HomeMy WebLinkAbout950692.tiffRESOLUTION
RE: APPROVE CONTRACT FOR CANCER PREVENTION WITH COLORADO DEPARTMENT
OF PUBLIC HEALTH AND ENVIRONMENT 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 Contract for Cancer Prevention 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 Health Department, and the Colorado Department of
Public Health and Environment, commencing March 1, 1995, and ending July 31, 1995, with 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 Contract for Cancer Prevention 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 Health Department, and the Colorado Department of Public Health and Environment,
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 5th day of April, A.D., 1995, nunc pro tunc March 1, 1995.
BOARD OF COUNTY COMMISSIONERS
ATTEST:
Weld County Clerk to the Board
BY. Pe, 1 Y)1 i o
Deputy Cle to the Board
APPRO ■ AS TO FORM:
unty • torney
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WELD COUNTY, COLORADO
ale K. Ball, Gnalrman 7
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Georga Baxter
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Constance L. Harbert
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W. H. Webster
950692
HL0021
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COLORADO
mEmoRanuum
To Clerk to the Board
From
Subject:
Date
Judy Nero, Health Department 7"-
._ )
April 29, 1996 CIE
State Certification of Cancer Prevention Contract #PPG9507R7
This memo is addressing your request for a State certified original of the Cancer Prevention
Program Contract #PPG950782 that was signed by the Weld County Board of Commissioners
(BOCC) on April 5, 1995.
After this contract was signed by the BOCC, it was sent to the Colorado Department of Public
Health and Environment for State certification. Before the contract was certified and returned to
Weld County Health Department, the State Cancer Control Program decided to abandon this
contract. It was then reissued using the same contract number with changes to some of the
provisions. The term of the contract was also changed from March 1, 1995 through
July 31, 1995 to February 1, 1995 through July 31, 1996. Please reference the Cancer Prevention
Program Contract signed by the BOCC on May 17, 1995. It is my understanding there is a State
certified original of this contract on file.
Please contact me if you need further clarification as to why there is no State certified original of
the Cancer Prevention Program that was signed by the BOCC on April 5, 1995.
mEmoRAnDum
COLORADO
Dale Hall, Chairman
To Board of County Commissioners
From
Subject:
Date
April 3, 1995
John Pickle, Director, Health Departmen
Cancer Prevention Contract
Enclosed for Board approval is a contract between the Colorado Department of Public Health
and Environment and Weld County Health Department for breast and cervical cancer screening
and diagnostic services for women aged 20 to 39 who receive family planning services from
WCHD. In exchange for these services, WCHD will receive up to $6, 122 for the time period of
March 1, 1995 through July 31, 1995.
WCHD routinely providesthesecancer screening and diagnostic services to family planning
clients under the age of 40. This contract provides a small amount of finding to offset costs
incurred.
I recommend your approval of this contract.
Enclosure
950692
Form 6 -AC -02A (R 5/91)
CONTRACT
Department or Agency Name
Health
Deparuent or Agency Number
260000 — PAA
Contract Routing Number
PPG950782
THIS CONTRACT, made this 1st day of March 1995, by and between the State of Colorado for the use and benefit of
the Department of PUBLIC HEALTH AND ENVIRONMENT , 4300 Cherry Creek Drive South, Denver, Colorado 80222-1530
hereinafter referred to as the State and Weld County Health Department, 1517 16th Avenue Ct.. 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 uncommitted balance thereof remains available for encumbering and subsequent payment of this contract under Encumbrance
Number FLA PPG950782 , in Fund Number 100, Appropriation Account 773, and Organization 7340.
