HomeMy WebLinkAbout20251342.tiffMariah Higgins
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Sent:
To:
Cc:
Subject:
Attachments:
Follow Up Flag:
Flag Status:
Bill Fritz
Monday, May 12, 2025 7:55 AM
CTB
Amanda Gomez
Communication Option Letter FDA Tobacco
a Form Modification Submittal Checklist [PSD Formatted 4.11.25].docx.pdf; b SAM.pdf; 1
2025-1126 OL1_CP.pdf; 2 2025-1126 OL1_SP.pdf; 3 2025-1126 OL1_Exh C Budget.pdf
Follow up
Flagged
Good morning, attached is an option letter for communication for the FDA Tobacco grant for completing Tobacco
Inspections in our corner of the state. It goes beyond Weld. Thanks Bill
COUNTY CO
Bill Fritz
Finance Manager
Department of Public Health and Environment
Desk: 970-400-2122
1555 North 17th Ave., Greeley, CO 80631
Office Hours 7am-4pm Mon -Fri
08000
Join Our Team
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From: DocuSign NA3 System <dse_NA3@docusign.net>
Sent: Friday, May 9, 2025 3:59 PM
To: Bill Fritz <bfritz@weld.gov>
Subject: Completed: Notification of Executed Contract - 2025*1126 OL1 Weld TOB FDA
This Message Is From an External Sender
This email vvas sent by someone outside Weld County Government: Do not click links or open attachments unless you recognize
the sender and know the content is safe.
O5/1.‘i.2.5
2025-1342
Hl-OO57
Lilly Smith
lilly.smithstate.co.us
COLORADO
Department of Public
Health b Environment
All parties have completed Notification of Executed Contract - 2025*1126 OL1 Weld
TOB FDA.
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 Kirlin at
lilly.kirlin@state.co.us.
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Docusign Envelope ID: 83C4B0C4-9A0B-4269-AA9A-EB4DD3772957
STATE OF COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
OPTION LETTER #1
State Agency:
Original Contract Number:
Colorado Department of Public Health and Environment
20254'1126
4300 Cherry Creek Drive South
Denver, Colorado 80246
Main Task Order Contract Number:
23 FAA 00051
Contractor:
Option Letter Contract Number:
Board of County Commissioners of Weld County
2025* 1126 Option Letter #1
(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:
Current Contract Expiration Date:
November 17, 2024
May 29, 2026
CONTRACT MAXIMUM AMOUNT TABLE
Document Type
Contract Number
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original
2025*1126
$127,636.68
Contract O5/29/2O25
$0.00
$0.00
11/17/2024-
$127636.68
'
Option Letter #1
2025*1126
Option Letter #1
$182,529.75
$0.00
$0.00
05/30/2025-
05/29/2026
$182,529.75
Current Contract Maximum Cumulative Amount
$310,166.43
1. OPTIONS:
A. Option to extend for an Extension Term
B. Option to change the quantity of Services under the Contract
2. REQUIRED PROVISIONS:
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, 2025 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 into Fiscal Year 2026.
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
Option Letter Contract Number: 2025 * 1126 Option Letter #1
Page 1 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: 83C4B0C4-9A0B-4269-AA9A-E.DD3772957
Exhibit C - Budget attached to this Option Letter, for the following reason: to add funds supporting
the renewal term.
C. The Contract Maximum Amount table on the Contract's Cover Page is hereby 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, 2025,
whichever is later.
Option Letter Contract Number: 2025* 1126 Option Letter #1
Page 2 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: 83C4B0C4-9A0B-4269-AA9A-E.DD3772957
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
gDocuSiyned by:
ast.a.
2C i391241052481...
By: Signature
Chelsea Gilbertson
Name of Executive Director Delegate
Procurement & Contracts Section
Title of Executive Director Delegate
Date:
2025-05-07
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:
[14.41Wat....
73305F4A4A084BC...
