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Home My WebLink About20241723.tiffMariah Higgins From: Sent: To: Cc: Subject: Attachments: Follow Up Flag: Flag Status: Bill Fritz Tuesday, September 30, 2025 7:19 AM CTB Shaun May; Jason Chessher Women's Wellness Connection Option Letter #6 for Communication WWC OL#6.pdf Follow up Flagged Good morning, I have attached an option letter #6 for our WWC Grant. Please put on agenda for communication to the Board. Thanks Bill COUNTY, CO Bill Fritz Finance Manager Weld County Department of Public Health and Environment Desk: 970-400-2122 1555 North 17th Ave., Greeley, CO 80631 013000 Join Our Team IMPORTANT: 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 e-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. Co M,i•Avn; co.+; o nS 20,24 - 1723 1 O /06/25 {-1 L_ a 056, Docusign Envelope ID: 1 BDDEE42-6717-4D71-9568-C790D0E3004E State of Colorado Grant Modification Option Letter #6 State Agency: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Grantee: 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 Grantee UEI: MKKXT9U9MTV5 Agreement Performance Beginning Date: January 01, 2023 Fund Expenditure End Date: June 30, 2026 Original Agreement Number: 2023`2330 Option Letter Agreement Number: Option Letter #6 Current Agreement Expiration Date: June 30, 2026 AGREEMENT MAXIMUM AMOUNT TABLE Document Type Agreement Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Original Contract 2023*2330 $0.00 $19,253.00 $0.00 1/01/2023 — 6/29/2023 $19,253.00 Original Contract 2023*2330 $23,620.00 $0.00 $0.00 1/01/2023 — 6/29/2023 $23620.00 ' Amendment #1 2023*2330 Amendment #1 $25,898.00 $0.00 $0.00 6/30/2023 — 6/29/2024 $25,898.00 Amendment #1 2023*2330 Amendment #1 $0.00 $31,271.00 $0.00 7/01/2023 — 6/29/2024 $31,271.00 Option Letter # 1 2023*2330 Option Letter #1 $26,090.00 $0.00 $0.00 11/13/2023 — 6/29/2024 $26,090.00 Option Letter #2 2023*2330 Option Letter #2 $62,444.00 $0.00 $0.00 6/30/2024 — 6/29/2025 $62,444.00 Option Letter #2 2023*2330 Option Letter #2 $0.00 $20,815.00 $0.00 7/01/2024— 6/29/2025 $20,815.00 Grant Option Letter: 2023*2330 Option Letter #6 Page 1 of 3 Version OK A.11.24/CDPHE A.3.7.25 Docusign Envelope ID: 1BDDEE42-6717-4D71-9568-C790D0E3004E Document Type Agreement Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Option Letter #3 2023*2330 Option Letter #3 $0.00 $1,628.00 $0.00 11/22/2024 — 6/29/2025 $1,628.00 Option Letter #4 2023*2330 Option Letter #4 $11,896.00 $0.00 $0.00 3/17/2025 — 6/29/2025 $11,896.00 Option Letter #5 2023*2330 Option Letter #5 $0.00 ($20,815.00) $0.00 7/01/2024 — 6/29/2025 ($20,815.00) Option Letter #5 2023*2330 Option Letter #5 $0.00 $20,815.00 $0.00 7/01/2024 — 6/30/2025 $20,815.00 Option Letter #5 2023*2330 Option Letter #5 $0.00 ($1,628.00) $0.00 11/22/2024— 6/29/2025 ($1,628.00) Option Letter #5 2023*2330 Option Letter #5 $0.00 $1,628.00 $0.00 11/22/2024 — 6/30/2025 $1,628.00 Option Letter #5 2023*2330 Option Letter #5 $0.00 $34,883.00 $0.00 7/01/2025 — 6/30/2026 $34,883.00 Option Letter #6 2023*2330 Option Letter #6 $37,431.00 $0.00 $0.00 10/01/2025 — 6/29/2026 $37,431.00 Option Letter #6 2023*2330 Option Letter #6 $0.00 $13,477.00 $0.00 10/01/2025 — 6/30/2026 $13,477.00 Current Agreement Maximum Cumulative Amount $308,706.00 1. Options: A. Option to change the quantity of Services under the Agreement. 2. Required Provisions: A. In accordance with Section(s) 5Bv of the Original Main Task Order Agreement referenced above, the State hereby exercises its option to Increase the quantity of the Services at the rates stated in the Original Agreement, as amended. B. The Agreement Maximum Amount table on the Agreement's Signature and Cover Page is hereby deleted and replaced with the Current Agreement Maximum Amount table shown above. 3. Option Effective Date: The effective date of this Option Letter is upon approval of the State Controller or October 1, 2025, whichever is later. Grant Option Letter: 2023"2330 Option Letter #6 Page 2 of 3 Version OSC A.11.24/CDPHE A.3.7.25 Docusign Envelope ID: 1BDDEE42-6717-4D71-9568-C790D0E3004E STATE OF COLORADO Jared S. Polis, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director LDocuSigned by: CLSLkVfSOw 2r,n-,2e,gcyng� By: Signature Chelsea Gilbertson Name of Executive Director Delegate Procurement & Contracts Section Title of Executive Director Delegate 2025-09-12 Date: Grant Option Letter: 2023'2330 Option Letter #6 In accordance with §24-30-202 C.R.S., this Contract 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: C W 7236CF4A4A0N4RC By: Signature Kurt Williams Name of State Controller Delegate Controller Title of State Controller Delegate 2025-09-29 Option Letter Effective Date: Page 3 of 3 Version OSC A.11.24/CDPHE A.3.7.25 Docusign Envelope ID: 1BDDEE42-6717-4D71-9568-C790D0E3004E Exhibit C., Budget ,.lam COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Weld Om, Department of Public Health and Environment Budget Period 7/1/2025 - 6/30/2026 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 7.2025 Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weld.gov Bill Fritz Fiscal Contact Name, Title, Phone and Email Finance Manager 970-400-2122 bfritz@weld.gov Contract/Encumbrance Number CT FHLA 2023`2330 Expenditure Categories Budget Totals Personal Services Salaried Employees Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE ' Position Title Description of Work and Justification for Revision Supervisor For TCO. Provide supervision and oversight to the TCO staff and program; assist with progress reports, participate in webinars and site visits. Change: Increase in staff time due to increased budget. $792.75 $800.00 $1,592.75 Community Health Worker For TCO. The CHW will be responsible for identifying eligible community members, assessing barriers to screenings, and providing direct assistance to reduce barriers to access breast and cervical cancer screening services in a health system. Change: Increase in staff time due to increased budget. $15,904.68 $21,000.00 $36,904.68 Personal Services Hourly Employees Original Budget Modification to Budget In Amendment/ Option Letter Total Amount Requested from CDPHE Position Title Description of Work and Justification for Revision Program Coordinator For TCO & HNCS. Coordinates and completes progress reports, participates in webinars, prepares for and completes site visits and chart audits. Assists with TCO or events when bilingual staff is needed, enters data into the TCO data portal, and provides office support such as answering phones, and making copies far TCO. Change: Increase in staff time due to increased budget. $10,452.50 $20,500.00 $30,952.50 Total Personal Services (including fringe benefits) $27,349.93 $42,300.00 $69,449.93 Supplies & Operating Expenses Original Budget Modification to Budget In Amendment/ Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Operating/supplies For HNCS. Allowable purchase of supplies/operating items listed on the Health Navigation and Clinical Services allowable purchase document on the Cancer Prevention and Early Detection Funding Opportunities website: https://cancerplan.colorado.gov/help-for- grantees/hea lth-navigation-a nd-cl i n ical-services/hea Ith-navigation-and-cl i n ica I -services $870.00 $0.00 $870.00 Grant Option Letter: 2023*2330 Option Letter. Page 1 of 3 Revised -November 2013 Docusign Envelope ID: 1BDDEE42-6717-4O71-9568-C790D0E3004E Exhibit C., Budget COLORADO Department of Public Health b Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Weld County Department of Public Health and Environment Budget Period 7/1/2025 - 6/30/2026 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 7.2025 Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 rgonzalez@weld.gov Bill Fritz Fiscal Contact Name, Title, Phone and Email Finance Manager 970-400-2122 bfritz@weld.gov Contract/Encumbrance Number CT FHLA 2023'2330 Outreach and Education Expenses For TCO Includes educational materials and outreach supplies to promote awareness of breast and cervical cancer screenings, as well as items to improve engagement of the community during outreach events. $100.00 $0.00 $100.00 Participant Support Costs For TCO. Items to address basic social needs such as gift cards for food insecurity (6 x $10 each). *Excluded from indirect $60'00 $0.00 $60.00 Postage For TCO/HNCS. Postage for reminder letters. $0.73 x 50 clients Change: Increased due to increased budget. $52.56 $10.95 $63.51 Electronic Medical Record (EMR) Fees The TCO worker will take a laptop to outreach events and will utilize EMR to schedule screening appointments for clients who qualify for direct assistance. $200.00 $0.00 $200.00 Cell Phone Services The TCO program will use a cell phone for outreach and contacting clients who qualify for direct assistance; In addition, the phone will be used as a WIFI hot spot when at community events. Estimated at $25.00/month for 12 months. $300.00 $0.00 $300.00 Printing For TCO/HNCS. Printing costs for culturally and linguistically appropriate relevant small media to be distributed for educational benefits of the community. This include appropriate and approved education materials for breast and cervical cancer screening and early prevention. Estimated: 50 prints @ $1.00/each. $50.47 $0.00 $50.47 Total Supplies & Operating Expenses $1,633.03 $10.95 $1,643.98 Travel Original Budget Modification to Budget in Amendment/ Option Letter Total Amount front est E Item Description of Item and Justification for Revision Mileage For TCO/HNCS. Mileage for staff to provide community outreach, attend in -person training and meetings, and to travel to other community and clinic locations as needed. Current mileage reimbursement rate is 0.70mile Change: Increased due to increased budget. $175.70 $204.50 $380.20 per.. travel expenses For TCO/HNCS. Taxi Uber and Lyft vouchers or gas cards (5 x $10 each) to reduce barriers and assist participants in traveling to health system for screening. `Excluded from indirect $100.00 $0.00 $100.00 Total Travel $275.70 $204.50 $480.20 Page 2 of 3 Grant Option Letter: 2023*2330 Option Letter #6 Revised -November 2013 Exhibit C., Budget Dowsign Envelope ID: 1 BDDEE42-6717-4O71-9568-C790D0E3004E COLORADO Department of Public Health Er Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Flame Weld County Department of Public Health and Environment Budget Period 7/1/2025 - 6/30/2026 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 