HomeMy WebLinkAbout20251251.tiffResolution
Approve Purchase Order Agreement for Marketing Campaign Participation
Allocated Funds Concerning Diabetes Prevention Program (DPP) Education for
Local Health Care Providers and Authorize Chair to Sign — IFC Incorporated, LLC
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 Purchase Order Agreement for Marketing
Campaign Participation Allocated Funds Concerning Diabetes Prevention
Program (DPP) Education for Local Health Care Providers between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Department of Public Health and Environment, and IFC Incorporated,
LLC, commencing upon full execution of signatures, with further terms and conditions
being as stated in said purchase order agreement, and
Whereas, after review, the Board deems it advisable to approve said purchase order
agreement, 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 Purchase Order Agreement for Marketing Campaign Participation
Allocated Funds Concerning Diabetes Prevention Program (DPP) Education for Local
Health Care Providers between the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the Department of
Public Health and Environment, and IFC Incorporated, LLC, be, and hereby is, approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said purchase order agreement.
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 12th day of May, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppier: Excused
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
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OS /W3 /25
2025-1251
HL0058
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BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: WCDPHE Diabetes Prevention Program Health Care Provider marketing campaign
DEPARTMENT: Public Health, Health Education and Communication DATE: 4/28/25
PERSON REQUESTING: Jason Chessher, Executive Director
Bob McDonald, Health Education, Communication and Planning Division Director
Brief description of the problem/issue:
The Diabetes Prevention Program (DPP) was selected by CDC for a marketing program to educate local health
care providers on the benefits of the DPP so they can refer patients to the program. CDC contracts with ICF, a
global marketing agency, to administer the marketing program. Under the terms of the agreement, WCDPHE
will receive $16,000 to participate in a marketing program.
What options exist for the Board?
1. Approve the program agreement.
2. Decline the program agreement.
Consequences: Approving the program agreement will result in the allocation of $16,000 in grant
funding for the marketing program.
Impacts: Outreach to health care providers will allow more Weld County residents at risk of developing
diabetes to be referred to the DPP program.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): The marketing program is fully
supported by grant funding. No county funding is required.
Recommendation: I recommend approval to place this item on a future BOCC agenda for formal consideration.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
2025-1251
5/17_ Ob5g
PURCHASE ORDER
This Purchase Order (hereinafter the "Agreement"), is made and effective on the date of signature by the last party to
sign (Effective Date), and is made between:
ICF
OR
CONTRACTOR
SUBCONTRACTOR
ICF
1902
RESTON,
INCORPORATED
RESTON
VA
20190
METRO
L.L.C.
PLAZA
WELD
ENVIRONMENT
1555
GREELEY,
NORTH
COUNTY
CO
17TH
80631
DEPARTMENT
AVE
OF
PUBLIC
HEALTH
AND
POINTS
OF CONTACT
NAME:
DARRELL
DERR
NAME:
KELLY
MARTINEZ
TITLE:
ICF's
Procurement Representative
EMAIL:
KMARTINEZ(aWELD.GOV
EMAIL:
DARRELL.DERR@ICF.COM
NAME:
SARAH
CABAN
TITLE:
ICF's
Project
Manager
(PM)
EMAIL:
SARAH.CABAN
a ICFNEXT.COM
AGREEMENT
INFORMTION
AGREEMENT
NO.:
202774
ICF
PROJECT
NO.:
152691.1.026.01.04
PERIOD
OF PERFORMANCE:
EFFECTIVE
DATE
- 08/31/2025
AGREEMENT
TYPE:
FIRM
FIXED
PRICE
w/MILESTONE
PAYMENTS
AGREEMENT
CEILING
AMOUNT:
$16,000.00
Milestone
Description (hereinafter
the
"SOW")
Delivery
Date
Ongoing Communication
Ongoing
Team ICF
(a federal
communication
and
research
consulting
firm)
will
facilitate
ongoing
communication
with
and
between demonstration
study
site (Weld
County
Health
Department).
The
study site will
respond
to communication
within
3
business days
and
attend
regular
meetings.
• This
of
the
will
include
study
and
regular
next
(monthly
steps
or
biweekly)
virtual
meetings to discuss
progress
Final
Execution of Agreement
Signed
on or
before
April
The
ICF team will
develop
and
send
an Agreement to the
demonstration
study
site team.
30, 2025
The
demonstration
study
site is responsible
for signing and
sending
back
the
Agreement.
The
study
site can amend
the
SOW if
needed.
ICF
will
provide
the
Agreement to sign. The
demonstration
study
site team will
provide
any
edits
to the
agreement/vendor
language
before
finalizing.
Attending
a Kickoff
Meeting
On or
before
April
30,
The
ICF
team
will
schedule
a
project orientation/kick
off
for the
demonstration
study
site
2025
staff
and
volunteers
involved
to discuss
the
purpose
and
goals
of
this
project. The
demonstration
study
site team is responsible
for attending
the
to establish
project
meeting
deliverable
timelines
in consultation
with
the
ICF
team.
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
,ICF
In
Establish
deliverables
collaboration,
•
•
•
•
•
Pre
Defining
Discussing
and
-Planning
provider
the
timeline.
objectives
ICF
what
the
and
priority
offices)
Activities
and
people,
Decisions
types
planning
demonstration
and
audiences
of
time,
to
metrics
and
be
additional
(i.e.,
resources
study
determined
of
types
site
of
needs
team
interested
available
during
providers
for
will
the
formative
determine
meeting
in (e.g.,
and
ongoing
will
prioritizing
include:
key
players
On or
2025
before
April
28,
identifying
research
materials
most
materials)
Solidifying
Determining
with
Establishing
any
Pre -Messaging Formative Research
On or
before
May
31,
In
collaboration
with
the
demonstration
study
site team,
ICF
will
conduct
formative
research
2025
(e.g., virtual
focus groups
or interviews) to assess the
communication
preferences
and
needs
from their
intended
audiences.
With
the
support
the
demonstration
study
site team,
ICF will
develop
of
research
instruments.
ICF
will
provide
the
demonstration
study
site team with
a
high-level
report
(1-2
page report
with
bullets)
that
detail
key themes
and
insights
from
their
formative research
efforts.
Establishing
a Formal
Theme
and Messaging
Strategy
On or
before
May
31,
The ICF
team
will
schedule
at
least one
promotional
messaging call
to
brainstorm and
2025
determine
a theme
and
messaging strategy of
their
campaign.
