HomeMy WebLinkAbout921056.tiff RESOLUTION
RE: APPROVE WELL CHILD PROGRAM CONTRACT BETWEEN HEALTH DEPARTMENT AND COLORADO
DEPARTMENT OF HEALTH AND AUTHORIZE CHAIRMAN 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 Well Child Program Contract
between the Weld County Health Department and Colorado Department of Health,
commencing October 1, 1992, and ending September 30, 1993, with the further terms
and conditions being as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said
contract, 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 Well Child Program Contract between the Weld County
Health Department and the Colorado Department of Health be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 2nd day of November, A.D. , 1992 nunc pro
tunc October 1, 1992.
PR pp r BOARD OF COUNTY COMMISSIONERS
ATTEST: r. . WELD CO TY, COLORADO
Weld County Clerk to the Board �tii^ • " c QQi_-6�
George Kerrfiedy, C airman
Deputy C&rk to the Board onstance L. Harbert, Pro-Tem
APPROVED AS 0 FORM:
C. W. Kir
County Attorney ��✓✓) Gor . L cy
W. H. Webster
921056
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FORM 6-AC-02A(R5/85)
DEPARTMENT OR AGENCY NUMBER
260000 -- FAA
CONTRACT ROUTING NUMBER
930716
CONTRACT
THIS CONTRACT, made this 1st day of October, 1992, by and between the State
of Colorado for the use and benefit of the Department of Health', 4300 Cherry
Creek Drive South, Denver, Colorado, 80222-1530, hereinafter referred to as the
State and 2Weld County Health Department. 1517 16th Avenue Court. Greeley.
Colorado 80631 hereinafter referred to as the Contractor.
WHEREAS, authority exists in the Law and Funds have been budgeted,
appropriated and otherwise made available and a sufficient unencumbered balance
thereof remains available for payment in Fund umber 100. APPR code 585, Contract
Encumbrance Number FAA WCH 930716 ; and
WHEREAS, required approval, clearance and coordination has been
accomplished from and with appropriate agencies: and
WHEREAS, the State has formulated a comprehensive State Plan to carry out
a Maternal and Child Health Program, funded by Federal Health and Human Services
funds; and
WHEREAS, said comprehensive State Plan and Federal budget allocates funds
to be utilized for the implementation of the program through various agencies in
order to provide these health care services to the people of Colorado; and
WHEREAS, the Contractor is considered by the State to be an appropriate
agency to provide these services as herein set forth.
NOW THEREFORE, it is hereby agreed that for and in consideration of their
mutual promises to each other, hereinafter stated, the parties hereto agree as
follows:
1. The Contractor will provide Well Child Care Services as follows:
a. Provide Well Child Clinic Services to a minimum of 800 unduplicated
clients 0-16 years of age.
b. Promote the health status of children 0-16 years of age, through
public health nursing assessment and interventions. Assessment and
interventions shall be consistent with recommendations for well
child care as delineated in the Colorado Department of Health Child
Health Clinic Services Guide, Screener Manual, Well Child Flow sheet
and age appropriate forms, which have been made available to the
contractor and shall include, as appropriate & indicated:
i. A complete health history and unclothed physical exam
ii. Age-appropriate screening
Page 1 of 8 Pages
3` "a 56
iii. Age-appropriate immunizations
iv. Age-appropriate anticipatory guidance and teaching to parents
v. Appropriate nursing management and/or referral to appropriate
resources of children exhibiting actual or potential problems
in physical and/or developmental status.
c. Provide evidence that 90% of all 2 year old children who have been
enrolled in Well Child Clinics for at least one year are current on
recommended immunizations, including Hemophilus B.
d. Provide evidence that the agency has participated in a CDH sponsored
initiative to assess families and children at risk for abuse and
neglect and to provide intervention as indicated to try and prevent
abuse and neglect.
e. Refer for diagnosis and treatment children who fail screening in
Well Child Clinics for development, hearing and vision.
f. Provide case finding, referral and reasonable follow-up for children
eligible for the Handicapped Childrens Program.