7.2025 Program Contact Nam, Tide, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 rgonzalez@weld.gov Bill Fritz Fiscal Contact Name, Tide, Phone and Email Finance Manager 970-400-2122 bfritz@weld.gov ContracUEncumbrance Number CT FHLA 2023'2330 Contractual (payments to third parties or entities) Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Subcontractor Entity Name Description of Item and Justification for Revision CTS LanguageLink For TCO/HNCS. Interpretation services in person or via telephone to assist with education, direct assistance or screening services. Estimated at $10/call $100.00 $0.00 $100.00 Total Contractual $100.00 $0.00 $100.00 SUB -TOTAL BEFORE INDIRECT $29,158.66 $42,515.45 $71,674.11 Less: Expenses per OMB 2 CFR 200 Subcontractor in excess of $50,000 $0.00 Rent $0.00 Equipment in excess of $10,000 $0.00 Other Unallowable expenses $160.00 $160.00 Total Expenses per OMB 2 CFR 200 $100.00 $0.00 $160.00 Modified Total Direct Costs (MTDC) $28,998.66 $42,515.45 $71,514.11 Indirect Original Budget Modification tC Budget in Amendment/ Option Letter Total Amount Requested from RequesCDted HE Item Description of Item CDPHE Negotiated Indirect Cost Rate Weld County Health Department's approved indirect cost rate is 19.74% of MTDC effective January 1, 2025. Modified total direct costs, consisting of all salaries and wages, fringe benefits, materials and supplies, services, travel, and subgrants and subcontracts up to the first $50,000 of each subgrant or subcontract (regardless of the period covered by the subgrant or subcontract). Equipment, capital expenditures, charges for patient care, tuition remission, rental costs, scholarships, and fellowships, participant support costs and the portion of each subgrant and subcontract in excess of $50,000 shall be excluded from modified total direct costs. $5,724.34 $8,392.55 $14,116.89 Total Indirect $5,724.34 $8,392.55 $14,116.89 Page 3 of 3 Grant Option Letter: 2023"2330 Option Letter #6 Revised -November 2013 Docusign Envelope ID: A211248B-8BAB-4CEA-8092-A1C6F71C63B7 STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT OPTION LETTER #5 State Agency: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2023*2330 Main Task Order Contract Number: 23 FAA 00051 Contractor: Board of County Commissioners of Weld County (a political subdivision of the state of Colorado) Option Letter Contract Number: 2023*2330 Option Letter #5 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: January 01, 2023 Current Contract Expiration Date: June 30, 2026 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Original Contract 2023*2330 $0.00 $19,253.00 $0.00 1/01/2023 — 6/29/2023 $19,253.00 Original Contract 2023*2330 $23,620.00 $0.00 $0.00 1/01/2023 - 6/29/2023 $23,620.00 Contract Amendment #1 2023*2330 Amendment #1 $25,898.00 $0.00 $0.00 6/30/2023 - 6/29/2024 $25,898.00 Contract Amendment #1 2023*2330 Amendment #1 $0.00 $31,271.00 $0.00 7/01/2023 — 6/29/2024 $31,271.00 Option Letter #1 2023*2330 Option Letter #1 $26 090.00 $0.00 $0.00 11/13/2023 - 6/29/2024 $26 090.00 ' Option Letter #2 *2330 Option2023 Letter #2 $62,444.00$0.00 $0.00 6/30/2024 - 6/29/2025 $62,444.00 Option Letter #2 2023*2330 Option Letter #2 $0.00 $20,815.00 $0.00 7/01/2024 - 6/29/2025 $20,815.00 Option Letter Contract Number: 2023*2330 Option Letter #5 Page 1 of 3 Version OSCA12.24/CDPHE A1.25 Docusign Envelope ID: A211248B-8BAB-4CEA-8092-A1 C6F71 C63B7 Option Letter #3 2023*2330 Option Letter #3 $0.00 $1,628.00 $0.00 11/22/2024 - 6/29/2025 $1,628.00 Option Letter #4 2023*2330 Option Letter #4 $11,896.00 $0.00 $0.00 3/17/2025 - 6/29/2025 $11,896.00 Option Letter #5 2023*2330 Option Letter #5 $0.00 ($20,815.00) $0.00 7/01/2024 - 6/29/2025 ($20,815.00) Option Letter #5 2023.'2330$0.00 Option Letter #5 $20,815.00 $0.00 7/01/2024 - 6/30/2025 $20,815.00 Option Letter #5 p 2023*2330 Option Letter #5 $0.00 ($1,628.00) $0.00 11/22/2024 — 6/29/2025 ($1,628.00 ) Option Letter #5 2023*2330 Option Letter #5 $0.00 $1,628.00 $0.00 11/22/2024 - 6/30/2025 $1,628.00 Option Letter #5 2023*2330 Option Letter #5 $0.00 $34,883.00 $0.00 7/01/2025 - 6/30/2026 $34,883.00 Current Contract Maximum Cumulative Amount $257,798.00 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 June 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 current term by one day, and to extend the performance under this Contract for another term. 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 for State Fiscal Year 2026 to support deliverables and services as specified in the Contract's Statement of Work. 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 July 1, 2025, whichever is later. Option Letter Contract Number: 2023*2330 Option Letter #5 Page 2 of 3 Version OSCA12.24/CDPHE A1.25 Contract for Women's Wellness Connection (WWC) This agreement is made by and between Brighton Community Hospital Association d/b/a Intermountain Health Platte Valley Hospital ("Contractor") and the Board of Weld County Commissioners ("Weld County") (the "Agreement"). WHEREAS, Weld County is an agency of state and a body politic and corporate which desires to contract with Contractor to provide certain medical services to patients covered through the Women's Wellness Connection ("WWC") grant program; WHEREAS, WWC is a grant program offered by the State of Colorado which offers free breast and cervical cancer screenings to individuals with limited or no health insurance who meet certain Federal Poverty Level, gender and age criteria; and WHEREAS, Contractor is qualified to provide such medical services. NOW THEREFORE, in consideration of the promises and covenants contained herein, the parties hereby agree as follows: I. Scope of Agreement Contractor shall provide the following professional services, (hereinafter "Services") as in the manner set forth in the Scope of Services, attached hereto and incorporated herein as Attachment A. II. Term This Agreement shall commence on June 1, 2025, and shall expire on May 31, 2027 (the "Initial Term"). Contract may renew at the end of the term for an additional one (1) year term with written approval of both parties unless terminated by either party. The Initial Term along with the additional one-year term shall herein be defined as the "Term". III. Schedule of Payment Weld County agrees to pay Contractor in a manner set forth in the Scope of Services, annexed hereto and incorporated herein as Attachment A. The parties acknowledge and agree that all payments to Contractor specified in this Agreement have been determined through good -faith and arm's length bargaining and are consistent with what the parties reasonably believe to be within fair market value for the WWC eligible services provided by Contractor, unrelated to the volume or value of any referrals or business generated between the parties. The parties understand and agree that nothing in this Agreement is intended to require, nor requires, nor provides payment or benefit of any kind (directly or indirectly) for, the referral of individuals or business to either party by the other party, and neither party shall require or encourage their health and health -related professionals to refer patients to the other party (or to any other entity or person). IV. Contractor Status It is the expressed intent of the parties that the Contractor is an individual Contractor and not the agent or employee of Weld County and that: Page 1of11 2025-WELDC-57547 A. Contractor shall satisfy all tax and other governmentally imposed responsibilities including, but not limited to, payment of state, federal and social security taxes, unemployment taxes, worker's compensation and self-employment taxes. No federal, state or local taxes of any kind shall be withheld or paid by Weld County; B. Neither Contractor nor its employees are entitled to unemployment insurance, employer fringe benefits, workers' compensation benefits or any other benefit of any type from Weld County; C. Contractor does not have the authority to act for Weld County, or to bind Weld County in any respect whatsoever, or to incur any debts or liabilities in the name of or on behalf of Weld County; D. Contractor has and hereby retains control of and supervision over the performance of Contractor's obligations hereunder and control over any persons employed by Contractor for performing the Services hereunder; E. Contractor shall be solely responsible for all physical injuries or death to its agents, servants, or employees or to any person or damage to any property sustained during its operations and work on the project under this agreement resulting from any act or omission or commission or error in judgment of any of its officers, trustees, employees, agents. F. Contractor acknowledges that it is not required to work exclusively for Weld County; nor is Weld County required to use Contractor's services; G. All services are to be performed solely at the risk of the Contractor, and the Contractor shall take all precautions necessary for the proper and sole performance thereof; and H. Contractor will not combine its business operations in any way with Weld County's business operations and each party shall maintain their operations as separate and distinct. I. Contractor agrees that during the Term of this Agreement, the staff employed to provide Services to Weld County patients hereunder will be and remain (i) duly licensed, certified, registered and/or otherwise qualified to provide such Services, as verified through Contractor's credentialing process in accordance with applicable federal, state and local laws; and (ii) competent and fit to perform the Services hereunder, as assessed through Contractor's privileging process. V. Indemnification of Parties Each party to this Agreement shall indemnify and hold the other harmless from any and all claims, demands, causes of action, judgments, or additional costs and expenses arising from or out of any negligent act or omission of either party to this Agreement, or its agents or employees, while in the performance of its obligations under this Agreement. Each party shall immediately notify the other party in writing of any such claim or potential claim for which indemnification may be sought. VI. Insurance: A. During the Term of this Agreement and any extensions thereof, the parties shall each be responsible to obtain and maintain, at their own expense, the following minimum insurance coverages and limits (which may be satisfied by a combination