activities with those
women in their community.This list will be provided on a quarterly basis.
4. The State shall pay Contractor an amount not to exceed$5.00 per woman that receives one or
more initial screening exams at a CWCCI service provider through a Coordinator screening
referral documented on the CWCCI Screening Referral List.
5. 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:
Melanie Simons-Dahlstrom,Public Education Coordinator
Colorado Women's Cancer Control Initiative
Mail Code:EMSPD-CC-A5
4300 Cherry Creek Drive South
Denver,CO 80246
Phone: 303-692-2534
Fax: 303-782-0095
D. COMPENSATION. The State shall cause to be paid to the Contractor an amount not to exceed
TWENTY-THREE THOUSAND,ONE H[1NDRED AND NINETY-EIGHT DOLLARS
I$23,12&02)under this Task Order. Of this total amount,$23 $.0¢,are derived from a funding sour e
of the Federal government and,£0.00 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 h\
the contractor as well as the subsequent reimbursement by the State.
The contractor shall submit a"Task Order 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 supplerne d 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. FAYMENT_MEECHANISM, 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 Charlie
Order letter shall include the following information.
Page 3 of 6
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.
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 Contracto ,
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 nol be
relieved of their respective duties and obligations under this Task Order until the effective date of
termination has occurred.
(i• RENEWAL LIETTEn. 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. Additionslly,the
Task Order Renewal Letter shall include the following information:
A. Identification of this 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_evel 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.
Page 4of6
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.
fl; MWITYONAL ROYISIQNS
1. The Contractor agrees to provide services to all Program participants and employees in a smoke-free
environment in accordance with Public Law 103-227, also known as "the Pro-Children Act of
1994", (Act). Public Law 103-227 requires that smoking not be permitted in any portion of any
indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the
provision of health,day care,early childhood development services,education or library services
to children under the age of 18, if the services are funded by Federal programs either directly or
through State or local governments,by Federal grant,contract,loan or loan guarantee.The law also
applies to children's services that are provided in indoor facilities that are constructed,operated,or
maintained with such Federal fund. The law does not apply to children's services provided in
private residences;portions of facilities used for inpatient drug or alcohol treatment;service
providers whose sole source of applicable Federal funds is Medicare or Medicaid; or facilities
where WIC coupons are redeemed. Failure to comply with the provision of each violasion and/or
the imposition of an administrative compliance order on the responsible entity. By signing tins
contract, the Contractor certifies that the Contractor will comply with the requirements of the Ant
and will not allow smoking within any portion of any indoor facility used for the provision pt.
services for children as defined by the Act. The contractor agrees that it will require that the
language of the Act be included in any subcontracts which contain provisions for children's services
and that all contractors shall sign and agree accordingly.
2. Contractor certifies,to the best of its knowledge and belief,that no federally appropriated funds have
been paid or will be paid by or on behalf of the Contractor, to any person for influencing ur
attempting to influence an officer or employee of any agency,a Member of Congress,an officer or
employee of Congress,or an employee of a Member of Ccs gress in connection with the awarding
of this Task Order, and the extension,continuation,renewal,amendment, or modification of this
Task Order,or any grant,loan,or other cooperative agreement that utilizes Federal Funds. If any
funds other than federally appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency,Member of Congress,
or employee of Congress in connection with this Task Order Contract,or any other grant, loan.or
other cooperative agreement,then the Contractor shall complete and submit Standard Form— L LI„
"Disclosure Form to Report Lobbying" in accordance with its instructions. The Contractor shall
require that the language of this certification be included in the award documents for subawards at
all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly. This certification is
a material representation of fact upon which reliance was placed when this transaction imposed by
section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than$10,000 and not more than$100,000 for each soot failure.
Page 5 of 6
L &T 'AOHI FNTS. All attachments are incorporated herein by this reference and made a part hereto as
if fully set forth herein. In the event of any conflict or inconsistency between the terms of this Task
Order and those of any attachment hereto,the terms and conditions of this Task Order shall control.
IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written.