2. The Contractor will, whenever possible, use para-professional Screeners to
perform screening components of Well Child Services, specifically the Denver
Developmental Screening Test (Denver II) . Screeners will be trained and
evaluated as determined appropriate by the State Screening Program Manager.
Contractor will assign public health nurse(s) to provide day-to-day direction for
these screeners.
3. The Contractor will submit to the State screening data utilizing the
ADD'S:5 data system or other system as may be implemented or approved by the
State.
4. By September 30, 1993, a qualitative audit will be done on 10% of currently
enrolled and active Well Child records, using the State Child Health Impact Tool
or similar audit format approved by the Well Child Program Director. A copy of
the aggregate audit results shall be submitted to the Well Child Program Director
and shall demonstrate that 60% of the problems identified in the Well Child
Clinic demonstrate resolution and/or improvement.
5. The Contractor will provide to the State in writing the total dollar amount
that was reimbursed to them for EPSDT/Medicaid screenings provided in Well Child
Clinics by December 31, 1993.
6. The Contractor will submit to the State, at the request of the Well Child
Program Director, progress reports and data indicating numbers of children served
and other relative information.
7. Title V funds may not be used to pay for any item or service (other than
an emergency item or service) furnished by an individual or entity convicted of
a criminal offense under the Medicare or any State health care program (i.e. ,
Medicaid, Maternal and Child Health, or Social Services Block Grant programs) .
8. The Contractor shall: (1) inform potentially eligible recipients that the
"Colorado Baby Care Program" ("CBC/KCP") exists and that potentially eligible
recipients should apply for coverage under that program through the local county
department of Social Services; (2) inform the potential recipient that CBC/KCP
may be a potential source of payment for their child's care; and (3) inform the
potential recipient that in order to receive continuing coverage under CBC/KCP
they be encouraged to complete an application fully as soon as possible (CBC/KCP
allows for up to 60 days of presumptive eligibility for pregnant women who are
Page 2 of 8 Pages
registered with Medicaid.) ; and (4) obtain from Medicaid and have present at
their facility current information regarding eligibility and services under
CBC/KCP. Potentially eligible recipients are pregnant women, up to two months
postpartum, and their babies up to one year of age, who are reasonably believed
to meet CBC/KCP family financial requirements.
9. The Contractor will submit to the State new federally required data on the
number of patients and the number of visits by: category of patient (mothers and
infants, children and adolescents, children with special health care needs) ; type
of service (prenatal care, postpartum care, preventive and primary care, family
planning, other, service to children with special health care needs) ; race
(white, black, American Indian, Pacific Islander, other); Hispanic origin (yes
or no); and source of payment (Medicaid EPSDT, Medicaid, other sources,
insurance, self-pay, no source) . The Progress Reports will be revised by the
State to include the data items listed above. Estimates must be provided until
such time as actual numbers can be submitted.
10. The Contractor will not charge for services those individuals of families
at or below the official poverty line as defined by the Office of Management and
Budget in accordance with Title V, Section 501 (B)(2) and Section 505 (2)(d) .
The 100% of poverty income guideline for farm or non-farm families is currently
at $9,190 for a family of 2; $11,570 for a family of 3; $13,950 for a family of
4; $16,330 for a family of 5; $18,710 for a family of 6; $21,090 for a family of
7; $23,470 for a family of 8. For families of more than eight, add $2,380 for
each additional member. These guidelines will change during the contract year.
When the new poverty income guidelines are received by the State from the Office
of Management and Budget, they will be forwarded to the Contractor and should be
used upon receipt.
11. If any charges are imposed for services to clients who are above the 100%
of poverty level, such charges must be on a sliding scale which takes into
account the client's family size, income and resources. These charges and the
sliding fee scale must be made available to the general public and to all clients
and must be based on the agency's usual and customary cost for the service.