of primary and excess or umbrella insurance policies or through a program of self-insurance, or a combination thereof), to cover their respective duties under this Agreement, including without limitation: Page 2 of 11 2025-WELDC-57547 Comprehensive general liability insurance with minimum limits of one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) annual aggregate for losses resulting from Services provided under this Agreement. Such coverage shall include broad form blanket contractual liability coverage, and coverage for personal injury, bodily injury and property damage and, if applicable, products liability, as well as completed and ongoing operations. Contractor's General Liability policy shall be endorsed to provide Intermountain Health additional insured status. b. Worker's compensation insurance in full compliance with the statutory requirements of the states in which services are to be performed or a claim may be presented. and employer's liability insurance for employee illness, bodily injuries and death, with minimum limits of $1,000,000 bodily injury for each accident, $1,000,000 for each employee, and $1,000,000 bodily injury for each disease. VIL Notice: The Contractor and Weld County hereby designate the business addresses specified below as the places where all notices, from one such party to the other, shall be delivered or to which they shall be mailed. Any notice to be given hereunder shall be deemed given when sent by Certified Mail. A. Notices to Weld County shall be addressed to: Weld County Attn: President/CEO 1555 North 17. Avenue Greeley, CO 80631 B. Notices to Contractor shall be addressed to: Brighton Community Hospital Association d/b/a Intermountain Health Platte Valley Hospital 1600 Prairie Center Parkway Brighton, CO 80601 Attn: President With a copy to: Intermountain Health Legal Department 500 Eldorado Boulevard, Suite 4300 Broomfield, CO 80021 C. If either party changes its address during the Term herein, it shall so advise the other party in writing, addressed as herein provided. Any notice thereafter required to be given shall be sent by Certified Mail to such new address. D. Nothing in this section shall be deemed to serve as a waiver of any requirements for the service of notice or process in the institution of an action or proceeding as provided by law, including the Civil Practice Law and Rules. Page 3 of 11 2025-WELDC-57547 VIII. Termination Either party may terminate this Agreement with thirty (30) days' prior written notice to the other party of intent to terminate without cause. The parties shall deal with each other in good faith during the 30 -day period after any notice of intent to terminate without cause has been given. IX. General Terms and Conditions A. Non-exclusive Nature This Agreement does not grant Contractor an exclusive privilege or right to supply Services to Weld County. Weld County makes no representations or warranties as to a minimum or maximum procurement of Services hereunder. B. Entire Agreement This Agreement constitutes the entire Agreement between Weld County and Contractor with respect to the Services covered in this Agreement. The provisions contained herein shall supersede or replace any conflicting or additional provisions which may be contained in any other writing or document. C. Ownership of Intellectual Property The Contractor hereby acknowledges and agrees that Weld County will have complete and full ownership, including publishing rights, of all data, research, studies, information, analyses, conclusions and any other intellectual property compiled or developed by Contractor in the course of performing his or her duties pursuant to this Agreement, herein known as Intellectual Property. Contractor hereby agrees to maintain Intellectual Property as "Proprietary and Confidential Information" according to terms and conditions found within Attachment A of this Agreement, entitled "Confidentiality Agreement". D. Conflict of Interest 1. The Contractor agrees that, at the time of contracting, they have no interest and shall not acquire any interest, direct or indirect, that would conflict with the performance of the Services hereunder. The Contractor further warrants that, in the performance of this Agreement, they currently do not and shall not employ any person having any such known interests. 2. Contractor shall advise Weld County if a conflict of interest arises in the future. Upon learning of a conflict of interest situation, the Contractor shall submit to Weld County a full disclosure statement setting forth the details that create the conflict of interest. Contractor shall then refrain from participating in the particular services until Weld County, in writing either (1) agrees to the continuation of such services, or (2) terminates this Agreement. Any willful violation of this section constitutes misconduct on the part of the Contractor and shall serve as grounds for immediate termination of this Agreement. 3. Contractor acknowledges that Weld County maintains and operates under several agreements with the State of Colorado and warrants that no conflict of interest exists in the performance of this Agreement with any of Weld County agreements with the State of Colorado. E. HIPAA Compliance Contractor will make commercially reasonable efforts to ensure that any Service provided under this Contract by Contractor will reflect Weld County's compliance with all applicable HIPAA requirements. Any act of non-compliance with this provision shall be grounds for Page 4 of 11 2025-WELDC-57547 immediate termination of this Agreement. Patient Information Privacy and Security Requirement. The parties agree to comply with the Health Information Technology for Economic and Clinical Health Act of 2009 (the "HITECH Act"), the Administrative Simplification Provisions of the Health Insurance Portability and Accountability Act of 1996, as codified at 42 U.S.C.A. §1320d et seq. ("HIPAA") and any current and future regulations promulgated under the HITECH Act or HIPAA, including without limitation the federal privacy regulations contained in 45 C.F.R. Parts 160 and 164 (the "Federal Privacy Regulations"), the federal security standards contained in 45 C.F.R. Parts160, 162 and 164 (the "Federal Security Regulations"), and the federal standards for electronic transactions contained in 45 C.F.R. Parts 160 and 162 (the "Federal Electronic Transaction Regulations"), all as may be amended from time to time, and all collectively referred to herein as "HIPAA Requirements." The parties further agree to comply with all Colorado privacy and security requirements. If either party is requested to disclose confidential or protected information concerning the services provided herein, that party shall promptly notify the other party and shall cooperate if the other party seeks a protective order or other appropriate remedy to prevent disclosure of the confidential or protected information. F. Certification Regarding Debarment Pursuant to Executive Order 12549, Contractor certifies by submission of this Agreement that neither it nor its principals have been convicted of or had a civil judgment rendered against them for commission of a fraud or a criminal offense in connection with obtaining, attempting to obtain or performing a Federal, State or local transaction and neither it nor its principals is debarred, suspended, proposed for debarment or declared ineligible from participation in a transaction by any Federal, State or local department or agency. Each party certified that neither it nor any of its providers/staff performing services pursuant to this Agreement is an "Ineligible Person/Entity," which is defined for purposes of this Agreement to mean an entity that (i) is debarred, suspended or otherwise excluded from Medicare, Medicaid and/or any other applicable federal or state healthcare program (42 U.S.C. §1320-7(a)); or (ii) has been convicted of a criminal offense that falls within the ambit of 42 U.S.C. §1320-7(a), but has not been excluded, debarred, suspended, or otherwise declared ineligible. A party shall promptly notify the other party upon receipt of any notice, whether or not official, that the party or any of its providers/staff providing services pursuant to this Agreement have become or may become an Ineligible Person/Entity during the Term of this Agreement. Each party agrees that upon notice that any of its providers or staff has been, or may be, debarred, suspended, or excluded, the party will promptly remove that provider or staff member from providing services pursuant to this Agreement. G. Governing Law This Agreement shall be deemed executed in the State of Colorado, regardless of the domicile of the Contractor, and shall be construed and interpreted in accordance with, and its performance governed by, the laws of the State of Colorado. H. Independent Contractors The relationship between Contractor and Weld County is that of independent contractor in order to offer patient Services. Contractor shall supply all personnel at its own expense. Contractor shall not be deemed to be, nor shall it represent itself as an employee, partner or Page 5 of 11 2025-WELDC-57547 joint venture (or construed as an employer -employee) of Weld County. No employee or officer of Contractor shall supervise Weld County employees or providers nor shall Weld County supervise employees or providers of Contractor. The employees and providers of Contractor are not entitled to worker's compensation benefits under the Weld County's worker's compensation coverage. Upon request by Weld County, Contractor agrees to provide confirmation that Contractor's employees and providers are covered by Contractor's worker's compensation. Contractor shall be solely responsible for payment of federal and state income tax that may arise from monies earned under this Agreement. Weld County will not withhold or make payments for social security, make unemployment or disability insurance contributions or obtain Workers Compensation insurance on Contractor's behalf. Contractor agrees that during the Term of this Agreement, the clinicians employed or contracted by Contractor who provide services will: (i) be duly licensed, certified, and/or otherwise qualified to provide WWC eligible services in the State of Colorado; and (ii) furnish services in accordance with all relevant federal, state, and local laws and regulations, including, but not limited to, non-discrimination