WHEREAS, required approval, clearance and coordination has been accomplished from and with appropriate agencies: and
WHEREAS, the State has entered into a Cooperative Agreement with the Centers for
Disease Control to provide breast and cervical cancer screening and diagnostic services; and
WHEREAS, the intent of the Cooperative Agreement is to increase screening and
diagnosis among all groups of women in the state, with special efforts to reach those women who
are of low income, uninsured, underinsured, minority, Native American and/or served by Health
Resources and Services Administration primary care centers and/or Title X Family Planning fund
recipients; and
WHEREAS, the Contractor is considered by the State to be an appropriate agency which
has the facilities, personnel and capability to provide the 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 cervical cancer screening and diagnostic services to women
aged 20 to 39 who receive family planning services provided by the Contractor.
2. Breast and cervical cancer screening and diagnostic services will include the following:
• Screening breast and pelvic exams, and Pap tests per the budget for new screens,
a copy of which is attached and by reference made part hereof as Exhibit A.
• Colposcopies with biopsy per the budget, which is attached and by reference made
part hereof as Exhibit B.
• Other diagnostic procedures as allowed by the program including diagnostic
mammograms, repeat breast exams, fine needle aspirations, surgical/medical
consultations, repeat pelvic exams and repeat Pap tests which must be allocated out
of the budget included in Exhibit A.
• Maintain a tracking and follow-up system which will assure patients with abnormal
screening results receive appropriate diagnostic follow-up and treatment services,
and rescreening on a timely basis.
Page I of 8 Pages
3. The Contractor agrees to utilize nationally accepted guidelines for women as the standard
for breast and cervical cancer screening as follows:
An annual Pap smear with a pelvic examination. After three or more consecutively
satisfactory normal annual examinations, the Pap smear may be performed less frequently
at the physicians discretion. (For purposes of this contract only a physical breast exam can
be done yearly in conjunction with the pelvic exam whereas the national guidelines allow
one every three years for women from ages 20-39 and yearly thereafter).
4. The Contractor agrees that only qualified personnel who are licensed or certified
professionals will conduct medical examinations, operate the equipment, conduct the tests and
interpret results.
Cytology laboratories must be in compliance with the federal Clinical Laboratory Improvement
Act of 1988 (CLIA-88).
If the Contractor continues to utilize a facility after receiving notification that the cytology
laboratory is found not to be in compliance with CLIA-88 regulations the Cancer Control
Program may deny reimbursement for services provided by the laboratory after the date of
notification. This paragraph does not preclude the State from any other remedy provided by
the law.
If a diagnostic or repeat mammogram must be performed on a woman covered by this contract,
the mammography center must be accredited by the American College of Radiology (ACR).
Mammography centers must be certified by the Food and Drug Administration (FDA) certified
in accordance with the Mammography Quality Standards Act of 1992, which took effect October
1, 1994. A mammography facility who is American College of Radiology (ACR) accredited is
automatically certified by the FDA.
5. The Contractor agrees to receive prior approval from the Cancer Control Program to enter
into agreements with, or to change providers of cytology laboratory services.
6. The Contractor agrees to seek reimbursement for services only for those women who meet
the following eligibility criteria:
• Be a women aged 20 to 39;
• Family income at or below 200% of the federal poverty level:
• Be a recipient of family planning services;
• Be a resident of Colorado as defined by the Colorado Resident Discount Program.
7. -The Contractor agrees to provide data to the Colorado Women's Cancer Control Initiative
including total number of women screened for breast and cervical cancer, clinical results of
abnormal exams, and tracking and follow-up data to be integrated with the cervical cancer
tracking and follow-up system (CCTFS) and the Colorado Mammography Advocacy Project
(CMAP) maintained by the Cancer Control Program.
8. The Contractor agrees to share information with the Colorado Cancer Control Program
for federal matching funds requirement purposes.
Page 2 of 8 Pages
9. The administrators of the Colorado Cancer Control Program shall have the authority to
conduct annual program performance reviews of services provided through this project.
Administrative and clinical records of patients receiving services through this project shall be
made available to the reviewers for this purpose.