This
can
be a one-time
or a series of
meetings.
During the
the
demonstration study
site team and
meeting
meeting,
ICF
will
collaborate
to determine
the
following:
Weld
Co. to send
• Calls
to action
template
back
to
ICF
by
•
Formatting
of
the
materials
June
16,
2025
•
Determining any
branding
requirements
•
Type of
needed
materials
• Amount of
variation in
materials
The
demonstration
study
site will
be responsible
for ensuring all
necessary
parties from
their
organization review and
approve
materials
and
plans.
ICF
will
develop
a template
and
document
insights
from
the
meeting(s).
After
the
meeting,
ICF will
send
the
document
template
to the
demonstration
study
site to
review the
form.
Within
two weeks
of
the
final
meeting, the
demonstration site will
complete
their
review and
send
back
the
template
to the
ICF team.
Planning
the
Cost of Campaign
Efforts
Weld
Co to send
The
demonstration
study
site staff
team will
deliver
a written concept of
the
marketing
and
template
back
to
ICF
by
promotional
activities and
the
associated
costs.
Deliverables
to
be determined
could
June
16,
2025
include
(but
are not
limited
to):
•
Deliver
efforts.
an itemized
breakdown
of
the
anticipated
costs, if
any,
for the
marketing
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
,ICF
ICF
will
provide
a template
for
the
concept
draft
and
cost
planning.
Developing
ICF
materials
rounds
The
will
that
efforts.
All
materials
will
demonstration
provide
is
use
within
of
for
revision
existing
the
materials
the
the
should
demonstration
demonstration
for
marketing
study
resources
be
the
materials.
site
and
completed
to
will
site
sites.
communication
develop
be
responsible
with
by
The
June
2D
up
demonstration
templates
23,
to
5
unique
for creating
and/or
theme for
if not
2D
sites
the
sooner.
communication
any
style
demonstration
can
guides
request
for
up
and
to
materials.
easy
study's
marketing
two
creation
ICF
ICF
of
2025
delivers
materials:
initial
June
version
23,
additional
2025,
Launch
The
information
demonstration
of Messaging
about
the
Effort
study
selected
site
will
diabetes
use
approved
-related
materials
program.
and
strategy to engage
HCPs
with
July
15, 2024
Determine
The
questions
document
demonstration
the
are
and
appropriate
type
contact
study
of
post
site
people
for
-promotion
team
post
for
and
-promotion
post
ICF
-promotion
feedback
will
collaborate
interviews
interviews.
needed
to
and
determine
plan
out
what
the
types
best
of
ways
to
July
14,
i
2025
ICF
Development
The
promotion
2025.
The
receiving
need
demonstration
demonstration
will
for
submit
feedback
instruments.
and
for
any
approval
study
study
and
CDC
site
send
site
approvals
of
and
them
team
post
ICF
will
-promotion
to
will
the
review
deemed
demonstration
and
necessary
feedback
instruments
provide
study
any
for the
for
feedback
site
CDC
the
agreed
team
team
by
upon
August
and
2 weeks
specify
post
1,
-
of
a
August
1, 2025
approval.
the
develop
within
ICF
ICF
feedback
interest
Monitoring
ICF
and
methods
surveys,
will
and
will
communication
document
provide
of
demonstration
being
post
gathering
interviews)
and
contacted.
-promotion
metrics,
strategies.
disseminate
with
post
post
study
-promotion
random
The
contingent
evaluation
-promotion
site
nine
selection
team
$125
feedback
dollar
of
on all
feedback,
will
gift
of
necessary
collaborate
those
gift
cards
(e.g.,
and
interviews,
card
that
for
incentives
CDC
lessons
and
signed
any
approvals
additional
determine
learned
focus
up
for
and
groups,
post
research
(i.e.,
about
the
expressed
-promotion
OMB).
best
(estimated
start)
TBD
class
based
start
date
on
Fall
launch
2025
and
marketing
surveys).
(e.g.,
the
in
for
more
interviews
a
is
provision
Deliver
The
breakdown
demonstration
the
final
of
the
overall
study
actual
cost and
site will
costs
for
level
complete
the
production
of
effort
the ICF-provided
report
and
template
of
hours.
that
details
itemized
No
after
materials.
later
launch
than
12
of
-weeks
the
number
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
\I
,ICF
ICF
feedback.
Post
of the
-promotion
will
develop
Fall
will
evaluation
a
brief
send
1
-3
the
-page
report
efforts.
reporting
report
to the
detailing
demonstration
insights
from
study
the
site
post
following
-promotion
the
conclusion
(estimated
start)
TBD
class
based
start
date
on
Fall
launch
2025
and
ICF
2025
messaging
[Optional]
The
questions
The
demonstration
demonstration
Formative
are appropriate
study
study
Research
site
would
for
team
Electronic
for Phase
and
be responsible
ICF
Health
2
will
collaborate
Record
for
recruitment
intervention
to
plan
out
outreach
formative
what
and
types
research.
connection.
of
TBD
of
phase
based
1.
on conclusion
[Optional]
recommendations
intervention.
The
demonstration
Strategy
Planning
study
for
engaging
for
site team
Phase
health
and
care
ICF
2
will
provider
collaborate
to plan
organizations
out the
to integrate
needed
an
EHR
and
TBD
of
phase
based
1.
on conclusion
Milestone Payment Schedule
Subcontractor will receive a payment of $16,000 for the partnership in the demonstration study. The site can also receive
incentive assistance in the form of up to $3,625 in Vanilla Visa gift cards. The payment schedule is detailed below based
on completion of certain milestones:
Milestone
Anticipated
Payment
Date(s)
Payment Amount
Final
Execution of
Study
and
• Successful
Payment: 7,500.00
Attending
Kick
-Off
Meeting
Subcontractor
Additional
Incentive gift
cards*:
Registration,
Agreement
•
Up
promotional
to
one
hundred
help
(if
$25 gift
needed)
cards
for
execution, and
• Up
to
Nine
$125
gift cards
for
9 interviews
receipt and
Total:
7,500.00
acceptance
of
+ up to $3,625 for
incentives for post -feedback
Subcontractor
interviews
Invoice by
ICF
Establishing
activities
the
to develop
and
•
Estimated
July/August
2025,
Payment: 4,250.00
materials
after
acceptance
receipt
and
of
Total
breakdown:
4,250.00
Subcontractor
Invoice
by
ICF
Conclusion
of
all
SOW criteria
• Within
2 weeks
after
Payment: 4,250.00
receiving
cost
report,
receipt
acceptance
and
and
and
labor
finalized
after
of
Total
breakdown:
4,250.00
Subcontractor
Invoice
by
ICF
AGREEMENT CEILING AMOUNT
$16,000.00
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER ,ICF
FEES, PAYMENT, AND INVOICING
a. In consideration of Services performed, Contractor will pay Subcontractor the fees set forth in Milestone Payment
Schedule, at the Anticipated Payment Dates upon receipt of a proper invoice from Subcontractor that is approved
by Contractor.
b. Subcontractor is not authorized to perform and shall not receive compensation for performing Services, making
expenditures; and/or incurring obligations which exceed the amounts set forth in Milestone Payment Schedule.