12. The Contractor shall protect the confidentiality of all applicant/recipient
records and other materials that are maintained in accordance with this contract.
Except for purposes directly connected with the administration of this
Program/Project, no information about or obtained from any applicant/recipient
shall be disclosed in a form identifiable with the applicant/recipient without
the prior written consent of the applicant/recipient or a minor's parent or
guardian or as otherwise properly ordered by a court of competent jurisdiction.
The contractor shall have written policies governing access to duplication and
dissemination of all such information. The Contractor shall advise its
employees, agents, servants, and subcontractors, if any, that they are subject
to these confidentialities.
13. Contractor agrees to provide services to all program participants and
employees in a smoke-free environment. Smoking may not be permitted in waiting
areas, examination rooms, formal sessions providing education, therapy, or
similar services. Designated smoking areas may be established for staff, program
participants, family members, and visitors. These designated areas should be
well ventilated in order that the waiting area and the service environment
remains smoke free.
Page 3 of 8 Pages
•
14. The Contractor will submit to the State an accounting of actual
expenditures, for the project on standardized forms (Attachment A, which by this
reference is made a part hereof) or similar format. Such accounting of actual
expenditures for the contract period is to be sent to the Family and Community
Health Services Division, attention Administrative Section, within 90 days after
the termination date of this contract. Because this information will be used in
part to match Federal funds, the source of "Applicant and Other" funding must be
detailed in the space provided on the forma and noted as to whether these funds
are used to match other funding, and signed by a certified official. This
contract includes $18,522.00 which represents your share of the $413,053 Maternal
and Child Health funds appropriated by the legislature to local health
departments for the period July 1, 1992 to June 30, 1993. Receipt of these funds
requires local match that is subject to specific audit which in this case,
amounts to $13,891.00.
15. The State will, in consideration of said services by the Contractor, cause
to be paid to the Contractor an amount not to exceed THIRTY SIX THOUSAND THREE
HUNDRED THIRTY ONE DOLLARS AND NO CENTS (S36.331.00) , upon receipt of signed
monthly statements, submitted in duplicate, to the FAMILY AND COMMUNITY HEALTH
SERVICES DIVISION, ADMINISTRATIVE SECTION requesting reimbursement in the
following manner: $ 3,542 per month for the first 9 months and $ 1,484 per month
for the last 3 months of the contract.
16. Changes in total reimbursement amounts for the above named services in
consideration of increased or decreased levels of utilization in the original
contract shall be made by a mutually signed letter of approval which shall
include the following:
a. Identification of contract by Contract number and number of affected
paragraph; •
b. Type of services increased,or decreased;
c. Amount of increase or decrease in funding;
d. Amount of increase or decrease in utilization;
e. Effective date of the funding change:
f. Authorized signatures of the State, the Contractor and the State
Controller, or his designee. It is understood that no change except
funding amounts and resulting changes in utilization shall be made
through the letter of approval.
17. The term of this contract is beginning October 1, 1992 and ending September
30, 1993.
Page 4 of 8 Pages
92..m..03;
COLORADO DEPARTMENT OF HEALTH - hereinafter, under the General Provisions referred to as
"Health".
GENERAL PROVISIONS -- page 1 of 2 pages
1. The contractor shall perform its duties hereunder as an independent contractor and
not as an employee. Neither the contractor nor any agent or employee of the contractor
shall be or shall be deemed to be an agent or employee of the state. Contractor shall
pay when due all required employment taxes and income tax withholdin shall provide and
keep in force worker's compensation (and show proof of such insurance) and unemployment
compensation insurance in the amounts required by law. Contractor will be solely
responsible for its acts and the acts of its agents, employees, servants and
subcontractors during the performance of this contract.
2. Contractor authorizes Health, or its agents, to perform audits and to make
inspections for the purpose of evaluating performance under this contract.
