HomeMy WebLinkAbout20241095.tiffMariah Higgins
From:
Sent:
To:
Cc:
Subject:
Attachments:
Follow Up Flag:
Flag Status:
Bill Fritz
Monday, April 29, 2024 2:27 PM
CTB
Jason Chessher
Communication Item — Option Letter
1 2021-2930 OL4_CP.pdf; 2 2021-2930 OL4_SP.pdf; 3 2021-2930 OL4_Exh C Budget.pdf
Follow up
Flagged
This grant is for the continuation of the FDA Enforcement of Family Smoking Prevention and Tobacco Control Project.
This is the 5th year, Option Letter #4 of this program and will cover 1 FTE, Community Inspector position and several
part-time underage minors and a chaperone, who will conduct a minimum of 503 inspections in an 11 county region on
the FDA Tobacco Retailer inspection Map or as directed by CDPHE for the compliance with the law. The contract amount
of $61,163.41, all of which is Federally Funded. The contract becomes effective with the contract execution from May
30, 2024 and ends September 29, 2024. Activities will be conducted by current staff; no additional FTE is being
requested.
Please let me know if you need any other information to place on the Consent Agenda for the next available BOCC
meeting. I will have Lily forward a DocuSign once a date is assigned.
Thanks Bill
Bill Fritz
Finance Manager
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
Direct Phone: 970.400.2122
VISION: Everyone in Weld County has the opportunity to live their healthiest lives.
MISSION: We serve Weld County by cultivating partnerships to promote public health and environmental quality
through the delivery of relevant, innovative, and cost-effective services.
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain
information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return a -mail and
destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the
named recipient is strictly prohibited.
From: DocuSign NA3 System <dse_NA3@docusign.net>
Sent: Monday, April 29, 2024 1:40 PM
To: Bill Fritz <bfritz@weld.gov>
Subject: Completed: Request for Signature - Sign by 05/29 - 2021*2930 OL4 Weld FDA TOB
Cote tun;Col onS
05/06./.4
2024-1095
HLoo57
Caution: This email originated from outside of Weld County Government. Do not click links or open attachments unless you recognize the
sender and know the content is safe.
COLORADO
Department of Public
Health & Environment
Lilly Smith
lilly.smithstate.co.us
All parties have completed Request for Signature - Sign by 05/29 - 2021 *2930 OL4
Weld FDA TOB.
You are receiving notification that a contract from the Colorado Department of Public
Health and Environment (CDPHE) is fully executed.
CDPHE authorizes work to begin on the effective date of the attached contract.
If you have any questions or concerns, please contact Lilly Smith at
lilly.smith@state.co.us.
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DocuSign Envelope ID: 31 D38597-F341-4600-93B0-60D7FB3A9BCE
OPTION LETTER #4
State Agency:
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
2021*2930
Option Letter Contract Number:
2021*2930 Option Letter #4
Contractor:
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
1150 "O" Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Contract Performance Beginning Date:
November 19, 2020
Current Contract Expiration Date:
September 29, 2024
CONTRACT MAXIMUM AMOUNT TABLE
Document
Type
Contract
Number
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original Contract
2021*2930
$164,830.00
$0.00
$0.00
—
11/19/2020 9/29/2021
$164,830.33
Option Letter #1
2021*2930
Option Letter
$113,220.97
$0.00
$0.00
9/30/2021 —
$113,220.97
#1
5/29/2022
Option Letter #2
2021 *2930
Option Letter
$173,171.81
$0.00
$0.00
5/30/2022 —
$173,171.81
#2
5/29/2023
Amendment #1
2930
2021*2930
Amendment
$0.00
$0.00
$0.00
10/5/2022 —
$0.00
#1
5/29/2023
Option Letter #3
2021*2930
$180,699.30
$0.00
$0.00
5/30/2023 -
$180,699.30
Option Letter
5/29/2024
#3
Option Letter#4
2021*2930
$61,163.41
$0.00
$0.00
5/30/2024-
$61,163.41
Option Letter
9/29/2024
#4
Current Contract Maximum
$693,085.82
Cumulative Amount
1) OPTIONS
A. Option to extend for an Extension Term.
B. Option to change quantity of services under the Contract.
2) REQUIRED PROVISIONS:
Page 1 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #4
Ver. 27.01.20
DocuSign Envelope ID: 31 D38597-F341-4600-93B0-60D7FB3A9BCE
A. In accordance with Section 2C of the Original Main Task Order Contract referenced above,
the State hereby exercises its option for an additional term, beginning May 30, 2024 and
ending on the current contract expiration date shown above, at the rates stated in the Original
Task Order Contract, as amended for the following reason: To extend the contract through
Federal Fiscal Year 2024.