Unless otherwise expressly specified herein or solely to the extent provided in a formal change order issued by an
authorized ICF procurement representative, such amount set forth in Milestone Payment Schedule is the maximum
amount for which Contractor shall be liable. Contractor shall not be obligated to use all Services or assistance
referenced herein and Contractor shall pay only for those Services authorized by Contractor pursuant to the terms
of this Agreement, and actually rendered by Subcontractor.
c. Subcontractor shall submit invoices upon completion of each Milestone indicated in the Milestone Payment
Schedule, by the 10' day of the following the month in which the Services were performed. The invoiced period
shall match the period for monthly progress reporting, if applicable.
d. Subcontractor invoices shall include, at a minimum, the following information:
• ICF Entity indicated on Page 1
• ICF PM
• Payee Name and Remittance Address (as provided on W9/W8)
• Invoice Number and Date
• Agreement Number No.
• ICF Project No.
• Invoice/Billing Period Dates
• Description of Goods/Services
• Billed Amounts and Other Direct Cost Amounts Being Billed
• Remaining Amount to be Billed (funded value less cumulative amounts billed)
• Certification: "I hereby certify that, to the best of my knowledge and belief, all payments requested are
correct, accurate, and complete, that payment therefore has not been received and that all amounts
requested are for the appropriate purposes and in accordance with this Agreement."
e. Invoices shall be in non -editable format, should include the information detailed in Section d above, and be
submitted to invoiceintakegicf.com for processing.
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
APPENDIX A - GENERAL TERMS & CONDITIONS
1. INDEPENDENT CONTRACTOR Subcontractor shall
perform its obligations under this Agreement as an independent
contractor and not an employee, agent, or representative of
Contractor. Subcontractor agrees that it is not an agent, joint
venturer, partner, or employee of ICF, nor is it entitled to any
employee benefits provided by ICF. Subcontractor shall be solely
responsible for all employment -related wages, benefits, FICA,
federal and state unemployment, social security, withholding and
payroll taxes, and other taxes and payments as required by law,
for itself and any persons it employs. Subcontractor shall perform
the services and provide the necessary facilities, personnel,
materials, equipment, and shall otherwise do all things necessary
for the performance of the Statement of Work, and shall be solely
responsible for its own financial obligations to third parties and
to its employees and contractors. Subcontractor shall be solely
responsible for its own acts and the acts of those employed by,
contracting with, or otherwise performing on its behalf with
regard to the Services or other work performed under this
Agreement. Further, Subcontractor agrees that it shall not be
covered by any Contractor insurance or benefits, including but
not limited to Worker's Compensation, Professional Liability,
General Liability, Employer's Liability, Automotive Liability, and
Unemployment Compensation. Subcontractor shall protect,
defend, and hold Contractor harmless, to the extent permitted
under Colorado Law, from any claims or penalties asserted or
assessed against Contractor by any person or governmental
entity relating to Subcontractor's responsibilities as an
independent contractor.
2. TAXES AND LIENS Subcontractor agrees to pay and
discharge all valid taxes, lienable claims, claims for labor, services,
materials, charges or other materials imposed, in connection with
or otherwise resulting from Subcontractor's provision of Services
or performance of its obligations under this Agreement. Except
as otherwise specified in this Agreement, the fees for Services
and Deliverables shall include all applicable federal, state, local
sales, provisional, municipal, use, privilege, and other taxes or
assessments, however designated or levied, which are required
pursuant to any applicable law, rule, or regulation and relate to
any amounts payable under this Agreement and any required
taxes or amounts in lieu thereof paid or payable by
Subcontractor, exclusive of taxes based on Subcontractor net
income or net worth, which still remain Subcontractor's
responsibility..
3. CONFIDENTIAL INFORMATION Proprietary or
confidential information ("Confidential Information") developed
or disclosed by either party under this Agreement shall be clearly
labeled and identified as Confidential Information by the
disclosing party at the time of disclosure.
Confidential Information shall not be disclosed by the receiving
party except to those individuals who need access to such
Confidential Information to ensure proper performance of the
Services.
Neither party shall be liable for disclosure or use of Confidential
Information which: (1) was known by the receiving party at the
/ICF
time of disclosure due to circumstances unrelated to this
Agreement; (2) is generally available to the public without breach
of this Agreement; (3) is disclosed with the prior written approval
of the disclosing party; or (4) is required to be released by
applicable law or court order, provided the party receiving such
order for release provides prior notice to the other party.
Each party shall return to the disclosing party all of the disclosing
party's Confidential Information relating to this Agreement upon
request of the disclosing party or upon termination of this
Agreement, whichever occurs first. Each party shall have the
right to retain a copy of the Confidential Information for its
internal records and subject to ongoing compliance with the
restrictions set forth in this Section. This Section shall survive
termination of this Agreement.
4. DELIVERABLES
Works Made for Hire. With the exception of Subcontractor
Knowledge Capital and/or Third -Party Intellectual Property
embodied in the Deliverables, all right, title, and interest in
Materials and/or Deliverables, as part of, or produced in
performing, the Services shall be and remain Contractor's sole
and exclusive royalty -free property of, and shall vest with,
Contractor or such party as Contractor may designate. The
Materials and/or Deliverables shall be deemed to be "work made
for hire" in the course of Subcontractor's performance hereunder.
Subcontractor shall make full and prompt disclosure to
Contractor of all Deliverables and/ or Materials and deliver all
Deliverables and/ or Materials to Contractor. To the extent any
Deliverable contains Client's or Subcontractor's Confidential
Information, it shall be subject to Section 3 hereof ("Confidential
Information").