3. Either party shall have the right to terminate this agreement by giving the other
party thirty days notice by registered mail, return receipt requested. If notice is so
given, this agreement shall terminate on the expiration of the thirty days, and the
liability of the parties hereunder for the further performance of the terms of this
agreement shall thereupon cease, but the parties shall not be relieved of the duty to
perform their obligations up to the date of termination.
4. This agreement is intended as the complete integration of all understandings
between the parties. No prior or contemporaneous addition, deletion, or other amendment
hereto shall have any force or effect whatsoever, unless embodied herein in writing. No
subsequent novation, renewal, addition, deletion, or other amendment hereto shall have
any force or effect unless embodied in a written contract executed and approved pursuant
to the State Fiscal Rules.
5. If this contract involves the expenditure of federal funds, this contract is
contingent upon continued availability of federal funds for payment pursuant to the
terms of this agreement. Contractor also agrees to fulfill the requirements of:
a) Office of Management and Budget Circulars A-87, A-21 or A-122, and A-102 or
A-110, whichever is applicable;
b) the Hatch Act (5 USC 1501-1508) and Public Law 95-454 Section 4728. These
statutes state that federal funds cannot be used for partisan political purposes of any
kind by any person or organization involved in the administration of federally-assisted
programs;
c) the Davis-Bacon Act (40 Stat. 1494, Mar. 3, 1921, Chap. 411, 40 USC
276A-276A-5) . This act requires that all laborers and and mechanics employed by
contractors or sub-contractors to work on construction projects financed by federal
assistance must be paid wages not less than those established for the locality of the
project by the Secretary of Labor;
d) 42 USC 6101 et seq, 42 USC 2000d, 29 USC 794. These acts require that no
person shall, on the grounds of race, color, national origin, age, or handicap, be
excluded from participation in or be subjected to discrimination in any program or
activity funded, in whole or in part, by federal funds; and
Page 5 of 8 Pages
Rev. 06/01/92
GENERAL PROVISIONS--Page 2 t 2 pages
) the ities 12111e- 12117, Americans131 - 12134, 12141b- 12150,Act 12161u- ic 12165,a 1218136 12189, 12201 11_ 12102,
3
and 47 USC 225 and 47 USC 611. 12213
f) if the contractor is acquiring real property and displacing households or
businesses in the performance of this contract, the contractor is in compliance with the
Uniform Relocation Assistapce and Real Property Acquisition Policies Act, as amended
(Public Law 91-646, as amended and Public Law 100-17, 101 Stat. 246 - 256) ;
g) when applicable, the contractor is in compliance with the provisions of the
"Uniform Administrative Requirements for Grants and Cooperative Agreements to State and
Local Governments (Common Rule) .
6. By signing and submitting this contract the contractor states that:
a) the contractor is in compliance with the requirements of the Drug-Free
Workplace Act (Public Law 100-690 Title V, Subtitle D, 41 USC 701 et seq.) ;
b) the contractor is not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by any federal
department or agency; and
7. To be considered for payment, billings for payment pursuant to this contract must
be received within 60 days after the period for which payment is being requested and
final billings on the contract must be received by Health within 60 days after the end
of the contract term.
8. If applicable, Local Match is to be submitted on the monthly payment statements, in
the column provided, as required by the funding source.
9. If Contractor receives $25,000.00 or more per year in federal funds in the
aggregate from Health, Contractor agrees to have an annual audit, by an independent
certified public accountant, which meets the requirements of Office of Management and
Budget Circular A-128 or A-133, whichever applies. If Contractor is required to submit
an annual indirect cost proposal to Health for review and approval, Contractor's auditor
will audit the proposal in accordance with the requirements of OMB Circular A-87, A-21
or A-122. Contractor agrees to furnish one copy of the audit reports to the Health
Department Accounting Office within 30 days of their issuance, but not later than nine
months after the end of Contractor's fiscal year. Contractor agrees to take appropriate
corrective action within six months of the report's issuance in instances of
noncompliance with federal laws and regulations. Contractor agrees to permit Health or
its agents to have access to its records and financial statements as necessary, and
further agrees to retain such records and financial statements for a period of three
years after the date of issuance of the audit report. This contract contain federal funds as of the date it is signed. This requirement is in addition to
any other audit requirements contained in other paragraphs within this contract.