10. The State will, in consideration of said services by the Contractor, cause to be paid to the
Contractor a sum not to exceed THREE THOUSAND MINTY TWO Dollars ($3,092.00) for
new screenings and diagnostic services per Exhibit A and THREE THOUSAND TWENTY
Dollars ($3,020.00) for Colposcopy services per Exhibit B, for the period beginning 1 March
1995 and ending 31 July 1995. For subsequent periods, the amount will be mutually determined
and set forth in a letter to be signed by the State and the Contractor, and approved by the State
Controller. Payment will be made by the State based on submission of the required CPCP forms
indicating that services were rendered with the necessary results indicated. Monthly reports will
be computer generated; one to indicate the total amount of services rendered by procedure, and
a second one giving specific details on the women served and the procedures performed.
Additional covenants covering payments made under this contract are as follows:
a) The Contractor must prepare a signed Contract Reimbursement Statement
(CRS), a copy of which is attached and by reference made part hereof as
Exhibit C, to receive payment on this contract.
b) In accordance with P.L. 101-345, patient charges for services provided will be
made according to a schedule of charges that is made available to the public, and
that is adjusted to reflect the income of the women involved. No patient charges
will be imposed on any woman with an income of 200% or less of the federal
poverty line.
c) Any program income generated such as donations shall be used by the program for
cancer prevention and control purposes which further the objectives of the
legislation under which this contract is made.
d) The Contractor agrees that Medicare rates, which are changed on an annual basis,
will be used for establishing the reimbursement rates for breast and cervical cancer
screening and diagnostic services. The current year's rates are those contained on
the budget (Exhibit A).
11. Changes in reimbursement amounts for the above -named services in consideration of
increased or decreased levels of utilization and/or the Medicare rate change from the levels
funded in the original contract shall be made with approval of the Contractor, the State (Cancer
Control Program) and the State Controller as evidenced by a mutually signed Letter of Approval
a copy .of which is attached and by reference made part hereof as Exhibit C.
12. The Contractor agrees, to the best of his or her knowledge and belief, that:
a) No Federal appropriated funds have been paid or will be paid, by or on behalf of
the contractor to any person for influencing or attempting to influence an officer
or employee of any agency, a Member of Congress, an officer or employee of
Page 3 of 8 Pages
Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract, the making of any Federal grant, the making of
any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation,..renewal, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
b) If any funds other than Federal 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, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal contract,
grant, loan, or cooperative agreement, the Contractor shall complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with
its instructions.
c) The Contractor shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subcontracts, subgrants, and contracts under grants, loans and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly.
13. The term of this contract is beginning 1 March 1995, and continuing through July 31,
1995.
Page 4 of 8 Pages
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 withholding, 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. Eicher party shall have the right to terminate this agreement by giving the ocher
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
co 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
k-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.
276A -276A-5). This act requires that
contractors or sub -contractors to work on
assistance must be paid wages not less
project by the Secretary of Labor;
1494, Mar. 3, 1921, Chap. 411, 40 USC
all laborers and and mechanics employed by
construction projects financed by federal
than those established for the locality of the
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 PR0V1S10NS--Page.2 of 2 pages
e) the Americans with Disabilities Act (Public Law 101-336; 42 USC 12101, 12102,
12111 - 12117, 12131 - 12134, 12141 - 12150, 12161 - 12165, 12181 - 12189, 12201 - 12213
and 47 USC 225 and 47 USC 611.
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 Assistance 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 does (100%)
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. 06/04/92
SPECIAL PROVISIONS
CONTROLLER'S APPROVAL
I. This contract shall not be deemed valid until it shall have been approved by the Controller of the 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 of Colorado 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 work for this State, the contractor shall, before entering upon the performance of any such work included
in this contract, duly execute and deliver to the State official who will sign the contract, 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 bond shall be duly executed by a qualified corporate
surety conditioned upon the 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, provendor or other supplies used or consumed by such contractor or his subcontractor in performance of the work
contracted to be done or fails to pay any person who supplies rental machinery, tools, or equipment in the prosecution of the work 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 is executed. delivered and
filed, no claim in favor of the contractor arising under such contract shall be audited, allowed or paid. A certified or cashier's check or a bank money order payable
to the Treasurer of the State of Colorado may be accepted in lieu of a bond. This provision is in compliance with CRS 3g-26-106.