laws. Weld County shall be responsible for the overall administration and management of Contractor and/or its staff furnishing Services to Weld County's patients on behalf of Weld County. Weld County's Chief Medical Office (CMO) or Weld County's CMO appointed designee will monitor, evaluate, and oversee the daily provision of WWC eligible services by contractor and its clinicians, including whether such clinicians are furnishing WWC eligible services consistent with the terms and conditions of this Agreement, the prevailing standards of care and any Weld County clinical policies, protocols and/or procedures applicable to the WWC eligible services provided hereunder, and will report to Weld County's Chief Medical Officer (CMO) or Weld County's CMO's appointed designee, including any identified deficiencies or concerns. Weld County's CMO or Weld County's CMO appointed designee will report to contractor any identified deficiencies or concerns that require corrective action and/or could result in suspension or removal. I. Use of Confidential Information i. Unless otherwise agreed to in writing by the other party, each party agrees to maintain in confidence, and shall keep confidential, all confidential information of the other party obtained while performing the services described herein, whether received intentionally or inadvertently, and shall not disclose any such information to (i) any person other than those persons employed by or directly affiliated with each party who are actively and directly participating in the services described herein; or (ii) as may be required by law or compelled by deposition, interrogatory, subpoena, civil investigative demand or similar legal process, or any governmental entity entitled to disclosure of the same. ii. Contractor and Weld County acknowledge and agree that either party shall not, at any time, during or after the Term of this Agreement, purposely access, use, reveal or disclose PHI to any persons outside of Contractor or the Practice, except as may be required in the course of providing the services under the terms of this Agreement, or as required by federal, state or local law. As an integral part of the terms and conditions of this Agreement, the parties further understand that their obligations concerning the protection of and the confidentiality of PHI is related to the entire PHI that the parties may acquire through their Agreement. The parties understand that unauthorized use or disclosure of PHI may result in the termination of this Agreement and such other action as required or appropriate under federal, state or local law. Page 6 of 11 2025-WELDC-57547 iii. Contractor shall prepare, maintain and provide to Weld County programmatic and financial records and other data (as defined by Weld County) necessary for Weld County to meet its applicable federal reporting requirements related to this Agreement and/or the provision of WWC eligible services under this Agreement. Such reports and data shall be prepared and maintained in an accurate and timely manner and in accordance with (a) applicable state and federal laws and regulations including, but not limited to applicable confidentiality requirements of HIPAA; (b) plan billing, reimbursement, and administrative requirements; and (c) applicable Weld County policies and procedures. J. Governmental Compliance i. The parties will each comply with all applicable statutes, laws, rules, regulations, licenses, certificates, and authorizations of any governmental body or authority in the performance or carrying out of its obligations under this Agreement, including but not limited to so-called fraud and abuse laws (e.g., the False Claims Act, the Anti -Kickback Statute, the Civil Monetary Penalties law, and the Physician Self - Referral law ("Stark")). This Agreement shall be subject to amendments of the applicable laws and regulations relating to the subject matter of this Agreement. In the event any amendment to the applicable laws and regulations creates an inconsistency with the terms of this Agreement, the parties shall use their best efforts to accommodate both the terms and intent of this Agreement and such amendments. ii. Each party shall be solely responsible for obtaining and maintaining all necessary licenses, accreditation, certifications, authorizations and/or permits for its applicable employees, personnel and operations. iii. Contractor shall obtain back -ground checks, based on contractor's established back- ground check policy and procedure, for all employees, providers, volunteers and approved contractors, as may be required by state and federal law. iv. The parties acknowledge that nothing in this Agreement restricts, or is intended to restrict, either party's ability, if it chooses, to enter into agreements with other providers or suppliers of comparable goods, items, or services, or with other donors. v. The independent clinical judgment of all health professional employed by or under contract with either party shall not be impeded in any manner. Each of the parties recognizes and agrees that each party's health professionals who perform services on its behalf, whether as employees or as independent contractors, shall have sole and complete discretion, subject to any valid restriction(s) imposed by participation in a managed care plan, to refer patients to any and all provider(s) based upon the health professional's clinical judgment and the best interests of the patient. Nothing in this Agreement requires, or is intended to require, or provides payment or benefit of any kind (directly or indirectly) for, the referral of individuals or business to either party by the other party. vi. The parties acknowledge that all patients have the freedom to choose (and/or request referral to) any provider of services and the parties shall advise patients of such Page 7 of 11 2025-WELDC-57547 right, subject to any valid restriction(s) imposed by participation in a managed care plan. K. Record Retention and Access and Audit Consistent with the requirements of 45 CFR Part 75 and the Health Center Program Compliance Manual, Contractor shall prepare and maintain financial records and reports, supporting documents, statistical records, and all other books, documents, papers or other records related and pertinent to this Agreement for a period of three (3) years from the date this Agreement expires or is terminated. If an audit, litigation, or other action involving the records is started before the end of the three (3) year period, Contractor agrees to maintain the records until the end of the three (3) year period or until the audit, litigation, or other action is completed, whichever is later. Contractor shall make available to Weld County, the Department of Health and Human Services (DHHS), the Health Resources and Services Administration (HRSA) and the Comptroller General of the United States, or any of their duly authorized representatives, upon appropriate notice, access to such financial records, reports, books, documents, and papers as may be necessary for audit, examination, excerpt, transcription, and copy purposes, for as long as such records, reports, books, documents, and papers are retained. This right also includes timely and reasonable access to contractor's personnel for the purpose of interview and discussion related to such documents. Contractor shall, upon request, transfer identified records to the custody of DHHS or HRSA when either DHHS or HRSA determine that such records possess long term retention value. Page 8 of 11 2025-WELDC-57547 Signature Page for Contract for Women's Wellness Connection (WWC) between Brighton Community Hospital Association d/b/a Intermountain Health Platte Valley Hospital (Contractor) and Board of Weld County Commissioners (Weld County) IN WITNESS WHEREOF, the parties have caused their duly authorized representatives to sign this Agreement. Brighton Community Hospital Association dba Intermountain Health Platte Valley Hospital /Pitt 6e /free Kurt Gensert (May 28, 2025 10:09 MDT) (Signature) Kurt Gensert (Print Name) CNO & Interim President (Title) 05/28/2025 Board of Weld County Commissioners Weld County, Colorado Perry L. Buck, Chair ATTEST: Clerk to the Board By: Deputy Clerk to the Board (Signature Date) (Signature Date) Page 9 of 11 2025-WELDC-57547 Attachment A — To Contract for Women's Wellness Connection (WWC) Weld County agrees to: Identify patients that are eligible for Women's Wellness Connection (WWC) for breast services (mammography screening, breast ultrasound, diagnostic mammography, breast biopsy) Issue voucher to the WWC eligible patient listing approved services that patient will present to the contractor at the time of services Fax the WWC voucher and the diagnostic imaging order to Contractor • Assist to connect eligible patients with Contractor for Contractor to set appointment. • Conduct any required tracking or follow up care • Weld County will remit payment only for services authorized on the voucher issued and defined on the WWC Reimbursable Services and Procedure List which is located at the following website:https://cancerplan.colorado.gov/help-for-grantees/health-navigation-and-clinical- services/health-navigation-and-cl inical-services Payment will be made to Contractor 45 days after receipt of monthly billing statements. Contractor's Responsibilities Services • Contractor will accept vouchers issued by Weld County identifying the WWC eligible patient and the list of approved services patients are eligible to receive. • Contractor will schedule appointments for patients eligible for WWC breast services (mammography screening, breast ultrasound, diagnostic mammography, breast biopsy), and as determined by the Weld County issued voucher. • Contractor agrees to notify and advise patients of services not covered under the WWC program and advise the patient of the uncovered costs before the service is performed. Billing and Reimbursement Contractor will directly bill Weld County for eligible patients receiving Women's Wellness Connection (WWC) for breast services (mammography screening, breast ultrasound, diagnostic mammography, breast biopsy). Contractor will send monthly billing statements for eligible services for the previous month of eligible services performed to: Weld County 1555 North 17. Avenue, Greeley, Colorado 80631 OR electronically to: health-ap@weld.gov Contractor agrees to accept the reimbursement provided