By: Signature
Kurt Williams
Name of State Controller Delegate
Controller
Title of State Controller Delegate
Option Effective Date:
2025-05-09
Option Letter Contract Number: 2025.1126 Option Letter #1
Page 3 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: 83C4B0C4-9A0B-4269-AA9A-EB4DD3772957
CONTRACT MODIFICATION SUBMITTAL CHECKLIST
Contractor/Subrecipient Name: Weld County Department of Public Health and Environment
Original Contractor/Subrecipient Name if Assigned: Enter Contractor/Subrecipient Name (previous)
❑ All Contractor name occurrences and Secretary of State Status Summary Page match exactly
Modification Routing —# 2025*1126 Option Letter #1
Current Encumbrance # CT FHLA 2025*1126
Ori final Routing # 2025*1126
or ❑ NO ENCUMBRANCE
Modification Term (START and END Date): 05/30/2025-05/29/2026
OnBase: SOW Pre -Approval # or Regents/DDPHE Pre -Review #: Enter # (if applicable)
Submitter Name/Division: Lilly Kirlin/PSD
SOW Delegate Name: N A
Purpose(s) of Modification (Select all that apply)
❑ Scope of Work x Budget x Renewal ❑ No Cost ❑ Assignment ❑ Other, If 'Other' Describe
Modification DOCUMENT TYPE
Select Only One
A
B fi C
A. Amendment
❑
B. Option Letter
X
C. Assignment
❑
Modification — Docu5ign Backup Documents
Mark all that
apply for the
selected
Document Type.
Include requested backup documents (as required).
s�
Contract Modification Quality Assurance Checklist
❑
❑
❑
Contract Modification Submittal Checklist
❑
x
❑
If Subrecipient. Pre -Award Financial Risk Assessment # (See Internal Audit Site) Enter #
❑
❑
(Renewal required each year)
Personal Services Certification Form or Internal HR Waiver: (See CDPHE Human Resources Site for
❑
❑
Information on Modifications)
If Internal HR Waiver: Enter Category or If Waived Service: Enter Category
Secretary of State Status Summary Page (Amendment or Option Letter for a new term)
(Must state the entity is in 'good standing')
(If Assignment, SOS for Assignee only; NOT required for Interagency Agreement, Intergovernmental
Contract)
❑
❑
❑
If 'Doing Business As' (dba), Secretary of State Status Summary Page for dba
❑
❑
❑
Modification Submittal Checklist
Version Al2.10.24
Docusign Envelope ID: 83C4B0C4-9A0B-4269-AA9A-E64DD3772957
Signature Authority Letter or Corporate Documentation (If contract signed by other than apparent
authority) (See OSC Policy Signature Authority Delegation)
SAM Exclusion Summary Page (Record verified and no exclusions/restrictions) (See SAM Verification
Guidance)
(If Assignment, SAM for Assignee only; NOT required for Interagency Agreement Contract or LPHA)
If Federal funds AND Subrecipient: Contract Federal Provisions Information Sheet.
IOcuSign Contract Document and Exhibit:
Mark all that
apply for the
selected
Document Type.
A,
.ig
Contract Modification and Exhibits (as shown on cover page of modification being submitted)
X
CMS RECORD
Required for contracts $100,000 over the life of the contract
(X)
Completed
1. Record Type — Record type chosen is 'Modification'.
❑
2. Linked Record — Record is linked to the Master Record ONLY.
❑
3. Record Title — Title follows the naming convention for a Modification to a Master Record.
❑
4. Data Field: Vendor Name — Has been selected in the 'Contractor/Vendor field.
❑
5. Data Fields: If this Modification is to renew or extend a contract, has the contractor's work to date been
certified as complying with the terms of the contract AND the Master CMS contract record updated?
Choose 'Yes' when renewing or extending the expiration date and enter 'Yes' in the corresponding field in
the Master Record. If the Modification is not to renew or extend, choose 'N/A' and do not make any
changes in the corresponding field in the Master Record.
❑
6. Data Field: Certification — If applicable, enter date of MOST RECENT annual certification of contractor
work — If contract has been renewed or extended, enter expiration date of the contract. We are using the
expiration date of the contract to represent the last contractor performance evaluation of the contract
period (quarterly or 3x per year). If the Modification is not to renew or extend, leave blank.
If the corresponding field in the Master Record is set to 'Yes' as a result of a previous renewal/extension, do
not change it.
❑
7. Data Fields: All other relevant data fields are completed per CDPHE protocol.
❑
8. Update Master Record — Cumulative Dollar Amount, Latest Performance End Date, and Recertification data
fields have been updated as applicable.