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 coon 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 (CRS 24-34.402). and as required by Executive Order, Equal Opportunity and Affirmative Action, dated April 16.
1975. Pursuant thereto. the following provisions shall be contained in all Stare contracts or sub -contracts.
During the performance of this contract, the contractor agrees as follows:
(a) The contractor will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, sex,
marital status, religion, ancestry, mental or physical handicap. or age. The contractor will take affirmative action to insure that applicants am employed, and that
employees are treated during employment, 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 advertisings; lay-offs or terminations; rates of pay or other forms of compensation; and
selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment.
notices to be provided by the contracting officer setting forth provisions of this non-discrimination clause.
(b) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the 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 age.
(c) The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or
understanding, 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.
(d) The contractor and labor unions will furnish all information and reports required by Executive Order, Equal Opportunity and Affirmative Action of April
16, 1975, and by the rules, regulations and Orders of the Governor, or pursuant thereto, and will permit 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.
(e) 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 in such labor organization or discriminate against any of its members in the full enjoyment of work opportunity because of see, creed, color.
sex, national origin, or ancestry.
(f) A labor organization. or the employees or members thereof will not aid, abet, incite, compel or coerce the doing of any act defined in this contract to be
discriminatory or obstruct or prevent any person from complying with the 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.
Form 6-AC.02B
Revised 1/93
395-53-01-1022
page of ? pages
(g) In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such rul regulations, or orders,
this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible f• further State contracts in
accordance with procedures. authorized in Executive Order, Equal Opportunity and Affirmative Action of April 16. 1975 nd the rules, regulations, or
orders promulgated in accordance therewith, and such other sanctions as may be imposed and remedies as may be invoked • provided in Executive Order,
Equal Opportunity and Affirmative Action of April 16. 1975: or by rules, regulations, or orders promulgated in actor nee therewith, or as otherwise
provided by law.
(h) The contractor wi include the provisions of paragraphs (a) through (h) in every sub -contract and subcontract • purchase order unless exempted by
rules, regulations, or o • en issued pursuant to Executive Order. Equal Opportunity and Affirmative Action of Ap ' 16, 1975. so that such provisions will
be binding upon each su • • • ntractor or vendor. The contractor will take such action with respect to any sub -contra- ing or purchase order as the contracting
agency may direct, as a m ,s of enforcing such provisions, including sanctions for non-compliance: provide • however, that in the event the contractor
becomes involved in. or is th . coed with, litigation, with the subcontractor or vendor as a result of such direc - by the contracting agency, the contractor
may request the State of Colors • to enter into such litigation to protect the interest of the State of Colon
COLORADO LABOR PREFERENC
6a. Provisions of CRS 8.17-101 & 102 for pr react of Colorado labor am applicable to this contract if pub c works within the Slate are undertaken hereunder and
are financed in whole or in part by State funds.
b. When a construction contact for a public projec ' to be awarded to a bidder, a resident bidder sha be allowed a preference against a non-resident bidder from
a state or foreign country equal to the preference given • requited by the state or foreign country in w It the non-resident bidder is a resident. If it is determined by
the officer responsible for awarding the bid that compli - with this subsection .06 may cause denia of federal funds which would otherwise be available or would
otherwise be inconsistent with requirements of Federal law, •.'s subsection shall be suspended, but • ly to the extent necessary to prevent denial of the moneys or to
eliminate the inconsistency with Federal requirements (CRS 8 9-101 and 102)
GENERAL
7. The laws of the State of Colorado and rules and regulations issu want th
contract. Any provision of this contract whether or not incorporated hem • y mitten
is otherwise in conflict with said laws, rules, and regulations shall be consid • null
which purports to negate this or any other special provision in whole or in part sha be v
defence, or otherwise. Any provision rendered null and void by the operation of
contract is capable of execution.
quo
cc
all be applied in the interpretation, execution, and enforcement of this
w ich provides for arbitration by any extra -judicial body or person or which
an void. Nothing contained in any provision incorporated herein by reference
d or enforceable or available in any action at law whether by way of complaint.
vision will not invalidate the remainder of this contact to the extent that the
8. At all times during the performance of this contract, the Contractor shall s •' y • to all applicable federal and state laws, riles, and regulations that have
been or may hereafter be established.