by the WWC program of approved Medicare allowable rates shown in the WWC Reimbursable Services and Procedure List for each service which is located at the following website: https://cancerplan.colorado.gov/help-for- grantees/health-navigation-and-cI inical-services/health-navigation-and-clinical-services Contractor must not bill clients for any related costs associated with the WWC breast services (mammography screening, breast ultrasound, diagnostic mammography, breast biopsy) for which the WWC voucher was issued Contractor agrees to accept the reimbursement provided by WWC program as payment in full. Page 10 of 11 2025-WELDC-57547 Reporting Contractor will submit the patient's report via electronic interface transfer directly into the patient's Weld County electronic health record or manually (via fax) to Weld County's medical records, the radiology and any lab reports for biopsies to the referring Weld County provider and/or Weld County's WWC Navigator within 14 days. Weld County medical records staff will transfer the report(s) into the patient's health record. Page 11 of 11 2025-WELDC-57547 Docusign Envelope la A211248B-8BAB-4CEA-8092-A1C6F71C63B7 STATE OF COLORADO Jared S. Potts, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director DocuSigned by: 1/4-21-1.191241662481 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 Do usigned by: LImzm 40124DOCAC134C6 By: Signature Chelsea Gilbertson By: Signature Erica Benton Name of Executive Director Delegate Procurement & Contracts Section Name of State Controller Delegate Environmental Divisions Controller Title of Executive Director Delegate 2025-06-11 Date: Title of State Controller Delegate 2025-06-23 Option Effective Date: Option Letter Contract Number: 2023*2330 Option Letter #5 Page 3 of 3 Version OSCA12.24/CDPHE A1.25 Docusign Envelope ID:A2112488-8BAB-4CEA-8092-A1C6F71C6387 Exhibit C., Budget COLORADO Department of Public Health Br Environment PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing 2023"2330 Contractor Name Board of County Commissioners of Weld County Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weld.gov Budget Period 7/01/2025 6/30/2026 Fiscal Contact Name, Title, Phone and Email Bill Fritz Finance Manager 970-400-2122 bfritz@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Contract (CT or PO) Number CT FHLA 2023*2330 Expenditure Categories Personal Services Salaried Employees Position Title Description of Work Gross or Annual Salary Fringe Percent of Time on Proiect Total Amount Requested from CDPHE Supervisor For TCO. Provide supervision and oversight to the TCO staff and program; assist with progress reports, participate in webinars and site visits. 115,000.00 43,550.50 0.50% 792.75 Community Health Worker For TCO. The CHW will be responsible for identifying eligible community members, assessing barriers to screenings, and providing direct assistance to reduce barriers to access breast and cervical cancer screening services in a health system. 82,400.00 31,204.88 14.00% 15,904.68 Personal Services Hourly Employees Position Title Description of Work Hourly Wage Hourly Fringe Total # of Hours on Project Total Amount Requested from CDPHE Program Coordinator For TCO & HNCS. Coordinates and completes progress reports, participates in webinars, prepares for and completes site visits and chart audits. Assists with TCO or events when bilingual staff is needed, enters data into the TCO data portal, and provides office support such as answering phones, and making copies for TCO. 54,153.00 20,507.74 14.00% 10,452.50 'total Peal.a e lincluding f 7,!4993' Page 1 of 5 Option Letter Contract Number: 2023"2330 Option Letter #5 January 2018 Docusign Envelope ID: A2112486-8BAB-4CEA-8092-A1 C6F71 C63B7 Exhibit C., Budget COLORADO Department of Public Health Er Environment PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Board of County Commissioners of Weld County Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weld.gov Budget Period 7/01/2025 6/30/2026 Fiscal Contact Name, Title, Phone and Email Bill Fritz Finance Manager 970-400-2122 bfritz@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Contract (CT or PO) Number CT FHLA 2023*2330 Supplies & Operating Expenses Item Description of Item Rate Quantity Total Amount Requested from CDPHE Operating/supplies For HNCS. Allowable purchase of supplies/operating items listed on the Health Navigation and Clinical Services allowable purchase document on the Cancer Prevention and Early Detection Funding Opportunities website: https://cancerplan.colorado.gov/help-for-grantees/health- navigation-and-cli nical-services/health-navigation-and-clinical- services 870.00 COO 870.00 Outreach and Education Expenses For TCO Includes educational materials and outreach supplies to promote awareness of breast and cervical cancer screenings, as well as items to improve engagement of the community during outreach events. 100.00 1.00 100.00 Participant Support Costs For TCO. Items to address basic social needs such as gift cards for food insecurity (6 x $10 each). *Excluded from indirect 10.00 6.00 60.00 Postage For TCO/HNCS. Postage for reminder letters. $0.73 x 50 clients 0.73 72.00 52.56 Electronic Medical Record (EMR) Fees The TCO worker will take a laptop to outreach events and will utilize EMR to schedule screening appointments for clients who qualify for direct assistance. 200.00 1.00 200.00 Cell Phone Services The TCO program will use a cell phone for outreach and contacting clients who qualify for direct assistance; In addition, the phone will be used as a WIFI hot spot when at community events. Estimated at $25.00/month for 12 months. 25.00 12.00 300.00 Printing For TCO/HNCS. Printing costs for culturally and linguistically appropriate relevant small media to be distributed for educational benefits of the community. This include appropriate and approved education materials for breast and cervical cancer screening and early prevention. Estimated: 50 prints @ $1.00/each. COO 50.47 50.47 Option Letter Contract Number: 2023*2330 Option Letter #5 Page 2 of 5 January 2018 Docusign Envelope ID: .11248B-8BAB-4CEA-8092-A1C6F71C63B7 Exhibit C., Budget a COLORADO Department of Public Health Et Environment PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing 2023"2330 Contractor Name Board of County Commissioners of Weld County Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weld.gov Budget Period 7/01/2025 6/30/2026 Fiscal Contact Name, Title, Phone and Email Bill Fritz Finance Manager 970-400-2122 bfritz@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Contract (CT or PO) Number CT FHLA 2023*2330 Supplies & Travel Item Description of Item Rate Quantity Total Amount Requested from CDPHE Mileage For TCO/HNCS. Mileage for staff to provide community outreach, attend in -person training and meetings, and to travel to other community and clinic locations as needed. Current mileage reimbursement rate is 0.70mile 0.70 251.00 175.70 Participant travel expenses For TCO/HNCS. Taxi, Uber and Lyft vouchers or gas cards (5 x $10 each) to reduce barriers and assist participants in traveling to health system for screening. *Excluded from indirect 10.00 10.00 100.00 Total Travel Page 3 of 5 Option Letter Contract Number: 2023*2330 Option Letter #5 January 2018 Docusign Envelope ID: .11248B-8BAB-4CEA-8092-A1 C6F71 C63B7 Exhibit C., Budget - COLORADO Department of Public Health Et Environment PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Board of County Commissioners of Weld County Program Contact Name, Tdie, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weld.gov Budget Period 7/01/2025 - 6/30/2026 Fiscal Contact Name, Title, Phone and Email Bill Fritz Finance Manager 970-400-2122 bfritz@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Contract (CT or PO) Number CT FHLA 2023*2330 Contractual Subcontractor Name Description of Item Rate Quantity Total Amount Requested from CDPHE CTS LanguageLink For TCO/HNCS. Interpretation services in person or via telephone to assist with education, direct assistance or screening services. Estimated at $10/call 10.00 10.0 100.00 T contractual 100.00 SUB -TOTAL OF DIRECT COSTS 29,158.66 Less: Expenses per OMB 2 CFR 200 Subcontractor in excess of $50,000 $- Rent $- Equipment in excess of $10,000 $- Other Unallowable expenses $160.00 Modified Total Direct Costs (MTDC) $28,998.66 Indirect Item Description of Item Percentage Total Amount Requested from CDPHE-Negotiated Indirect Cost Rate Indirect costs. Weld County Health Department's approved indirect cost rate is 19.74% of MTDC effective January 1, 2025. Modified total direct costs, consisting of all salaries and wages, fringe benefits, materials and supplies, services, travel, and subgrants and subcontracts up to the first $50,000 of each subgrant or subcontract (regardless of the period covered by the subgrant or subcontract). Equipment, capital expenditures, charges for patient care, tuition remission, rental costs, scholarships, and fellowships, participant support costs and the portion of each subgrant and subcontract in excess of $50,000 shall be excluded from modified total direct costs. 