B. In accordance with Section 5Bv of the Original Main Task Order Contract referenced above,
the State hereby exercises its option to Increase the quantity of the Services at the rates stated
in the Original Task Order Contract, as amended. Exhibit C — Budget is deleted and replaced
in its entirety with Exhibit C — Budget attached to this Option Letter, for the following reason:
To add funds supporting the Statement of Work activities and deliverables.
C. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown above.
2) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or May 30,
2024, whichever is later.
Page 2 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #4 Ver. 27.01.20
DocuSign Envelope ID: 31 D38597-F341-4600-93B0-60D7FB3A9BCE
SIGNATURE PAGE
STATE OF COLORADO
Jared S. Potts, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
DoeuSigned by:
L aaSt4 ain,thot,
In accordance with §24-30-202 C.R.S., this Option is not
valid until signed and dated below by the State Controller or
an authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
DocuSigned by: C14.4
2C13g12116521B1...
By: Signature
Chelsea Gilbertson
7336'4A4"84" By: Signature
Kurt Williams
Name of Executive Director Delegate
Director of Procurement and Contracts
Name of State Controller Delegate
Controller
Title of Executive Director Delegate
2024-04-29
Date:
Title of State Controller Delegate
2024-04-29
Option Effective Date:
-- Signature Page End --
Page 3 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #4 Ver. 27.01.20
Exhibit C Budget
DocuSign Envelope ID 31O38597-F341-4600-93B0-60D7FB3A9BCE
COLORADO
Department of Public
Health £t Environment
PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM
Original Contract Routing # 2021*2930
Weld
County Department of Public
Environment
Health
and
mcyphers@weldgov.com
Melanie
970-400-2423
Cyphers
Program
Title,
Phone
Contact
and
Name,
Email
Contractor
Name
Budget
g
Period
May
30, 2024 - Sept
29, 2024
Fiscal
Phone
Contact
and
Name,
Email
Title,
bfritz@weld.gov
Bill
970-400-2122
Fritz
FDA
Tobacco
Retail
Compliance
Program
Check
Inspection
Contract
Number
(CT
or
PO)
CT
FHLA
2021*2930
Project
Name
Budget
Information
Activity
/
Description
of Activity
Rate
Quantity
Total
Requested
CDPHE
Amount
from
Primary
Deliverable
Full
Statement of
Work
FDA
May
-directed
30,
2024
Undercover
- Sept
Buys
29, 2024
inspections
(UB)
$ 121.60
350.00
$ 42,559.04
Full
Statement of Work
FDA
Ma
-directed
Y30,
2024
Advertising
- Se
&
p t 29, 2024
Labeling
inspections (A&L)
$ 121.60
153.00
$ 18,604.38
$ 61,163.41
TOTAL
Option Letter Contract Number: 2021*2930 Option Letter #4 Page 1 of 1
DocuSign Envelope ID: BD789E55-A012-4C6C-9186-474C3937E820
OPTION LETTER #: 3
State Agency:
Colorado Department Of Public Health and Environment
Tobacco/FDA
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
202102930
Option Letter Contract Number:
2021*2930 Option Letter #3
Contractor:
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
1150 "O" Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Contract Performance Beginning Date:
November 19, 2020
Current Contract Expiration Date:
May 29, 2024
CONTRACT MAXIMUM AMOUNT TABLE
Document
Type
Contract
Number
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original Contract
2021*2930
$164,830.00
$0.00
$0.00
11/19/2020 - 9/29/2021
$164,830.33
Option Letter #1
2021*2930
Option Letter
#1
$113,220.97
$0.00
$0.00
9/30/2021- 5/29/2022
$113,220.97
Option Letter #2
2021*2930
Option Letter
#2
$173,171.81
$0.00
$0.00
5/30/2022 - 5/29/2023
$173,171.81
Amendment #1
2021*2930
Amendment
#1
$0.00
$0.00
$0.00
10/5/2022 - 5/29/2023
$0.00
Option Letter #3
2021 *2930
Option Letter
#3
$180,699.30
$0.00
$0.00
5/30/2023 - 5/29/2024
$180,699.30
Current Contract Maximum
Cumulative Amount
$631,922.41
1) OPTIONS
A. Option to extend for an Extension Term
B. Option to change quantity of services under the Contract
2) REQUIRED PROVISIONS:
A. In accordance with Section(s) 8, Exhibit A, Additional Provisions of the Original Contract
referenced above, the State hereby exercises its option for an additional term, beginning May 30,
2023 and ending on the current contract expiration date shown above, at the rates stated in the
Original Contract, as amended for the following reason: To extend for an additional term.