9. The signatories aver that they am familiar with CRS 18-8-301, et. seq. Bribery and Corte, Influences) and CRS 18-8-401. et. seq., (Abuse of Public Office).
and that no violation of such provisions is present.
10. The signatories aver that to their knowledge, no state employee any personal or beneficial int st whatsoever in the service or property described herein:
IN WITNESS WHEREOF, the parties hereto have executed this Con on the day first above written.
Contractor: Weld County Health Departmen
(Full Legal Name) Weld Count , Colorado
Weld Co Board of Co+r,is_' n
04/05/95
Position(Title) Dale K. Hall, Chai "an
846000p13 B
If Corporation:)
Attest (Seal)
By
ATTORNEY GENERAL
oard
By
Form 6 -AC -02C
Revised 1193
395.53-01.1030
STATE OF COLORADO
ROY ROMER, GOY . • NOR
By
•5 EXECUTIVE DIRECTOR
DEPARTMENT HEALTH
OF
WELD COUNTY
BY:
N S. PICKLE, M.S.E.H.
DIRECTOR
CONTROLLER
By
APPROVALS
f�
Page 8 which is the last of 8
-See instructions on reverse side.
pages
PROGRAM APPROVAL:
EXHIBIT A
COLORADO WOMEN'S CANCER CONTROL INITIATIVE
ANNUAL EXPENDITURE REPORT 1994 -95
Women Aged 20 to 39
AGENCY: Weld County Health Department
FISCAL. YEAR: 95
SERVICE
PROVIDED
REIMBURSEMENT
RATE
NUMBER
OF
PROCEDURES
TOTAL
AMOUNT
SCREENING
Clinical Breast Exam/ Pelvic Exam
$ 54.23
50
2,711.50
Pap Lab (by Cytotech)
7.60
50
380.00
Mammogram
59.63
SUBTOTALS
DIAGNOSTIC
Repeat Clinical Breast Exam
29.80
Surgical/Medical Consultation
76.58
Diagnostic/Repeat Mammogram
62.44
Fine Needle Aspiration (FNA)
161.44
Repeat Pelvic Exam
29.80
Pap Lab (by Pathologist)
19.05
Colposcopy
89.32
Colposcopy with Biopsy
201.36
SUBTOTALS
TOTALANNUAL COSTS
3,091.50
7/Srod SDMERANN.FRM
EXHIBIT B
COLORADO WOMEN'S CANCER CONTROL INITIATIVE
ANNUAL EXPENDITURE REPORT 1994 - 95
Women Aged 20 to 39
AGENCY: Weld County Health Department FISCAL YEAR: 95
SERVICE
PROVIDED
1
REIMBURSEMENT
RATE
NUMBER
OF
PROCEDURES
TOTAL
AMOUNT
SCREENING
Cinical Breast Exam/ Pelvic Exam
$ 54.23
ap Lab (by Cytotech)
7.60
_,:ammogram
59.63
I
SUBTOTALS
DIAGNOSTIC
Repeat Clinical Breast Exam
29.80
Surgical/Medical Consultation
76.58
Diagnostic/Repeat Mammogram
62.44
? Fine Needle Aspiration (FNA)
161.44
Repeat Pelvic Exam
29.80
I Pap Lab (by Pathologist)
19.05
CalposcopY
89.32
Colposcopy with Biopsy
201.36
15
3 ,0 20 .Z40
SUBTOTALS
TOTAL ANNUAL COSTS
3,020.x0
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