Assignment. If for any reason the Materials and/or Deliverables
are not considered "works made for hire" owned by the
Contractor by operation of law, Subcontractor hereby
unconditionally and irrevocably conveys and assigns to
Contractor and its successors all right, title and interest including
copyright and other intellectual property rights, in and to the
Materials and/or Deliverables in all media (whether now known or
later developed) throughout the world in perpetuity.
Subcontractor hereby irrevocably assigns to Contractor all moral
rights in the Materials and/or Deliverables. Subcontractor agrees
not to assert and hereby irrevocably waives any moral rights that
it may have in the Materials and/or Deliverables. Subcontractor
further assigns to Contractor all rights in any supporting data and
material used in creating the Materials and/or Deliverables, if and
to the extent that the copyright is not held by others.
Subcontractor shall defend and indemnify Contractor against any
Claim or Loss in connection with or otherwise related, directly or
indirectly, to the infringement of any patent, trademark or
copyright by or arising out of or otherwise connection with
Subcontractor or performance under this Agreement.
5. CONFLICTS of INTEREST Subcontractor warrants that
neither its entering into this Agreement nor its performance of
any Services and/or delivery of Deliverables hereunder will result
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
in an actual, apparent or potential conflict of interest on its part.
For purposes hereof, a conflict of interest includes, but is not
limited to, circumstances under which Subcontractor or its
subcontractors may become biased with respect to the Services
or Deliverables, gain an unfair competitive advantage or otherwise
not be in the best interest of the Contractor with respect to the
Services. Subcontractor further warrants that it will promptly
notify Contractor of any such actual, apparent or potential
conflict of interest of which it becomes aware after the Effective
Date of this Agreement. Failure of Subcontractor to promptly
disclose same shall constitute a material breach of this
Agreement. Subcontractor further warrants that entering into this
Agreement will not conflict with any existing agreements or
arrangement to which the Subcontractor is party.
6. LICENSES and PERMITS Subcontractor represents and
warrants that it has or shall, in advance of performance hereunder
and at its sole expense, obtain all licenses, certifications, permits,
approvals, inspections and other authorizations required to
perform the Services. Inability or failure to obtain such items shall
not excuse Subcontractor's failure to strictly comply with the
terms hereof.
7. CHANGES Neither this Agreement, nor any term,
condition, or provision hereof, may be altered, changed, or
modified in any manner whatsoever except upon the mutual
agreement of both parties evidenced by a modification to the
Agreement that is signed by both parties, with the exception of a
unilateral action by Prime Contractor to effectuate terminations
or suspension pursuant to Article 14 of this Appendix
(Termination & Suspension) or to enforce other clauses in the
Prime Contract, or this Agreement.
8. PERFORMANCE BY SUBCONTRACTOR, Subcontractor
shall furnish services, material and equipment at the time and
place agree upon and continue performance diligently without
delay, in a safe, proper, and workmanlike manner, in conformity
with the requirements of this Agreement. Subcontractor shall
immediately remove from performing the Services any employee
or other Personnel (including employees of approved lower tier
subcontractors or lower -tier consultants) at Contractor's
request. Subcontractor acknowledges and agrees that any such
request relates specifically to performance on the project that is
the subject of this Agreement and that all decisions regarding the
employment of employees or contracting of other Personnel are
made exclusively and solely by the Subcontractor and its lower -
tier subcontractors. Subcontractor shall promptly recommend a
suitable replacement for Contractor's approval. Persons so
removed shall not be used in the future for the Services without
the express written authorization of the Contractor.
Subcontractor warrants that it will only utilize personnel and
approved lower tier subcontractors who are adequately trained
and experienced to properly perform the Services in a safe and
efficient manner.
9. INSPECTIONS Contractor and/or its Client may inspect
and otherwise evaluate the Services or Deliverables at any
reasonable time and place, but such review or approval is for
Contractor's sole benefit and shall not relieve Subcontractor from
its representations and obligations set forth in this Agreement.
41ICF
10. WARRANTY Subcontractor warrants that all services
performed under this Agreement will be performed with the
exercise of reasonable skill, care and diligence and based upon
the standard of a fully qualified professional, be free from defects,
conform to the requirements of the Agreement, and be
performed in strict compliance with any regulatory or
international standards specified in the Statement of Work for
this Agreement. Any services corrected or re -performed will be
covered by this warranty.
If Subcontractor breaches this Warranty provision, Prime
Contractor may elect, at its sole discretion and with no increase
in the Agreement price to, require Subcontractor either to correct
or re -perform, at Prime Contractor's election, defective or
nonconforming services promptly or equitably reduce the
Agreement price.
11. AUDIT RIGHTS Subcontractor agrees to maintain
complete documentation and records concerning compliance or
noncompliance with applicable Law and the terms and
conditions of this Agreement. Throughout the Term of the
Agreement, and for the longer of either (i) three (3) years, or (ii)
as required by applicable law, Subcontractor will maintain and
allow Contractor, during normal business hours, to examine, audit,
and make copies of all documentation and records of
Subcontractor, and otherwise cooperate fully to assist with any
audit conducted relating to compliance or noncompliance with
the terms of this Agreement or applicable law. If Subcontractor
maintains in electronic format, Subcontractor will provide its
accounting records to Contractor in suitable electronic data
format.
12. TERMINATION Contractor may terminate this
Agreement at any time, with or without cause in whole or in part
and require Subcontractor to cease performance of the Services.
In such event, Subcontractor shall be paid only for the Services
properly performed prior to such termination. Subcontractor
waives all claims for profits not earned as a result of such
termination.
13. STOP -WORK Notwithstanding any other provision
hereof, Contractor may, by notice to Subcontractor, suspend all
or any portion of the Services. Subcontractor shall stop all such
Services immediately upon receipt of Contractor's stop -work
order and shall promptly resume the Services after receipt of
direction from the Contractor to proceed. Stop -work orders
issued for conditions or circumstances unrelated to the
Subcontractor's fault or negligence shall result in a reasonable
adjustment in the contract schedule.
14. INDEMNIFICATION To the extent not restricted by
applicable law, Subcontractor shall defend, indemnify and hold
the Client, Contractor, Contractor's Affiliates, and each of their
respective directors, officers, agents and employees harmless
against any injury, death, damages, suit, Claim or Loss, including
without limitation expenses, credits, refunds, costs, fines,
penalties and attorney's fees incurred by the indemnified parties
arising from, in connection with, or related to, directly or indirectly,
this Agreement, Subcontractor's performance hereunder, the
failure to perform or the breach thereof, failure to comply with
applicable laws or regulations, alleged infringement of Intellectual
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
Property, except to the extent that such Loss was caused by the
gross negligence or willful misconduct of the Contractor.