B. In accordance with Section(s) 7, Exhibit A, Additional Provisions of the Original Contract
Page 1of3
Option Letter Contract Number: 2021 *2930 Option Letter #3 Ver. 27.01.20
DocuSign Envelope ID: BD789E55-A012-4C6C-9186-474C3937E820
referenced above, the State hereby exercises its option to increase the quantity of services at the
rates stated in the Original Contract as amended. Exhibit C, Budget, is deleted and replaced in
its entirety with Exhibit C, Budget, attached to this Option Letter, for the following reason:
Add funds supporting the renewal term SOW deliverables .
C. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown above.
3) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or May 30,
2023 , whichever is later.
Page 2 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #3 Ver. 27.01.20
DocuSign Envelope ID: BD789E55-A012-4C6C-9186-474C3937E820
SIGNATURE PAGE
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
DecuSlyned by:
5Sit Ittzt,emut,
2EDFa70A1A7D4FC...
In accordance with §24-30-202 C.R.S., this Option is not
valid until signed and dated below by the State Controller or
an authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
DoauSigned by:
CiaLlAkite, S'arrita
ra a 1a AR7aaa
8 0 B 5
By: Signature
Lisa McGovern
By: Signature
Jannette Scarpino
Name of Executive Director Delegate
Procurement & Contracts section Director ft
Name of State Controller Delegate
Chief Financial Officer
Title of Executive Director Delegate
2023-03-28
Date:
Title of State Controller Delegate
2023-03-29
Option Effective Date:
-- Signature Page End --
Page 3 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #3 Ver. 03.01.20
Exhibit C
DocuSign Envelope ID: BD789E55-A012-4C6C-9186-474O3937E820
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM
Original Contract Routing # 2021*2930
Contractor Name
Weld
County Department of
Environment
Public
Health
and
Program
Title,
Contact
Phone and
Name,
Email
Melanie
mcyphers@weldgov.com
970-400-2423
Cyphers
Budget Period
May 30, 2023 - May 29, 2024
Fiscal
Phone
Contact
and
Name,
Email
Title,
Tanya Geiser
970-400-2122
tgeiser@weldgov.com
Project Name
FDA Tobacco Retail
Compliance
Program
Check
Inspection
Contract (CT or PO)
Number
FHLA 2021*2930
CT
Budget
Information
Primary
Deliverable
Activity
/
Description of Activity
Rate
Quantity
Total
Requested
CDPHE
Amount
from
Full
Statement of Work
FDA -directed
May 30,
2023
Undercover
- Sept
Buys inspections (UB)
29, 2023
$ 115.81
350.0
$ 40,532.42
Full
Statement of Work
FDA -directed
May 30,
2023-
Advertising
Sept
& Labeling
29, 2023
inspections (A&L)
$ 115.81
153.0
$ 17,718.46
Full
Statement of
Work
FDA- directed
Sept 30, 2023
Undercover
- May
Buys inspections (UB)
29, 2024
$ 121.60
700.0
$ 85,118.07
Full
Statement of Work
FDA -directed
Sept 30,
2023
Advertising
-
& Labeling
May 29, 2024
inspections (A&L)
$ 121.60
307.0
$ 37,330.35
$
$
$
$
$
TOTAL
$ 180,699.30
Option Letter Contract Number: 2021*2930 Option Letter #3 Page 1 of 1
DocuSign Envelope ID: 2CF78A6A-1389-4337-97DA-BD622FA9A6BF
OPTION LETTER #: 2
State Agency:
Colorado Department Of Public Health and Environment
Tobacco/FDA
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
2021 *2930
Option Letter Contract Number:
2021*2930 Option Letter #2
Contractor:
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
1150 "O" Street
Greeley, Colorado 80631
for the use and benefit of the Weld County Department of Public
Health and Environment
1555 North 17° Avenue
Greeley, Colorado 80631
Contract Performance Beginning Date:
November 19, 2020
Current Contract Expiration Date:
May 29, 2023
CONTRACT MAXIMUM AMOUNT TABLE
Document Type
Contract Number
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original Contract
2021*2930
$164,830.00
$0.00