10. Contractor agrees to not use federal funds to satisfy federal cost sharing . and
matching requirements unless approved in writing by the appropriate federal agency.
Page 6 of 8 Pages
Rev. 06/01/92
tA
Form 6-AC-028
SPECIAL PROVISIONS
CONTROLLER'S APPROVAL
I. This contract shall not be deemed valid until it shall have been approved by the Controller ofthe State of Colorado or such assistant as he may designate.This
provision is applicable to any contract involving the payment of money by the State.
FUND AVAILABILITY
2. Financial obligations of the State payable after the current fiscal year are contingent upon funds for that purpose being appropriated.budgeted and otherwise
made available.
BOND REQUIREMENT
3. If this contract involves the payment of more than fifty thousand dollars for the construction,erection,repair,maintenance,or improvement of any building,
road,bridge,viaduct,tunnel,excavation or other public works for this State,the contractor shall,before entering the performance of any such work included in this
contract,duly execute and deliver to and file with the official whose signature appears below for the State,a good and sufficient bond or other acceptable surety to be
approved by said official in a penal sum not less than one-half of the total amount payable by the terms of this contract Such pond shall be duly executed by a
qualified corporate surety,conditioned for the due and faithful performance of the contract,and in addition,shall provide that if the contractor or his subcontractors
fail to duly pay for any labor,materials,team hire,sustenance,provisions,prmendoror other supplies used orconsumed by such contractor or his subcontractor in
performance of the work contracted to be done,the surety will pay the same in an amount not exceeding the sum specified in the bond,together with interest at the
rate of eight per cent per annum.Unless such bond,when so required,is executed,delivered and filed,no claim in favor of the contractor arising under this contract
shall be audited,allowed or pad.A certified orcashier's check or a bank money order payable to the Treazurerof the State of Colorado may be accepted in lieu of a
bond.This provision is in compliance with 38-26-106 CRS,as amended.
INDEMNIFICATION
4. To the extent authorized by law,the contractor shall indemnify,save and hold harmless the State,its employees and agents,against any and all claims,
damages,liability and court awards including costs,expenses,and attorney fees incurred as a result of any act or omission by the contractor.or its employees,
agents,subcontractors,or assignees pursuant to the terms of this contract.
DISCRIMINATION AND AFFIRMATIVE ACTION
5. The contractor agrees to comply with the letter and spirit of the Colorado Antidiscrimination Act of 1957,as amended,and other applicable law respecting
discrimination and unfair employment practices(24.34.402.CRS 1982 Replacement Vol.),and as required by Executive Order,Equal Opportunity and Affums-
tive Action,dated April 16, 1975.Pursuant thereto, the following provisions shall be contained in all State contracts or rub-contracts.
During the performance of this contract,the contractor agrees as follows:
(I) The contractor will not discriminate against any employee or applicant for employment because of race,creed,color,national origin,sex,marital status,
religion,
treated,]a inancestry,employment,
or physical handicap.or age.The contractor will take affirmative action to insure that applicants are employed,and that employees are
g ployment,without regard to the above mentioned characteristics.Such action shall include,but not be limited to the following employment,
upgrading,demotion,or transfer.recruitment or recruitment advertising layoffs or terminations;rates of pay or other forms of compensation;and selection for
training,including apprenticeship.The contractor agrees to post inconspicuous places,available to employees and applicants for employment,notices to be pro-
vided by the contracting officer setting forth provisions of this non-discrimination clause.