This provision shall survive termination of this Agreement.
15. INSURANCE Subcontractor shall maintain workers'
compensation (statutory minimum) and comprehensive general
liability insurance in form and amount(s) reasonable and
customary for the industry in which Subcontractor is engaged.
Subcontractor's insurance shall not be deemed to limit
Subcontractor's liability.
16. DISPUTES The Parties agree to attempt in good faith to
first resolve any dispute arising out of or relating to this
Agreement through negotiations between authorized
representatives of each respective Party in the normal course of
business, before resorting to the pursuit of any other remedies
available at law or in equity.
Each Party agrees to bear its own costs related to resolving any
dispute arising under or related to this Agreement. Pending any
decision, appeal or judgment referred to in this provision or the
settlement of any dispute arising under this Agreement, the
Parties shall proceed diligently with the performance of this
Agreement.
17. ASSIGNMENT/SUBCONTRACTING Neither the
Agreement nor any duty or right under the Agreement shall be
delegated or assigned by Subcontractor to another party without
the prior written consent of Contractor.
Any assignment or transfer not in accordance with this Article
shall be in a material breach of the Agreement, which shall entitle
Contractor to terminate the Agreement immediately.
18. PUBLICITY and PUBLICATIONS Subcontractor may not
publicize this Agreement, or its subject matter or state that
Contractor and/or Client has approved or endorsed any Services
or Deliverables Subcontractor has provided or provides as
contemplated by this Agreement. No public releases including
those for news, advertising, information, technical or scientific
purposes relating to this Agreement shall be issued by
Subcontractor without Contractor's prior written consent.
19. ORDER of PRECEDENCE In the event of a conflict in the
terms and conditions of the contract documents, the following
order of precedence shall apply:
• General Terms and Conditions (this Appendix A)
(*)
• The/This Agreement (*)
• The Scope of Work
• Fee Schedule
• Other contractual documents
References to "the Agreement," "this Agreement," "the
Subcontract" or "this Subcontract" shall refer to the base
subcontract agreement to which this Appendix A is appended.
2O. NON -WAIVER Failure of Contractor to insist on strict
performance of any of the terms and conditions contained in this
Agreement shall not constitute or be construed as a waiver or
relinquishment of Contractor's right to subsequently require
strict compliance with such terms and conditions.
\I
,ICF
21. SEVERABILITY If any part of this Agreement shall be
held by a court of competent jurisdiction to be invalid, illegal, or
unenforceable as to particular provisions, this Agreement shall
remain in full force and effect as to the remaining provisions.
22. COMPLIANCE with LAW
Subcontractor specifically agrees to comply with all Federal and
state laws and regulations of Subcontractor/Contractor conduct
such as procurement integrity regulations, and post -government
service employment regulations including, but not limited to 41
U.S.C. 423 and 18 U.S.C. 207 which apply to Subcontractor,
Subcontractor's employees, or the work performed by
Subcontractor under this Agreement.
Subcontractor shall not offer or provide any bribe or kickback to
any person, nor shall Subcontractor offer or provide any gratuity
of any type or nature, including the purchase of meals, to any
Federal, State, or local government employees or officials.
Subcontractor hereby acknowledges that at the time of entering
into this Agreement neither it nor any person employed by or
representing Subcontractor is (1) presently debarred, suspended,
proposed for debarment, declared ineligible or voluntarily
excluded from participation in any program sponsored by a
Federal, State or local department or agency; or (2) under current
investigation for a crime or otherwise engaged in conduct for
which an entity or individual can be debarred by any Federal,
State, or local department or agency. Subcontractor represents
that it will immediately notify Contractor of any inquiry or
commencement of any debarment proceedings from any
government procurement activity; and any suspension,
debarment, pending debarment charges or criminal convictions
or notice thereof received during the performance of this
Agreement. Upon receiving such written notice of inquiry or
commencement of any such proceeding from Subcontractor,
Contractor shall have the right to immediately terminate this
Agreement.
23. GOVERNING LAW The validity, construction, scope, and
performance of this Agreement shall be governed by the laws of
the State of Colorado without regard to its conflict of law
principles, except as to any provisions hereof which are governed
by the laws or regulations of the United States of America, as to
which provisions such laws of the United States shall govern
provided, however, that the Parties hereby expressly agree that
any resulting award shall not be governed under the terms and
conditions of the U.N. Convention on Contracts for the
International Sale of Goods. In the event an action or proceeding
is commenced with respect to this Agreement, each party shall
be responsible for their own legal fees and expenses.. Each Party
expressly and irrevocably consents that any suit, action, or
proceeding arising out of or related to this Agreement and
brought by either party will be instituted in a state or federal court
sitting in Weld County or federal court in Denver., and both Parties
further expressly waives any objection that it has or may have to
the jurisdiction of such courts. Further, each Party hereby waives
its right to a jury trial in any action arising hereunder Further, each
Party waives any objection based on improper venue or forum
non conveniens.
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
24. NO AGENCY Except as specifically set forth otherwise,
it is agreed and understood that neither party hereto is, by this
Agreement or anything herein contained, constituted or
appointed agent or representative of the other for any purpose
whatsoever, nor shall anything in this Agreement be deemed or
construed as granting either party any right or authority to
assume or to create any obligation, warranty or responsibility,
express or imp'ied, for or in behalf of the other.
25. BUSINESS ETHICS & CONDUCT Contractor is
committed to conducting its business free from unlawful,
unethical, or fraudulent activity. Subcontractor, and each of its
personnel, and subcontractors that perform Services or provide
Deliverables hereunder will (i) conduct their activities fairly,
impartially, and in an ethical and proper manner; and (ii) not
engage in any personal, business, or investment activity that may
be defined as a conflict of interest, whether real or perceived
Accordingly. Subcontractor by execution of this Agreement,
certifies that Subcontractor will adhere to Contractor's published
Code of Business Ethics and Conduct A copy of ICF's Code of
Business Ethics and Conduct can be found at
htwww.icf.comi-imedifjfilemicf[other-dots/ethics1i_e_f-
code-of-business-gnd-ethics web_externS_d_f or provided,
which is available upon request To report a related serious
concern or violation, please contact the ICE Ethics Hotline toll -
free at 866-373-6934 or by submitting a claim via by contacting
the ICF online ethics database at
http Bicfi silent:Thistle com ethfeedbacv'index isp. You should
use the Hotline only to make a good faith claim, as Contractor
takes all allegations seriously.