$0.00
11/19/2020 - 9/29/2021
$164,830.33
Option Letter#1
Optio2021nL*2930 # 1
etter
$113,220.97
$0.00
$0.00
9/30/2021 - 5/29/2022
$113,220.97
Option Letter#2
Optio2021*2930
n Letter #2
$173,171.81
$0.00
$0.00
5/30/2022 - 5/29/2023
$173,171.81
Current Contract Maximum
Cumulative Amount
$451,223.11
1) OPTIONS
A. Option to change quantity of services under the Contract
B. Option to extend for an Extension Term
2) REQUIRED PROVISIONS:
C. In accordance with Section(s) Section 7, Exhibit A, Additional Provisions of the Original
Contract, as amended, referenced above, the State hereby exercises its option to increase the
quantity of services at the rates stated in the Original Contract as amended. Exhibit C., Budget is
deleted and replaced in its entirety with Exhibit C., Budget attached to this Option Letter, for the
following reason: add funds for fiscal year to support deliverables and services as specified in the
Contract's Statement of Work.
D. In accordance with Section(s) Section 8, Exhibit A, Additional Provisions, of the Original
Contract, as amended, referenced above, the State hereby exercises its option for an additional
term, beginning May 30, 2022 and ending on the current contract expiration date shown above,
Page 1of3
Option Letter Contract Number: 2021 *2930 Option Letter #2 Ver. 27.01.20
DocuSign Envelope ID: 2CF78A6A-1389-4337-97DA-BD622FA9A6BF
at the rates stated in the Original Contract, as amended for the following reason: to extend for an
additional term.
E. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown above.
3) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or May 30,
2022 , whichever is later.
Page 2 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #2 Ver. 27.01.20
DocuSign Envelope ID: 2CF78A6A-1389-4337-97DA-BD622FA9A6BF
SIGNATURE PAGE
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
DocuSgned by:
rtiStt
2COF870A1A7O4�C...
In accordance with §24-30-202 C.R.S., this Option is not
valid until signed and dated below by the State Controller or
an authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
DocuSgned by:
5AStit'
(`dRA5d(1FLiA7Qd(15
By: Signature
Lisa McGovern
By: Signature
Justin Weigle
Name of Executive Director Delegate
Procurement & Contracts section Director
Name of State Controller Delegate
ft Health Divisions Controller
Title of Executive Director Delegate
2022-05-20
Date:
Title of State Controller Delegate
2022-05-25
Option Effective Date:
-- Signature Page End --
Page 3 of 3
Option Letter Contract Number: 2021 *2930 Option Letter #2 Ver. 03.01.20
DocuSign Envelope ID: 2CF78A6A-1389-4337-97DA-BD622FA9A6BF
Exhibit C., Budget
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM
Original Contract Routing # 2021 *2930
Contractor Name
Weld
County Department of Public
Environment
Health
and
Program
Title, Phone
Contact
and
Name,
Email
Melanie
mcyphers@weldgov.com
970-400-2423
Cyphers
Budget
Period
May 30, 2022 - May 29, 2023
Fiscal
Phone
Contact Name,
and Email
Title,
Tanya Geiser
970-400-2122
tgeiser@weldgov.com
Project
FDA Tobacco Retail
Compliance
Program
Check
Inspection
Contract
PO)
FHLA 2021*2930
(CT
Number
or
CT
Name
Budget
Information
Primary
Deliverable
Activity /
Description of
Activity
Rate
Quantity
Total
Requested
CDPHE
Amount
from
Full
Statement of
Work
FDA -directed
May 30, 2022
Undercover
Sept
Buys inspections (UB)
29, 2022
112.4339
350
$ 39,351.87
Full
Statement of
Work
FDA -directed
May 30,
2022
Advertising
-
& Labeling
Sept 29, 2022
inspections (A&L)
112.4339
153
$ 17,202.39
Full
Statement of Work
FDA-
Sept 30,
directed
2022
Undercover
May
Buys inspections (UB)
29, 2023
115.8069
700
$ 81,064.83
Full
Statement of Work
FDA -directed
Sept 30,
2022
Advertising
-
& Labeling
May 29, 2023
inspections (A&L)
115.8069
307