19.74% 5,724.34 Page 4 of 5 Option Letter Contract Number 2023*2330 Option Letter #5 January 2018 Docusign Envelope ID:A211248B-8BAB-4CEA-8092-A1C6F71C63B7 Exhibit C., Budget 4,, COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Board of County Commissioners of Weld County Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weid.gov Budget Period 7/01/2025 6/30/2026 Fiscal Contact Name, Title, Phone and Email Bill Fritz Finance Manager 970-400-2122 bfritz@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Contract (CT or PO) Number CT FHLA 2023*2330 Option Letter Contract Number: 2023*2330 Option Letter #5 Page 5 of 5 January 2018 Mariah Higgins From: Sent: To: Cc: Subject: Attachments: Follow Up Flag: Flag Status: Bill Fritz Thursday, March 13, 2025 7:17 AM CTB Shaun May; Jason Chessher Option Letter #4 for Communication WWC Option Letter #4.pdf Follow up Flagged Good Morning, Please accept the attached Option Letter #4 for Women's Wellness Connection (WWC) with additional funding for communication to the board. Please let me know if you need any thing else. Thanks Bill Aks COUNTY, Bill Fritz Finance Manager Department of Public Health and Environment Desk: 970-400-2122 1555 North 17th Ave., Greeley, CO 80631 011000 Join Our Team IMPORTANT: 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 e-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. CoMMur ; Ca. fi;onS O3/17/25 202y- 1723 !4 t_ ooS6 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT OPTION LETTER #4 State Agency: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2023*2330 Contractor: Board of County Commissioners of Weld County (a political subdivision of the state of Colorado) Option Letter Contract Number: 2023*2330 Option Letter #4 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: January 1, 2023 Current Contract Expiration Date: June 29, 2025 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Original Contract 2023*2330 $0.00 $19,253.00 $0.00 1/01/2023 - 6/29/2023 $19,253.00 Original Contract 2023*2330 $23,620.00 $0.00 $0.00 1/01/2023 - 6/29/2023 $23,620.00 Contract Amendment #1 2023*2330 Amendment #1 $25,898.00 $0.00 $0.00 6/30/2023 - 6/29/2024 $25,898.00 Contract Amendment #1 2023*2330 Amendment #1 $0.00 $31,271.00 $0.00 7/01/2023 - 6/29/2024 $31,271.00 Option Letter #1 2023*2330 Option Letter #1 $26,090.00 $0.00 $0.00 11/13/2023 - 6/29/2024 $26,090.00 Option Letter #2 2023*2330 Option Letter #2 $62,444.00 $0.00 $0.00 6/30/2024 - 6/29/2025 $62,444.00 Option Letter #2 2023*2330 Option Letter #2 $0.00 $20,815.00 $0.00 7/01/2024 - 6/29/2025 $20,815.00 Option Letter #3 2023*2330 Option Letter #3 $0.00 $1,628.00 $0.00 11/22/2024 - 6/29/2025 $1,628.00 Option Letter Contract Number: 2023'2330 Option Letter #4 Page 1 of 3 Version OSCA12.24/CDP. A1.25 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C Option Letter #4 2023*2330 Option Letter #4 $11,896.00 $0.00 $0.00 3/17/2025 — 6/29/2025 $11,896.00 Current Contract Maximum Cumulative Amount $222,915.00 0. OPTIONS: A. Option to change the quantity of Services under the Contract 2. REQUIRED PROVISIONS: A. 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 to the current term to support deliverables as specified in the Statement of Work. B. Exhibit D., Federal Provisions — Colorado Cancer Prevention and Control, is deleted and replaced in its entirety with Exhibit D., Federal Provisions, attached to this Option Letter, for the following reason: To reflect changes to the federal award identification information. 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 March 17, 2025, whichever is later. Option Letter Contract Number: 2023*2330 Option Letter #4 Page 2 of 3 Version OSCA 12.24/CDPHE A1.25 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C STATE OF COLORADO Jared S. Potts, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director DocuSigned by: LOrenkVSbtu 24R1 By: Signature Chelsea Gilbertson Name of Executive Director Delegate Procurement & Contracts Section Title of Executive Director Delegate 2025-03-12 Date: 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 C14.4 w; By: Signature Kurt Williams DocuSigned by: 7:i985F4A4A084AC Name of State Controller Delegate Controller Title of State Controller Delegate 2025-03-12 Option Effective Date: Option Letter Contract Number: 2023*2330 Option Letter #4 Page 3 of 3 Version OSCA12.24/CDPHE A1.25 Dowsign Envelope ID: 983640EC-43C6.4AE4-9A2,8838413E682C Exhibit C., Budget .Mn M COLORADO Department of Public Health fr Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023"2330 Contractor Name Weld County Department of Public Health and Environment Budget Period 6/30/2024 - 6/29/2025 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 6.2024 Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 Gonzalez@weld.gov Bill Fritz Fiscal Contact Name, Title, Phone and Email Finance Manager 970-400-2122 bfirtz@weld.gov Contract/Encumbrance Number CT FH.2023`2330 Expenditure Categories Budget Totals Personal Services Salaried Employees Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Position Title Description of Work and Justification for Revision Supervisor For TCO. Provide supervision and oversight to the TCO staff and program; assist with progress reports, participate in webinars and site visits. $1,689.23 $0.00 $1,689.23 Chief Nursing Officer For HNCS. Provide clinical supervision and grant oversight; assure clinic is prepared to serve clients. $183.42 $0.00 $183.42 Community Health Worker For TCO. The CHW will be responsible for identifying eligible community members, assessing barriers to screenings, and providing direct assistance to reduce barriers to access breast and cervical cancer screening services in a health system. $57,761.26 $0.00 $57,761.26 Personal Services Hourly Employees Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Position Title Description of Work and Justification for Revision Program Coordinator For TCO & HNCS. Coordinates and completes progress reports, participates in webinars, prepares for and completes site visits and chart audits. Assists with TCO or events when bilingual staff is needed, enters data into the TCO data portal, and provides office support such as answering phones, and making copies for TCO. $6,044.11 $0.00 $6,044.11 New Program Coordinator Change: new position addded to cross train new program coordinator in HNCS activities, enrollment, data entry etc. Work with current program coordinator to develop HNCS written process and training materials. New coordinator will contact previos/likey eligible HNCS clients due for screening. $0.00 $4,500.00 $4,500.00 Total Personal Services (including fringe benefits) 5,678.02 $4,500.00 $70,178.02 Supplies & Operating Expenses Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Operating/supplies For HNCS. Allowable purchase of supplies/operating items listed on the Health Navigation and Clinical Services allowable purchase document on the Cancer Prevention and Early Detection Funding Opportunities website: https://cancerplan.colorado.gov/help-for-grantees/health- navigation-and-cl finical-services/health-navigation-and-clinical-services. Change: increase need to purchase items on the allowable purchase list. $2,000.00 $2,500.00 $4,500.00 Page 1 of 3 Option Letter Contract Number: 2023'2330 Option Letter #4 Revised -November 2013 Docusign Envelope ID: 983640EC-43C&4AE4-9A2A-883B413E682C Exhibit C., Budget 4%, COLORADO Department of Public Health b Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 contractor Name Weld County Department of Public Health and Environment Budget -Period 6/30/2024-6/29/2025 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 6.2024 Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 rgonzalez@weld.gov Bill Fritz Fiscal Contact Name, Tide, Phone and. Email E Finance Manager 970-400-2122 bfirtz@weld.gov ContrectlEncumbrance Number CT FH.2023`2330 Outreach and Education Expenses For TCO Includes educational materials and outreach supplies to promote awareness of breast and cervical cancer screenings, as well as items to improve engagement of the community during outreach events. Change: increased need for educational and outreach supplies by the TCO teams. $160.00 $800.00 $960.00 Participant Support Costs For TCO. Items to address basic social needs such as gift cards for food insecurity (20 x $25 each). Change: Increase need for gift cards at a rate of $ 20 -$25 per card . $40.00 $500.00 $540.00 Postage For TCO/HNCS. Postage for reminder letters. $0.63 x 55 clients . Additonal postage for 500 postcards Change: Increase in postage costs and need to mail out reminder letters. $34.65 $200.00 $234.65 Registration For TCO. Registration costs for Community Outreach staff to attend relevant trainings, including the Colorado Health Navigator Assessment for health navigators and/or credentialling tests. 13 $425.00 $0.00 $425.00 Office Supplies Office supplies for Community Outreach (not included in indirect). IH $100.00 $0.00 $100.00 Electronic Medical Record (EMR) Fees The TCO worker will take a laptop to outreach events and will utilize EMR to schedule screening appointments for clients who qualify for direct assistance. 1 EMR user license @ $100x] $1,000.00 $0.00 $1,000.00 Cell Phone Services The TCO program will use a cell phone for outreach and contacting clients who qualify for direct assistance; In addition, the phone will be used as a WIFI hot spot when at community events. Estimated at $30.00/month for 12 months.t $360.00 $0.00 $360.00 Printing For TCO/HNCS. Printing costs for culturally and linguistically appropriate relevant small media to be distributed for educational benefits of the community. This include appropriate and approved education materials for breast and cervical cancer screening and early prevention. Estimated: 100 prints @ $1.50/each. Print 500 postcard mailers for Equity areas in Weld County. Change: Increase need for postcard mailers. $150.00 $500.00 $650.00 Total Supplies & Operating Expenses $4269.65 , $4,500.00 $8,769.65 Page 2 of 3 Option Letter Contract Number: 2023*2330 Option Letter f/4 Revised -November 2013 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-8838413E682C Exhibit C., Budget a, - COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Weld County Department of Public Health and Environment Budget Period 6/30/2024 - 6/29/2025 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 6.2024 Program Contact Name, Title, Phone and Email Becky Gonzalez Program Coordinator 970-400-2349 ronzalez@weld.gov Bill Fritz Fiscal Contact Name, Title, Phone and Email Finance Manager 970-400-2122 bfirtz@weld.gov Contract/Encumbrance Number CT FHLA 2023.2330 Travel Original Budget Modification to Budget in Amendment] Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Meals For TCO/HNCS. Meals for staff to attend in -person training and meetings. Estimated rate is $60 per person per day x 3 days III $180.00 $0.00 $180.00 Mileage For TCO/HNCS. Mileage for staff to provide communty outreach, attend in -person training and meetings, and to travel to other community and clinic locations as needed. Current mileage re'mbursement rate is 0.65/mile DI $330.20 $0.00 $330.20 Lodging For TCO/HNCS. Lodging for staff to attend in -person training and meetings. Estimated 2 number of people @ $250/night x 3 nights. © $750.00 $0.00 $750.00 part.. travel expenses For TCO/HNCS. Taxi, Uber and Lyft vouchers or gas cards (5 x $10 each) to reduce barriers and assist participants in traveling to health system for screening. $50.00 50.00 $50.00 CPEDTrainings Change: Cost to include lodging, food, travel for 2 regional trainings this spring for NP's/TCO team. 50.00 $1,000.00 $1,000.00 Total Travel $1,310.20 $1,000.00 $2,310.20 Contractual (payments to third parties or entities) Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Subcontractor Entity Name Description of Item and Justifcation for Revision CTS LanguageLink For TCO/HNCS. Interpretation services in person or via telephone to assist with education, direct assistance or screening services. Estimated at $10/cell© $100.00 $0.00 $100.00 Total Contractual $100.00 $0.00 $100.00 SUB -TOTAL BEFORE INDIRECT $71,357.87 $10,000.00 $81,357.87 Indirect Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Item Description of Item CDPHE Negotiated Indirect Cost Rate Indirect costs. Weld County Health Department's approved indirect cost rate is 18.96% of MTDC effective January 1, 2024. Change: increased due to direct cost. $13,529.13 $1,896.00 $15,425.13 Total Indirect $13,529.13 $1,896.00 $15,425.13 TO Page 3 of 3 Option Letter Contract Number: 2023.2330 Option Letter #4 Revised -November 2013 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C EXHIBIT D, GRANT FEDERAL PROVISIONS 1. Applicability of Provisions. 