26. DATA PROTECTION COMPLIANCE The Parties shall
comply with their respective obligations under applicable data
privacy and data security laws and regulations (together, the
"Data Protection Laws")
Where, in connection with this Agreement, Subcontractor Treats
Personal Data, Subcontractor shall. (i) maintain throughout the
Term the appropriate data privacy and data security measures,
policies, and procedures that are designed to comply with the
Data Protection Laws; (ii) Treat Personal Data solely to provide the
Services hereunder and for no other purpose; (iii) only grant
"need to know" Personnel access to Personal Data; (iv) not
disclose Persoral Data to any person or third party except as set
forth in this Agreement or as required by law or with Contractor's
prior written consent, (v) implement all commercially reasonable
practices to prevent misuse, destruction, loss, theft, intrusion,
attack, computer virus infection, unauthorized Treatment, or
similar activities; (vi) preserve the integrity of all Personal Data
and system information on systems and in databases maintained
by Subcontractor in transfer to, transfer from, or while at rest
with Subcontractor (including, but not limited to, using industry
standard encryption technology); and (vii) immediately notify
Contractor if it becomes aware of any misuse of Personal Data or
actual unintended or unauthorized access of any Subcontractor
system that may Treat Personal Data produced under, provided
under, or related to this Agreement.
Subcontractor warrants that it has a formal written information
data privacy and data security program or an equivalent program,
which is incorporated herein to this Contract by reference.
27. CLOSEOUT Unless otherwise requested from
Contractor, the Subcontractor shall provide Contractor, within
forty-five (45) calendar days following the end date of this
agreement, or any modification issued thereunder, a completed
closeout certification attached hereto as Appendix F with its
"Final" invoice submission.
In the event Subcontractor fails to submit the required closeout
information and documentation within ninety (90) calendar days,
such failure shall constitute Subcontractor's de facto agreement
that the amounts paid to date by Contractor pursuant to this
Agreement, as determined solely by Contractor's records, shall
constitute the full, complete and final extent of Contractor's
financial obligation to Subcontractor under this agreement.
Subcontractor further certifies and warrants its responsibility to
maintain all technical, contractual, and financial records
pertaining to this Agreement for a period of ten years following
final payment from Contractor
26. FORCE MAJEURE Neither Subcontractor nor
Contractor shall be liable in any way for failure to perform any
provision of this Agreement (except payment of monetary
obligations) if such failure is caused by any law, rule, or regulation,
or any cause beyond the control of the party in default Should
such acts or events occur that a Party believes should be covered
by this provision, such Party shall provide notice of such position
to the other Party promptly upon the occurrence of the act or
event, reasonably specifying all facts related thereto, the
anticipated consequences therefrom, and any proposed actions
to be taken in mitigation of the adverse consequences The
parties agree to use commercially reasonable efforts to address
the acts or events that are covered by this provision in order if
Contractor determines the work is to be resumed
29. SURVIVAL The provisions of this Agreement that by
their terms, nature or context survive the termination or
cancellation of the Agreement (including without limitation, all
warranty, confidentiality, publicity, audit, and indemnification
provisions) will survive the termination or expiration of this
Agreement as well as any Change of Control.
This Purchase Order is subject to all the attached Purchase Order General Terms & Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
PURCHASE ORDER
,ICF
IN WITNESS WHEREOF, The parties acknowledge that they have read this Agreement, understand it, and agree to be
bound by its terms. Unless expressly and specifically provided for in this Agreement, this Agreement and the exhibits,
appendices and other attachments incorporated herein by reference shall constitute the entire agreement of the parties
regarding the subject matter hereof. There are no provisions, terms, conditions, or other obligations other than those
contained in the Agreement, and this Agreement supersedes all prior agreements, whether written or oral, relating to the
subject matter hereof. No modification or other change to this agreement shall be binding unless such modification or
change is in writing and signed by an authorized representative of each party.
FOR: ICF INCORPORATED L.L.C.: FOR: WELD COUNTY DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
Digitally signed by
Darrell L. Derr
Date: 2025.05.21
10:49:36 -04'00'
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO:
x_CnViaa
Darrell L. Derr, Sr. Subcontracts Director Perry L. Buck, Chair
Name (Typed or Printed)
05/21/2025
Name & Title (Typed or Printed)
MAY 1 2 2025
Date Date
Attest:
Clerk of the Board
By:
70,k
Deputy Clerk to the Board
This Purchase Order is subject to all the attached Purchase Order General Terms (SI Conditions (Appendix A), unless
otherwise indicated within the body of the Purchase Order. Please reference this Purchase Order Number on all
correspondence pertaining to this procurement, including packing slips and invoices.
2OZS-IZS�
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�ICF ICF Supplier Registration Information Form
COMPANY NAME
Legal Name (As it appears on Line 1 of W8/W9 Form):
Doing Business as Name:
(if applicable)
Weld County Department of Public Health and Environment
Weld County Department of Public Health and Environment
SUPPLIER HEADQUARTERS ADDRESS
Address Line 1:
Address Line 2:
Address Line 3:
City:
Zip Code:
1555 N. 17th Ave.
Greeley
80631
COMPANY INFORMATION
Legal Structure:
State/Province:
Country:
CO
United States
O Corporation (Corp.) or Incorporated(Inc.)
O Limited Liability Company (LLC)
O Professional Limited Liability Company(PLLC)
O Sole Proprietorship
O Independent Consultant
O Limited Liability Limited Partnership (LLLP)
Professional Corporation (PC)
Limited Partnership (LP)
Limited Liability Partnership (LLP)
Non-profit Organization
O
Is your company headquarters based outside the United States? Q No ()Yes
U S Federal Tax ID:
84-6000813
U S Social Security Number (SSN) (Only to be used by Independent
Consultant):
International ID (International Suppliers -Enter your business registration number or similar):
Unique Entity Identifier (UEI):
Supplier Tax Form*:
Form W9 (Rev. Mar. 2024)
Form W-8 BEN, W-8 BEN -E, W-8EC1, W-8 EXP
or W-8 IMY (Rev. Oct. 2021)
*Completed applicable Tax Form (per above checked box) must be returned to ICF with this Supplier Registration Form.
V2.07.24.2024 Company sensitive. For internal use only.
1
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'ICF ICF Supplier Registration Information Form
Supplier Business Size:
All suppliers, including independent consultants, should refer to the North American Industry Classification System (NAICS) Codes
(U.S. Small Business Administration Table of Size Standards) to complete this table.