CONTRACTOR: STATE:
BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO
OF WELD COUNTY Bill Owens,Governor
(A Political Subdivision of the State of Colorado)
for the use and benefit of the Weld County
Department of Public Health and Environment
'7 j
By:A r d ^..4,, c By: tltQ --, __
/ For the Executive r:etor
Barbara J. Kirkmeyer Colorado Department of
Chair (07/26/200'0) Public Health and Environment
FEIN: 846000813
If Corporation,Town/City/County,or Equivalent: Program Approval:
_
L Idi
ATTEST(Affix S i`'.i ! - i� : i --,'/�
By C ).,;
,....._ _\
t�<
'9 !`?‘
Deputy Clerk to the ,$ 11N
APPROVALS:
COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL
OFFICE OF THE ATTORNEY GENERAL OFFICE OF THE STATE CONTROLLER
Ken Salazar,Attorney General Arthur L.Barnhart,State Controller
By: �61/' '��� — BY:
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMENT
BY: ".1
� ,�(( r2. /Y ) Qn3c.pR Page 6of6
J
Mark E. Wallace, MD, MPH•Director
Contract Routing Number 01-00030 Attachment A
Task Order
Scope of 03'ork
The Contractor agrees to provide the following Community Coordinator services:
1) Conduct public education and outreach activities to recruit women for breast and
cervical cancer screening services who meet all of the following criteria:
a) Women who are age 40 years and older;
b) Women whose household income is less than or equal to 250% of the
current federal guidelines established by the United States Department of
Health and Human Services. Current percent of poverty and federal
poverty guidelines have been provided to the Contractor and when the
guidelines and/or percents are updated in future years that information will
be provided to the Contractor by the State. The state will inform the
contractor the effective date of the new guidelines;
c) Women who do not have health insurance that would cover these services
(women with Medicare-Part B coverage are not eligible for these
services); and
d) Women who have not had a mammogram or Pap test in the past twelve
(12) months
Special efforts will be made to reach priority populations who are racial, ethnic,
and cultural minorities, i.e., American Indians, African Americans, Asian/Pacific
Islanders and Hispanics; lesbians; women with disabilities; and women who live
in hard to reach urban and rural areas. These activities shall include,but are not
limited to: conducting community-based media campaigns, coordinating
promotional events and conducting educational presentations (on a need basis).
2) Provide one-to-one(individual) recruitment and counseling of women eligible for
screening services for a minimum of fifty (50%) of the Contractor's time. These
activities shall include, but are not limited to: answering questions about services
and eligibility, arranging transportation and making appointments for screening
exams, providing support at community screening sites and following up with
women who do not go in for recommended exams.
3) Meet with Case Managers and other appropriate staff at agencies providing
CWCCI breast and cervical cancer screening services on a quarterly basis to
collaborate on recruitment of women eligible for services into those agencies.
4) Recruit volunteer members, regularly convene and maintain one community
coalition OR regularly participate in local breast cancer advocacy groups to solicit
assistance with the planning and implementation of CWCCI outreach and
screening activities.
5) Within fifteen (15) days following the end of the month during which services
were rendered:
a) Complete and submit to the State the CWCCI Community Coordinator
Contact Logs. These monthly logs shall describe all outreach activities
and meetings, including the dates, the types of activities, the location, the
number of women reached, the hours spent on one-to-one contact and the
total hours. Copies of print and, when feasible, electronic media shall also
be submitted to the state.
b) Submit to the State a summary of the minutes and attendance records of
community coalition meetings OR breast cancer advocacy group meetings.
The number of hours volunteered by members while attending meetings
and/or conducting outreach activities will be submitted on the CI,VCCI
Community Coordinator Contact Log.
c) Submit to the state the number of hotline calls received regarding program
services on the Summary of CWCCI Coordinator Hotline Calls form.
This information will be used to track and evaluate outreach efforts.
d) Submit to the state a list of names and date-of-birth of women who arc
referred for program services and the clinic they are referred to on the
CWCCI Screening Referral List form. This information will be used to
determine if women have followed-through with recommended screening
exams.
e) Provide documentation on in-kind or cash contributions received by the
Contractor while conducting public education, outreach and media
activities. Documentation shall be recorded on the Affidavit of In-Kind
Donation/Match form. In-kind may also include donated operating and/or
administrative expenses which shall be recorded on the monthly Contract
Reimbursement Statement. Matching funds information is required to
maintain the covenant of the federal grant from the Centers for Disease
Control and Prevention. The State shall require a summary of this
information at the end of the fiscal year (August 14, 2001).
6) Acknowledge the CWCCI on any material developed and distributed through
these activities.