1.1. The Grant to which these Federal Provisions are attached has been funded, in whole or in part, with an Award of Federal funds. In the event of a conflict between the provisions of these Federal Provisions, the Special Provisions, the body of the Grant, or any attachments or exhibits incorporated into and made a part of the Grant, the provisions of these Federal Provisions shall control. 1.2 These Federal Provisions are subject to the Award as defined in §2 of these Federal Provisions, as may be revised pursuant to ongoing guidance from the relevant Federal or State of Colorado agency or institutions of higher education. 2. Definitions 2.1. For the purposes of these Federal Provisions, the following terms shall have the meanings ascribed to them below. For a full list of definitions (as of October 1, 2024) under the Uniform Guidance, see 2 CFR 200.1. 2.1.1. "Award" means an award of Federal financial assistance, and the Grant setting forth the terms and conditions of that financial assistance, that a non -Federal Entity receives or administers. 2.1.2. "Entity" means: 2.1.2.1.a Non -Federal Entity; 2.1.2.2.a non-profit organization or for profit organization; 2.13. "Executive" means an officer, managing partner or any other employee in a management position. 2.1.4. "Federal Awarding Agency" means a Federal agency providing a Federal Award to a Recipient as described in 2 CFR 200.1. 2.1.5. "Grant" means the Grant to which these Federal Provisions are attached. 2.1.6. "Grantee" means the party or parties identified as such in the Grant to which these Federal Provisions are attached. Grantee also means Subrecipient. 2.1.7. "Non -Federal Entity" means a State, local government, Indian tribe, institution of higher education, or nonprofit organization that carries out a Federal Award as a Recipient or a Subrecipient. 2.1.8. "Nonprofit Organization" organization, that: 2.1.8.1. Is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest; Option Letter Contract Number: 2023*2330 Option Letter #4 Page 1 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-8838413E682C 2.1.8.2. Is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest; 2.1.8.3. Is not organized primarily for profit; and 2.1.8.4. Uses net proceeds to maintain, improve, or expand the organization's operations; and 2.1.8.5. Is not an IHE. 2.1.9. "OMB" means the Executive Office of the President, Office of Management and Budget. 2.1.10. "Pass -through Entity" means a recipient or subrecipient that provides a Subaward to a Subrecipient (including lower tier subrecipients) to carry out part of a Federal program. The authority of the pass -through entity under this part flows through the Subaward agreements between the pass -through entity and subrecipient. 2.1.11. "Recipient" means the Colorado State agency or institution of higher education identified as the Grantor in the Grant to which these Federal Provisions are attached. 2.1.12. "Subaward" means an award provided by a pass -through entity to a Subrecipient to contribute to the goals and objectives of the project by carrying out part of a Federal award received by the pass -through entity. The term does not include payments to a contractor, beneficiary or participant. 2.1.13. "Subrecipient" means an entity that receives a subaward from a pass -through entity to carry out part of a Federal award. The term subrecipient does not include a beneficiary or participant. A subrecipient may also be a recipient of other Federal awards directly from a Federal agency. Subrecipient also means Grantee. 2.1.14. "System for Award Management (SAM)" means the Federal repository into which an Entity must enter the information required under the Transparency Act, which may be found at http://www.sam.gov. 2.1.15. "Total Compensation" means the cash and noncash dollar value an Executive earns during the entity's preceding fiscal year. This includes all items of compensation as prescribed in 17 CFR 229.402(c)(2). 2.1.16. "Transparency Act" means the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6202 of Public Law 110-252. 2.1.17. "Unique Entity ID" (UEI) is the universal identifier for federal financial assistance applicants, as well as recipients and their direct subrecipients (first tier subrecipients). 2.1.18. "Uniform Guidance" means the Office of Management and Budget Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. The terms and conditions of the Uniform Guidance flow down to Awards to Subrecipients unless the Uniform Guidance or the terms and conditions of the Federal Award specifically indicate otherwise. Option Letter Contract Number: 2023*2330 Option Letter #4 Page 2 of 8 OSC A.I2.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C 3. Compliance. 3.1. Subrecipient shall comply with all applicable provisions of the Transparency Act and the regulations issued pursuant thereto, all applicable provisions of the Uniform Guidance, and all applicable Federal Laws and regulations required by this Federal Award. Any revisions to such provisions or regulations shall automatically become a part of these Federal Provisions, without the necessity of either party executing any further instrument. The State of Colorado, at its discretion, may provide written notification to Subrecipient of such revisions, but such notice shall not be a condition precedent to the effectiveness of such revisions. 4. System for Award Management (SAM) and Unique Entity ID Requirements. 4.1. SAM. Subrecipient must obtain a UEI but are not required to fully register in Sam.gov. Subrecipient shall maintain the currency of its information in SAM until the Subrecipient submits the final financial report required under the Award or receives final payment, whichever is later. Subrecipient shall review and update SAM information at least annually after the initial registration, and more frequently if required by changes in its information. 4.2. Unique Entity ID. Subrecipient shall provide its Unique Entity ID to its Recipient, and shall update Subrecipient's information at http://www.sam.gov at least annually after the initial registration, and more frequently if required by changes in Subrecipient's information. 5. Total Compensation. 5.1. Subrecipient shall include Total Compensation in SAM for each of its five most highly compensated Executives for the preceding fiscal year if: 5.1.1. The total Federal funding authorized to date under the Award is $30,000 or more; and 5.1.2. In the preceding fiscal year, Subrecipient received: 5.1.2.1. 80% or more of its annual gross revenues from Federal procurement contracts and subcontracts and/or Federal financial assistance Awards or Subawards subject to the Transparency Act; and 5.1.2.2. $25,000,000 or more in annual gross revenues from Federal procurement contracts and subcontracts and/or Federal financial assistance Awards or Subawards subject to the Transparency Act; and 5.1.2.3. The public does not have access to information about the compensation of such Executives through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d) or § 6104 of the Internal Revenue Code of 1986. Option Letter Contract Number: 2023*2330 Option Letter #4 Page 3 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-8838413E682C 6. Reporting. 6.1. Pursuant to the Transparency Act, Subrecipient shall report data elements to SAM and to the Recipient as required in this Exhibit. No direct payment shall be made to Subrecipient for providing any reports required under these Federal Provisions and the cost of producing such reports shall be included in the Grant price. The reporting requirements in this Exhibit are based on guidance from the OMB, and as such are subject to change at any time by OMB. Any such changes shall be automatically incorporated into this Grant and shall become part of Subrecipient's obligations under this Grant. 7. Effective Date and Dollar Threshold for Reporting. 7.1. Reporting requirements in §8 below apply to new Awards as of October 1, 2010, if the initial award is $30,000 or more. If the initial Award is below $30,000 but subsequent Award modifications result in a total Award of $30,000 or more, the Award is subject to the reporting requirements as of the date the Award exceeds $30,000. If the initial Award is $30,000 or more, but funding is subsequently de -obligated such that the total award amount falls below $30,000, the Award shall continue to be subject to the reporting requirements. 7.2. The procurement standards in §9 below are applicable to new Awards made by Recipient as of December 26, 2015. The standards set forth in §11 below are applicable to audits of fiscal years beginning on or after December 26, 2014. 8. Subrecipient Reporting Requirements. 8.1. Subrecipient shall report as set forth below. 