❑
NOTES:
Click here to enter text
Modification Submittal Checklist
Version Al2.10.24
Las[ undated by C,hri.etnnher D'nvidia nn AuQ 07. 2024 at / 1:5R fl M
Docusign Envelope ID: 83C4BOC4-9A06-4269-AA9A-E64DD3772957
WELD, COUNTY OF
!!! SAM*eov°
WELD, COUNTY OF
Unique Entity ID
MKKXT9U9MTV5
Registration Status
Active Registration
Physical Address
1150 O ST
Greeley, Colorado 80631-9596
United States
CAGE /NCAGE
4KEF9
Expiration Date
Aug 1, 2025
Mailing Address
1150 O Street
Greeley, Colorado 80631-1117
United States
Purpose of Registration
Federal Assistance Awards Only
Doing Business as
(blank)
Congressional District
Colorado 08
Division Name
(blank)
State / Country of Incorporation
(blank) / (blank)
Division Number
(blank)
URL
(blank)
Registration Dates
Activation Date
Aug 5, 2024
Submission Date
Aug 1, 2024
Initial Registration Date
Oct 9, 2006
Entity Dates
Entity Start Date
Jan 1, 1861
Fiscal Year End Close Date
Dec 31
Immediate Owner
CAGE
(blank)
Legal Business Name
(blank)
Highest Level Owner
CAGE
(blank)
Legal Business Name
(blank)
Executive Compensation
Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of
P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is
sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant
responded to the questions.
Proceedings Questions
Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9,
or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active
registration in SAM.gov demonstrates the registrant responded to the proceedings questions.
Active Exclusions Records,
No
I authorize my entity's non -sensitive information to be displayed in SAM public search results:
Yes
Business Types
Entity Structure
U.S. Government Entity
Profit Structure
(blank)
Entity Type
US Local Government
Organization Factors
(blank)
Apr 23, 2025 04:23.'19 PM GMT
h[; //sam.gov/e 02,, KKXT9U9MTV5koreData7status=null
Page 1 of 2
Last undated by Chri,ctnnher D'Ovidin nn Auv 07. 2024 at 71: SR AM
Docusign Envelope ID: 8Tatc4-9X9,1/Z69-AA9A-E64DD3772957
Socio-Economic Types
WELD, COUNTY OF
Check the registrant's Reps & Certs, if present, under FAR 52.2123 or FAR 52.219-1 to determine if the entity is an SBA -certified HUBZone small
business concern: Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the
SBA supplemental pages during registration.
Government Types
U.S. Local Government
County
Accepts Credit Card Payments
No
Debt Subject To Offset
No
EFT Indicator
0000
CAGE Code
4KEF9
Electronic Business
0
Chris D'Ovidio
Ryan Rose
1150 O Street
Greeley, Colorado 80631
United States
1150 O Street
Greeley, Colorado 80631
United States
Government Business
0
Chris D'Ovidio
Ryan Rose
1150 O Street
Greeley, Colorado 80631
United States
1150 O Street
Greeley, Colorado 80631
United States
NAILS Codes
Primary
NAICS Codes
This entity does not appear in the disaster response registry.
NAICS Title
Apr 23, 2025 04: 23: 29 PM GMT
hops: //sam. gov/entity/MKK�7'9U9MT I�5/careData?status=null
Page 2 of 2
Docusign Envelope ID: 83C4B0C4-9A0B-4269-AA9A-EB4DD3772957
Exhibit C Budget
M
COLORADO
Department of Public
Health & Environment
Version 6.2024
PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM
Original Contract Routing # 2025"1126
Contractor Name
Weld County Health Department
Program Contact Name,
Title; Phone and Email
Cathy Hoover
Program Manager
970-400-2371
choover@weld.gov
Budget Period
05/30/2025 - 05/29/2026
Fiscal Contact Name, Title,
Phone and Email
Bill Fritz
970-400-2122
bfritz@weld.gov
Project Name
FDA Tobacco Retail Compliance Check Inspection
Program
Contract (CT or PO)
Number
CT FHLA 2025*1126
Budget Information
9
Primary Activity /
Deliverable
Description of Activity
Rate
Quantity
Total Amount
Requested from
CDPHE
Undercover Buys (UBs)
FDA -directed Undercover Buys inspections (UB)
May 30, 2025 May 29, 2026
$ 187.21
775.0
$ 145,087.75
Advertising & Labeling
(A&L)
FDA -directed Advertising & Labeling inspections (A&L)
May 30, 2025 - May 29, 2026
$ 187.21
200.0
$ 37,442.00
$
jC
R i
Option Letter Contract Number: 2025*1126 Option Letter #1 Page 1 of 1
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