7) Participate in two (2) conference calls and two (2) meetings and/or trainings with
Community Coordinators statewide. One of the meetings will be held in Denver,
Colorado and one will be a regional meeting including both the Coordinators and
Service Providers working in that region.
Contract Routing Number 0140030 Attachment A
Task Order
Budget
The State shall, in consideration of those services satisfactorily and timely performed by
Contractor under this Contract, cause to be paid to the Contractor a sum not to exceed₹went .
three thpu,s.gii , oat 1 :E?1lred at r!. nine y-eighttdpllars_ for this renewal term. Of the total
financial obligation of the State referenced above,$73,198.00 are identified as attributable to a
funding source of the United States government and WO are attributable to a finding source of
the state of Colorado.
The following budget shall govern the expenditure of funds by the Contractor as well as the
subsequent reimbursement by the State.
1. Personnel/Fringe $18.817.00
2. Operating Expenses $ 2,863.00
3. Administrative Costs $ 1,518.00
TOTAL $23,198.00
(PLEASE SUBMIT IN DUPLICATE) CONTRACT REIMBURSEMENT STATEMENT ATTACHMENT B
TO: Colorado Dept. of Public Health and Environment
Emergency Medical Services and Prevention Division
Colorado Women's Cancer Control Initiative FEDERAL TAX ID #:
Mail Code: EMSPD-CCP-A5
4300 Cherry Creek Drive South TYPE OR NAME OF PROGRAM: Breast/Cervical Cancer Outreach
Denver, CO 80222-1530
FROM: EXPENDITURES: FROM TO
Brief Description of Expenditures Total Expenses Aggency's Sharei Expenditures
In-Iund/Othec Charged to CDP;JLE
':1OTALS: $ g
This is to certify that the above expenses were incurred per Contract d PPGQQQQ258___during the time period designated above.
SIGNA T[TRE CONTRACTOR: DATE:
I hereby certify that all contract requirements have been met and the amounts billed are correct. Payment is authorized.
uirka, irrogram Director ui nut:.0 nited tk r ;ucc. ___
[Date] Sample Task Order Change Order Letter Attachment
State Fiscal Year 20**-** Task Order Change Order Letter Number*7
Task Order Change Order Letter Contract Routing Number**-*****
(Master Contract Contract Routing Number*******) (Task Order 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 Teak 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,Dep,2rementref i'thl€idealtheand 194 ;ra stment and
Contract0.r's Legal 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£tall tiny mt_PQLL S, ($*.**)for a
new,total financial obli„&tion of the State of deapC3mo.0+t DQLL:A RS,( '*). The revised work plan,which it attached
hereto as"Attachment 1",and the rev:iced 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 i;intended to be effective as of********* **. ****. However,jn no event ehllljl,i tnendment be
deemed valid untiatushhall_hsvik rn ;P, Qed.hy the State-Csntcoller or such assi tant_as.J1e may desigwfl .
Please sign,date,and retun.all**originals of this Task Order Change Order Letter by********* **,****, to the attention
of: ************ ************ Colorzdn 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 b,
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
AND EVIRONMENT
FEIN:
APPROVALS:
STATE CONTROLLER: Program:
By: By:
Arthur L. Barnhart
State Controller
Page 7 of 6
.......................................... ...
[Date] Sample Task Order Renewal Letter Att2ebyrsczzt t
State Fiscal Year 20**-**, Task Order Renewal Letter Number**
Task Order Renewal Letter Contract Routing Number**-*****
(Master Contract Contract Routing Number **-*****) (Task Order 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***,contrast routine
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 rase a.part
hereof)between the State of Colorado,Pe Rr•2't££ss(of Public Healihun ',nvirongn_ent and Contractor's Leg&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/'errated by
Mar nmauRt 1kLtBS,(S*.**)for a new,total financial obligation of the State of�o lar nt0irPlDOL[..ARS,(8".**).
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,.ju
no event sha) lhinmerdtis be deurriusbaticl until it shahrave been approved by the State ContrOllersxiuch.acsiat pl2s
kinnY_dsesignate.
Please sign,date,and return all** originals of this Task Order Renewal Letter by********* **.****, to the attention of:
************ **********e* 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
AND ENVIRONMENT
FEIN:
APPROVALS:
STATE CONTROLLER: PROGRAM:
By: IF : -
Arthur L. Barnhart
State Controller
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