(2) The contractor will,in all solicitations oradvenjsement.s for employee placed byoron behalfofthe contractor,state that all qualified applicants will receive
consideration for employment without regard to race,creed,color,national origin,sex,marital status,religion,ancestry,mental or physical handicap,or
e
(3) The contractor will send to each labor union or representative of workers with which he has collective bargaining agreement or other contract or understand-
ing,notice to be provided by the contracting officer,advising the labor union or workers'representative of the contractor's commitment under the Executive
Order,Equal Opportunity and Affirmative Action,dated April 16, 1975,and of the rules,regulations,and relevant Orders of the Governor.
(4) The contractor and labor unions will furnish all information and reports required by Executive Order,Equal Opportunity and Affirmative Aaron of April 16,
1975,and by the rules,regulations and Orders of the Governor,or pursuant thereto,and will pennit access to his books,records,and accounts by the contracting
agency and the office of the Governor or his designee for purposes of investigation to ascertain compliance with such rules,regulations and orders.
(5) A labor organization will not exclude any individual otherwise qualified from full membership rights in such labor organization,or expel any such individual
from membership
ipiin or hh ancestry.
laor organization or discriminate against any of its members in the full enjoyment of work opportunity,because of race,creed,color,
sex,(6) A labor organization,or the employees.or members thereof will not aid,abet,incite,compel or coerce the
dis-
criminatory or obstruct or prevent any doing s of d any u definedorin t this m t ither to be oynet is horn complying ci imin provisions of this contract or any order issued thereunder,or attempt either directly or
indirectly,to commit any act defined in this contract to be discriminatory. _.
395-53-01-1022
Revised 1/88
Page_Z of_AL pages -
nDc-10-2300•45
Form 6-AC-02C
(7) In the event of the contractor's noncompliance with the non-discrimination clauses of this contractor or with any of such rules,regulations,or orders,this
contract may be cancelled,terminated or suspended in whole or in part and the contractor may be declared ineligible for further State contracts in
with procedures,authorized in Executive Order,Equal Opportunity and Affirmative Action of April 16,1975 and the rules,regulations,ormders accordance
in accordance therewith,and such other sanctions as may be imposed and remedies ac promulgated
Affirmative Action of April 16, 1975,or by rules, be invoked therewit in or a otherwise
wis Order,Equal Opportunity and
regulations,or orders promulgated is accordance Uerewirh, as otherwise provided by law,
(8) The contractor will include the provisions of paragraph(I)through(8)in every subemtract and subcontractor purchase ceder unless exem regulations,or orders issued pursuant to Executive Order,Equal Opportunity and ARrmetfve Action of l 16,1975,so that such plb binding
upon each subcontractor a vendor.The contractor will take such action with respect to any provisions will a cy may
direct,as a means of enfosuch sue.howverg that lihe event en t econtactor becnmgerutymed
provisions,including or vendor io for sukofsuch direction
howae, a en ,the the f breq est involved State
in,or is threatened o with,into uch litigation with the subcontractorgon the tarStakdsCh o adoion by the contracting agency,the contractor may request the
of Colorado to enter such litigation to protect the interest of the State of Colorado.
COLORADO LABOR PREFERENCE
6a. Provisions of 8-17-101&102,CRS for preference of Colorado labor are applicable to this contract if public works within the State are undertaken hereun-
der and are financed in whole or in part by State funds.
b. When construction contract for a public project is to be awarded to a bidder,a resident bidder shall be allowed a preference against a non-resident bidder
from a hate or foreign country equal to the preference given or required by the state or foreign country in which the non-resident bidder is a resident If it is deter-
mined by the officer responsible for awarding the bid that compliance with this subsection D6 may cause denial of federal funds which would otherwise be avail-
able or would otherwise be inconsistent with requirements offederal law,this subsection shall be suspended,but only to the extent necessary to prevent denial of
the moneys or to eliminate the inconsistency with federal requirements(section 8-19-101 and 102,CRS).