$ 35,552.72
TOTAL
$ 173,171.81
Page 1of1
Option Letter Contract Number: 2021*2930 Option Letter #2
vocuSign Envelope ID: 67A21127 -18E3 -432C-9! \D1993D0D0AF
OPTION LETTER #: 1
State
Agency:
Original
2021*2930
Contract
Number:
Colorado
4300
Tobacco
Denver,
Cherry
A35
Colorado
Department
Creek
Drive
80246
Of
Public
South
Health
and
Environment
Option
Letter
Contract Number:
2021*2930
Option
Letter
#1
Contractor:
Board
benefit
Environment
1555
Greeley,
of
North
of
County
Colorado
the
Weld
17"'
Avenue
Commissioners
80631
County
Department
of
Weld
of
County
Public
for
Health
the
use
and
and
Contract
November
Performance
19,
2020
Beginning
Date:
Current
May
29,
Contract
2022
Expiration
Date:
CONTRACT
MAXIMUM
AMOUNT
TABLE
Type
Document
Contract
Number
Federal
Amount
Funding
State Funding
Amount
Other
Amount
Funding
Term
(dates)
Total
Original
Contract
2021*2930
$164,830.00
$0.00
$0.00
11/19/20-
9/29/21
$164,830.33
Option
#1
Letter
2021*2930
Option
Letter
#1
$113,220.97
$0.00
$0.00
9/30/21-
05/29/22
$113,220.97
$278,051.30
Current Contract
Cumulative
Maximum
Amount
1) OPTIONS
A. Option to change quantity of services under the Contract
B. Option to extend for an Extension Term
2) REQUIRED PROVISIONS:
A. In accordance with Section(s) Section 7, Exhibit A, Additional Provisions of the Original
Contract, as amended, referenced above, the State hereby exercises its option to increase the
quantity of services at the rates stated in the Original Contract as amended. Exhibit, C, Budget is
deleted and replaced in its entirety with Exhibit, C, Budget attached to this Option Letter,
for the following reason: Option to extend for an Extension Term.
B. In accordance with Section(s) Section 8, Exhibit A, Additional Provisions, of the Original
Contract, as amended, referenced above, the State hereby exercises its option for an additional
term, beginning September 30, 2021 and ending on the current contract expiration date shown
above, at the rates stated in the Original Contract, as amended for the following reason: to extend
for an additional term.
C. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown above.
3) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or September
30, 2021 , whichever is later.
Page 1 of 1
Option Letter Contract Number: 2021*2930 Option Letter #1 Ver 27 01.20
.Ign Envelope ID: 67A21127-16E3-432C-896D-A01883D0D0AF
Exhibit C Budget
lawalipth COLORADO
Departmont o[ Publlo
Hcalth 6 Environment
PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM
Contract Routing # 2021.2930 Option Letter #1
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact Neme,
Title, Phone and Email
Melanie Cyphers
mcyphers'weldgov.com
970.400.2423
Budget PeriodSeptember
30, 2021- May 29, 2022
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser
tgeiser@weldgov.com
970.400.2122
Project Name
FDA Tobacco Retail Compliance Check Inspection
Program
Contrail (CT or PO) Number
CT FHIA 2021.2930
Expenditure Categories
Personal Services
Salaried Employees
Position Title
I
Gross or Percent of Total Amount
Description of work Fringe Time on Requested from
Annual Salary
Protect COME
NOT APPLICABLE TO FIXED PRICE BUDGET
I
I I I Is
Personal Services
Hourly Employees
Position Title
Total # of Total Amount
Description of Work Hourly Wage Hourly Fringe) Hourson Requested from
Protect COPHE
NOT APPLICABLE TO FIXED PRICE BUDGET
Total Personal Services (Including fringe benefits) S
Supplies & Operating Expanses
Item
Total Amount
Description of Item Rate Quantity Requested from
CDPHE
NOT APPLICABLE TO FIXED PRICE BUDGET
I
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Total Supples & Operating' $
Option Letter Contract Number: 2021.2930 Option Letter #1 Page 1 of 2
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