List
NAICS
and
Secondary
Primary
any
Codes
NAICS
Code
NAICS
Description
Business
on
NAICS
Size
Code
based
Primary
Secondary
923120
Community
health
programs
adrrOSmall
()Small
°Large
°Large
Secondary
()Small
O
Large
Secondary
()Small
O
Large
Secondary
()Small
O
Large
Secondary
Small
°Large
Secondary
O
Large
Small
Additional Supplier Business Classifications (check all that apply):
Diverse Business Enterprise (DBE)
Woman -Owned Business Enterprise (WBE)
Minority Business Enterprise (MBE)
Veteran -Owned Business Enterprise (VBE)
Mentor Protege Program
Alaskan Native Corporation (ANC) and
Indian Tribes
Small Disadvantage Business
Small Minority -Owned Business
Certification Date:
(As applicable)
Supplier Signature: Kelly Martinez
i
Women -Owned Small Business
Veteran -Owned Small Business
Lesbian, Gay, Bisexual, Transgender, or
Oueer Enterprise (LGBTQ)
8(a)
Historical Black Colleges and Universities
(HBCU)/ Minority Serving Institutions (MSI)
Historically Under -Utilized Business Zone
(HUBZone)
Service -Disabled Veteran -Owned Small
Business (SDVOB)
AbilityOne Non -Profit
Certification Number:
(As applicable)
Date: 04/25/2025
V2.07.24.2024
Company sensitive. For internal use only. 2
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®ICF ICF Supplier Registration Information Form
Supplier Business Classification Definitions:
8(a)
Small disadvantaged businesses that are certified as 8(a) by the Small Business Administration
Ability One Program
Nonprofit agency or organization creates jobs and training opportunities for people who are blind or
who have other severe disabilities
Diverse Business Enterpnse (DBE)
DBEs are for-profit small business concerns where socially and economically disadvantaged individuals
own at least a 51% interest and control management and daily business operations
HUBZone business
Small business operating in a historically underutilized business zone owned and controlled by one
or more U S citizens where at least 35 percent of its employees reside in a HUBZone HUBZone
businesses must be certified by the Small Business Administration
Historically Black Colleges and Universities
Historically Black colleges and universities (HBCUs) are institutions that were established prior to 1964
with the principal mission of educating Black Americans These institutions were founded and
developed in an environment of legal segregation and, by providing access to higher education, they
contributed substantially to the progress Black Americans made in improving their status
LGBTQ-owned business
At least 51 percent LGBT owned, operated, and controlled The business must also
• Exercise independence from any non-LGBT business enterpnse
• Have its principal place of business (headquarters) in the UnitedStates
• Have been formed as a legal entity of the UnitedStates
Mentor Protege Program
A program that pairs a mentor with a protege for the purpose of assisting the protege to compete
for Federal prime contracts and subcontracts
Minority Business Enterprise (MBE)
At least 51 percent owned and operated by a U S citizen or citizens, and whose ancestry is
• Asian -Pacific American - United States citizen whose origins are in Japan, China, the Philippines,
Vietnam, Korea, Samoa, Guam, the U S Trust Territory of the Pacific Islands (Republic of Palau),
the Northern Manana Islands, Laos, Kampuchea (Cambodia), Taiwan, Burma, Thailand, Malaysia,
Indonesia, Singapore, Brunei, Republic of the Marshall Islands, or the Federated States of
Micronesia
Black American - United States citizen having origins in any of the Black African racialgroups
Hispanic American - United States citizen of Spanish culture whose origins are from
Mexico, South America, Central America or the Caribbean Island, regardless of race
Native American - American Indian, Eskimo, Aleut, and Native Hawaiian
Subcontinent Asian American - United States citizen whose origins are inlndia,
Pakistan, Bangladesh, Sri Lanka, Bhutan or Nepal
• Indian Tribe - Any Indian tribe, bank, nation, or other organized group or community of Indians,
including any Alaska Corporation (ANC) as defined in 13 CFR 124 which is recognized as eligible
for the special programs and services provided by the U S to Indians because of their status as
Indians, or which is recognized as such by the State in which such tribe, band, nation, group, or
community resides
Native Hawaiian Organization - Any community service organization serving Native Hawaiians
in, and chartered as a not -for-profit organization by, the State of Hawaii, which is controlled by
Native Hawaiians, and whose business activities will principally benefit such Native Hawaiians
V2 07 24 2024
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®ICF ICF Supplier Registration Information Form
Service -disabled Veteran -owned Business
At least 51 percent owned, managed, and controlled by one or more individuals with a service -
connected disability
Small Business Enterprise
Independently owned and operated and not dominant in its field of operations The size will vary
from industry to industry and is defined by the Small Business Administration for Federal projects or
by each individual State
Small Disadvantaged
At least 51 percent owned by one or more individuals who are both socially and economically
disadvantaged This category can include a publicly owned business that has at least 51 percent of its
stock owned by one or more socially and economically disadvantaged individuals and whose
management and daily business are controlled by one or more such individuals
Veteran -owned Business Enterprise (VBE)
At least 51 percent owned, managed, and controlled by one or more veterans or service -disabled
veteran(s) The veteran owner(s) must have full control over the day-to-day management, decision -
making, and strategic policy of the business The owner must also possess managerial expenence of the
extent and complexity needed to manage the business, be the highest -compensated employee (unless
the veteran can explain lower compensation as a benefit to the business), devote full-time work to the
business, hold the highest officer position in the business, and be able to exercise independent business
judgment A veteran is a person who has served on active duty with the Army, Air Force, Navy, Marine
Corps, or Coast Guard for any length of time and who was discharged or released under conditions other
than dishonorable Reservists or members of the National Guard called to federal active duty or disabled
from a disease or injury incurred or aggravated in the line of duty or while in training status, also qualify
as veterans
Women's Business Enterprise (WBE)
A woman -owned business, regardless of size, that has received certification from the Women's
Business Enterprise National Council or other recognized certification agency
Women -owned business
At least 51 percent owned, managed, and controlled by one or more women Acceptable certifications
are provided by the Women's Business Enterprise National Council, the National Women Business
Owners Corporation, and by federal, state, and local governments
V2 07 24 2024
Company sensitive For internal use only 41
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�ICF ICF Supplier Registration Information Form
Environmental Impact & Sustainability:
Understanding the Environmental Impact of our third party providers is important to ICF , please
answer the following questions to help ICF understand you company's sustainability practices.