GENERAL
7. The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the interpretation,execution and enforcement ofthis
contrast y provision of this contract whether or not incorporated herein by reference which provides(or arbitration by any extra-judicial body or person or
which is otherwise in conflict with said laws,rules and regulation shall be considered null and void Nothing contained in any provision incorporated herein by
reference which purports to negate this or any other special provision in whole or in part shall be valid or enforceable or available in any action at law whether by way of complaint,defense orotherwise-Any provision rendemd null and void by the operation of this provision will not invalidate the remainder of this contract to
the extent that the contract is capable of execution.
& At all times during the performance ofthis Coteau,the Contractor shall strictly adhere to all applir.hl.federal and state laws,rules and regulations that
have been or may hereafter be established.
9. The signatories hereto aver that they we(amain with 18.8.301,et seq.,(Bribery and Corrupt Influences)and 18.8.401,et sag.,(Abuse of Public Office),
CRS 1978 Replacement VoL,and that no violation of such provisions is present,
10. The signatories aver that to their knowledge, no state employee has a personal a beneficial interest whatsoever in the service or property
described herein
IN WITNESS WHEREOF,the parties hereto have executed this Contract on the day fun above written.
Contractor.
(Full Legal Name) WELD COUNTY HEALTH STATE of COLORADO
DEPARTMENT ROY ROMER, GOVERNOR
By for the
•s EXECUTIVE DIRECTOR
Position(Tae)
Social Saevhy Meeker a row tD.Mamba DEPARTMENT
(If Corporation) OF HEALTH
Attest(Seal) WELD COHEALTH DEPARTMENT
t'
Br BY: vL—
Cwo=•+•a Secretary.or&pinked,Tot.rt:a/Ccar y cut Randolph g Gordon, M.D. , M.P.H.
APPROVALS ctor .
ATTORNEY GENERAL CONTROLLER
By By
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO PROGRAM APPROVAL:
•
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»sasaaww(era.ued m ennedy, Chart Page 8 tier is tut d u.t 8 rages
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DC-to-:let.ar
ATTEST: ! .T_ ;r
WELD COUNTY CLERK TO THE BOARD
BY: aG(�
Deputy Clerk to the Board
ATTACHMENT A
APPLICANT:
PROJECT:
FOR THE PERIOD:
Annual Number Total Source of Funds
Salary Months Amount v*Applicant '.Requested
Rate Budget ! Required and''Ottter from DH
PERSONAL SERVICES:
Contractual/Fee for Service:
Supervising Personnel:
Fringe Benefits: Rate=
Sub total Personal Services
OPERATING EXPENSES:
includesBuilding/Facility
Cost not part of Indirect
Sub total Operating
TRAVEL:
Sub total Travel
EQUIPMENT:
Sub Total Eqiupment
Administrative/Indirect Cost
TOTAL PROJECT COST * .
.........:
'Source of Funding for'Applicant and Other'
Local:** S
Medicaid: $
Patient Fees: S
Other: $
Total Applicant and Other $
**Are these local funds used b match any other grant? Yes No
Signature of Director or Authorized Representative .4
mEmoRAnDum
V I`P C. Kennedy, Chairman
Board of County Commissioners Date October 26, 1992 �Y
To
COLORADO Jeannie K. Tacker, Business Manager, Weld County Health Dept
From
Subject: Well Child Program Contract
Enclosed for Board approval is a contract between the Weld County Health
Department and the Colorado Department of Health for the Child Health Program.
The Health Department will provide well child clinic services to a minimum of 800
unduplicated clients 0-16 years of age. The services will include health history
screenings, physical exams, immunizations and referrals to appropriate agencies,
if necessary.
The Health Department will receive a total reimbursement of $36,331, $18,522 of
which represents the department's share of the Maternal and Child Health funds
appropriated by the legislature to local health departments. The base contract
amount ($17,809) is an increase of $1,166 over the prior year's contract.
The term of the contract shall be from October 1, 1992 through September 30,
1993.
If you have any questions, please feel free to contact me.
921056
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