For additional information, please refer to the U.S. Environmental Protection Agency's Green Power
Markets
webpage
. Additional
information
can
be found
under
Glossary
within
the
Resources Section.
# Field
description:
- --
-
Field
response
type:
1.
Do
operations?
you measure Green
House
Gas (GHG)
emissions of
your
0
Yes
O
No
1.a.
If
yes, what
is the
most
recent
year measured?
1.b.
field)
If
scope
Scope
owned
Scope
generation
heat
Scope
Scope
reporting
downstream
Scope
yes,
provide
Emissions
controlled
Emissions
Emissions
emissions)
company,
emissions,
of
emissions.
GHG
purchased
consumed
-
-
-
that
please
emissions
Emissions
Indirect
All
including
indirect
the
occur
For
or
visit
reporting
emissions
acquired
by
more
reporting
in
both
by
from
the
emissions
the
metric
information
upstream
GHG
operations
company.
electricity,
value
from
company.
ton
Protocol
(excluding
chain
for
the
that
and
about
each
(Text
steam,
of
FAQ.
the
are
scope
scope
scope
1
2
3
or
—
1
or
2
cooling
3
2
3
by
2.
What
business
is included
travel,
in your
employee
scope
commuting,
3 emissions
etc.)
(e.g.,
3.
company
Have
you calculated
is responsible
the
during
GHG
the
emissions
most
for
recent
which
calendar
your
year?
Q Yes
No
Q
3.a.
If
responsible?
yes,
for
what
quantity
of
metric
tons is your company
4.
Do
Disclosure
report
you
report
or
other
Project
your
sustainability
GHG
(CDP)
emissions
or
a
reporting?
corporate
externally
citizenship
to Carbon
QYes
Q
No
in
4.a.
If
yes, where
do
you report?
Please
provide
a link.
5.
Do you set carbon
reduction
targets?
OYes
0
No
5.a.
If
Based
yes,
are your
Target initiative
targets
externally
(SBTi)or
verified
another
organization?
by Science
()Yes
0
No
5.b.
If
verification
your
targets are verified
(e.g., (e.g.,
(SBTi)
externally,
(for
describe
1.5 degrees
the
C)
5.c.
targets?
What
is your governance
process
to ensure you meet
6.
What
environmental
is your company
footprint?
doing
to reduce
your
V2.07.24.2024
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11CF ICF Supplier Registration Information Form
TO BE COMPLETED BY ICF BUYER/SUBCONTRACT ADMINISTRATOR
ICF Accounting System O CP1.0
Payment Terms
O CP2.0
If non-standard Payment Terms O Yes O No
have these terms been approved?
ICF Internal Operations or Corporate Contact
ICF Internal Buyer/SCA Contact
Please provide this supplier information form to the Supplier Setup Team via applicable email at:
Costpoint 1.0: icfvendorsetup@icf.com or Costpoint2.0: vendorsetup@icf.com
V2.07.24.2024
Company sensitive. For internal use only. 6
i
Form
-9
(Rev. March 2024)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Go to www.irs.gov/FormW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
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1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded
entity's name on line 2.)
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2 Business name/disregarded entity name, if different from above
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check
only one of the following seven boxes.
•
•
Individual/sole proprietor C corporation [1 S corporation ❑ Partnership ri Trust/estate
LLC Enter the tax classification (C = C corporation, S - S corporation, P = Partnership)
Note: Check the "L l C" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the approprate
box for the tax classification of its owner.
l iC Other (see instructions)
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3b If on line 3a you checked "Partnership" or "Trust/estate,'' or checked "LLC" and entered "P" as its tax classification,
and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
this box if you have any foreign partners, owners, or beneficiaries. See instructions . .
5 Address (number, street, and apt. or suite no.). See instructions.
I) Go //O" S �-
6 City, state, and ZIP code
(7-1(2-akeiLty Cv 8
7 List account number(s) here (optional)
a
4 Exemptions (codes apply only to
certain entities, not individuals;
see instructions on page 3):
Exempt payee code (if any)
Exemption from Foreign Account Tax
Compliance Act (FATCA) reporting
code (if any)
(Applies to accounts maintained
outside the United States.)
Requester's name and address (optional)
Part 1
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
INS
or
Employer identification number
8
6
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3
Part I
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than interest and dividends, you arr not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
Sign
Here
Signature of
U.S. person
General Instructions
Date
G /zw2--;
Section references are to the Internal Revenue Code unless otherwise
voted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
What's New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and enter its appropriate tax classification.
New line 3b has been added to this form. A flow -through entity is
required to complete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow -through entity in which it has an ownership interest. This
change is intended to provide a flow -through entity with informatior
regarding the status of its indirect foreign partners, owners. or
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file ar
information return with the IRS is giving you this form because they
Cat. No. 10231X
Form W-9 (Rev 3-2024)
Contract Form
Entity Information
Entity Name* Entity ID*
ICF INCORPORATED LLC @00049802
Contract Name*
DIABETES PREVENTION PROGRAM MARKETING
CAMPAIGN GRANT
Contract Status
CTB REVIEW
n New Entity?
Contract ID
9408
Contract Lead*
BFRITZ
Contract Lead Email
bfritz@weld.govtHealth-
Contracts@weld.gov
Contract Description*
DIABETES PREVENTION PROGRAM MARKETING CAMPAIGN GRANT
Contract Description 2
Contract Type*
AGREEMENT
Amount*
$16,000.00
Renewable*
NO
Automatic Renewal
Grant
IGA
Department
HEALTH
Department Email
CM-Healthgweld.gov
Department Head Email
CM-Health-
DeptHeadgweld.gov
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM -
C O U N TYATTO R N EYgW E L
D.GOV
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Requested BOCC Agenda
Date*
05/05'2025
Parent Contract ID
Requires Board Approval
YES
Department Project #
Due Date
05 01 2025
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Contact Info
Contact Name
Purchasing
Review Date*
08'31 2025
Committed Delivery Date
Contact Type Contact Email
Renewal Date
Expiration Date*
08,31 2025
Contact Phone 1 Contact Phone 2
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JASON CHESSHER
DH Approved Date
05/05/2025
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
05/12/2025
Finance Approver
CHERYL PATTELLI
Legal Counsel
BYRON HOWELL
Finance Approved Date Legal Counsel Approved Date
05'06, 2025 05/06!2025
Tyler Ref #
AG 051225
Originator
BFRITZ
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