8.1.1. To SAM. A Subrecipient shall report the following data elements in SAM for each Federal Award Identification Number (FAIN) assigned by a Federal agency to a Recipient no later than the end of the month following the month in which the Subaward was made: 8.1.1.1. Subrecipient Unique Entity ID; 8.1.1.2. Subrecipient Unique Entity ID if more than one electronic funds transfer (EFT) account; 8.1.13. Subrecipient parent's organization Unique Entity ID; 8.1.1.4. Subrecipient's address, including: Street Address, City, State, Country, Zip + 4, and Congressional District; 8.1.1.5. Subrecipient's top 5 most highly compensated Executives if the criteria in §4 above are met; and Subrecipient's Total Compensation of top 5 most highly compensated Executives if the criteria in §4 above met. 8.1.2. To Recipient. A Subrecipient shall report to its Recipient, upon the effective date of the Grant, the following data elements: 8.1.2.1. Subrecipient's Unique Entity ID as registered in SAM. 9. Primary Place of Performance Information, including: Street Address, City, State, Country, Zip code + 4, and Congressional District. Procurement Standards. Option Letter Contract Number: 2023#2330 Option Letter #4 Page 4 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C 9.1. Procurement Procedures. A Subrecipient shall use its own documented procurement procedures which reflect applicable State, local, and Tribal laws and applicable regulations, provided that the procurements conform to applicable Federal law and the standards identified in the Uniform Guidance, including without limitation, 2 CFR 200.318 through 200.327 thereof. 9.2. Domestic preference for procurements (2 CFR 200.322). As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. 93. Procurement of Recovered Materials. If a Subrecipient is a State Agency or an agency of a political subdivision of the State, its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247, that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. 9.4. Never contract with the enemy (2 CFR 200.215). Federal awarding agencies and recipients are subject to the regulations implementing "Never contract with the enemy" in 2 CFR part 183. The regulations in 2 CFR part 183 affect covered contracts, grants and cooperative agreements that are expected to exceed $50,000 during the period of performance, are performed outside the United States and its territories, and are in support of a contingency operation in which members of the Armed Forces are actively engaged in hostilities. 9.5. Prohibition on certain telecommunications and video surveillance equipment or services (2 CFR 200.216). Subrecipient is prohibited from obligating or expending loan or grant funds on certain telecommunications and video surveillance services or equipment pursuant to 2 CFR 200.216. 10. Access to Records. 10.1. A Subrecipient shall permit Recipient and its auditors to have access to Subrecipient's records and financial statements as necessary for Recipient to meet the requirements of 2 CFR 200.332 (Requirements for pass -through entities), 2 CFR 200300 (Statutory and national policy requirements) through 2 CFR 200.309 (Modification to period of performance), 2 CFR 200.337 (Access to Records) and Subpart F -Audit Requirements of the Uniform Guidance. Option Letter Contract Number: 2023*2330 Option Letter #4 Page 5 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C 10.2. A Subrecipient must collect, transmit, and store information related to this Subaward in open and machine-readable formats (2 CFR 200.336). 11. Single Audit Requirements. 11.1. If a Subrecipient expends $1,000,000 or more in Federal Awards during the Subrecipient's fiscal year, the Subrecipient shall procure or arrange for a single or program -specific audit conducted for that year in accordance with the provisions of Subpart F -Audit Requirements of the Uniform Guidance, issued pursuant to the Single Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR 200.501. 11.1.1. Election. A Subrecipient shall have a single audit conducted in accordance with Uniform Guidance 2 CFR 200.514 (Scope of audit), except when it elects to have a program -specific audit conducted in accordance with 2 CFR 200.507 (Program -specific audits). The Subrecipient may elect to have a program - specific audit if Subrecipient expends Federal Awards under only one Federal program (excluding research and development) and the Federal program's statutes, regulations, or the terms and conditions of the Federal award do not require a financial statement audit of Recipient. A program -specific audit may not be elected for research and development unless all of the Federal Awards expended were received from Recipient and Recipient approves in advance a program -specific audit. 11.1.2. Exemption. If a Subrecipient expends less than $1,000,000 in Federal Awards during its fiscal year, the Subrecipient shall be exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503 (Relation to other audit requirements), but records shall be available for review or audit by appropriate officials of the Federal agency, the State, and the Government Accountability Office. 11.1.3. Subrecipient Compliance Responsibility. A Subrecipient shall procure or otherwise arrange for the audit required by Subpart F of the Uniform Guidance and ensure it is properly performed and submitted when due in accordance with the Uniform Guidance. Subrecipient shall prepare appropriate financial statements, including the schedule of expenditures of Federal awards in accordance with 2 CFR 200.510 (Financial statements) and provide the auditor with access to personnel, accounts, books, records, supporting documentation, and other information as needed for the auditor to perform the audit required by Uniform Guidance Subpart F -Audit Requirements. 12. Required Provisions for Subrecipient with Subcontractors. 12.1. In addition to other provisions required by the Federal Awarding Agency or the Recipient, Subrecipients shall include all of the following applicable provisions; 12.1.1. For agreements with Subrecipients — Include the terms in the Grant Federal Provisions Exhibit (this exhibit) 12.1.2. For contracts with Subcontractors — Include the terms in the Contract Federal Provisions Exhibit. Option Letter Contract Number: 2023*2330 Option Letter #4 Page 6 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-883B413E682C 13. Certifications. 13.1. Unless prohibited by Federal statutes or regulations, Recipient may require Subrecipient to submit certifications and representations required by Federal statutes or regulations on an annual basis. 2 CFR 200.415. Submission may be required more frequently if Subrecipient fails to meet a requirement of the Federal award. Subrecipient shall certify in writing to the State at the end of the Award that the project or activity was completed or the level of effort was expended. If the required level of activity or effort was not carried out, the amount of the Award must be adjusted. 14. Exemptions. 14.1. These Federal Provisions do not apply to an individual who receives an Award as a natural person, unrelated to any business or non-profit organization he or she may own or operate in his or her name. 14.2. A Subrecipient with gross income from all sources of less than $300,000 in the previous tax year is exempt from the requirements to report Subawards and the Total Compensation of its most highly compensated Executives. 15. Event of Default and Termination. 15.1. Failure to comply with these Federal Provisions shall constitute an event of default under the Grant and the State of Colorado may terminate the Grant upon 30 days prior written notice if the default remains uncured five calendar days following the termination of the 30 - day notice period. This remedy will be in addition to any other remedy available to the State of Colorado under the Grant, at law or in equity. 15.2. Termination (2 CFR 200.340). The Federal Award may be terminated in whole or in part as follows: 15.2.1. By the Federal Awarding Agency or Pass -through Entity, if a Non -Federal Entity fails to comply with the terms and conditions of a Federal Award; 15.2.2. By the Federal awarding agency or Pass -through Entity with the consent of the Non -Federal Entity, in which case the two parties must agree upon the termination conditions, including the effective date and, in the case of partial termination, the portion to be terminated; 15.23. By the Non -Federal Entity upon sending to the Federal Awarding Agency or Pass -through Entity written notification setting forth the reasons for such termination, the effective date, and, in the case of partial termination, the portion to be terminated. However, if the Federal Awarding Agency or Pass -through Entity determines in the case of partial termination that the reduced or modified portion of the Federal Award or Subaward will not accomplish the purposes for which the Federal Award was made, the Federal Awarding Agency or Pass - through Entity may terminate the Federal Award in its entirety; or 15.2.4. By the Federal Awarding Agency or Pass -through Entity pursuant to termination provisions included in the Federal Award. 16. Additional Federal Requirements. 16.1. Whistle Blower Protections Option Letter Contract Number: 2023.2330 Option Letter #4 Page 7 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 983640EC-43CB-4AE4-9A2A-8836413E682C An employee of a subrecipient must not be discharged, demoted, or otherwise discriminated against as a reprisal for disclosing to a person or body described in paragraph (a)(2) of 41 U.S.C. 4712 information that the employee reasonably believes is evidence of gross mismanagement of a Federal contract or grant, a gross waste of Federal funds, an abuse of authority relating to a Federal contract or grant, a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a Federal contract (including the competition for or negotiation of a contract) or grant. The subrecipient must inform their employees in writing of employee whistleblower rights and protections under 41 U.S.C. 4712. See statutory requirements for whistleblower protections at 10 U.S.C. 4701, 41 U.S.C. 4712, 41 U.S.C. 4304, and 10 U.S.C. 4310. Option Letter Contract Number: 2023'2330 Option Letter #4 Page 8 of 8 OSC A.12.24/CDPHE A.12.24 Mariah Higgins Subject: Attachments: Option Letter for Communication. 1 2023-2330 OL3_CP.pdf; 2 2023-2330 OL3_SP.pdf; 3 2023-2330 Exh C Budget.pdf From: Bill Fritz <bfritz@weld.gov> Sent: Monday, December 2, 2024 10:37 AM To: CTB <CTB@co.weld.co.us> Subject: Option Letter for Communication. Good morning, I have attached an option letter for Women's Wellness Connection that provides cancer screening for women. 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 e-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: Sonya Oster <soster@weld.gov> Sent: Monday, December 2, 2024 9:46 AM To: Health Contracts <Health-Contracts@weld.gov> Subject: FW: Completed: Request for Signature - Start by 11/25 - 2023*2330 OL3 - WWC (Weld County) FYI Sonya Oster, MBA -HA Business Operations Manager Weld County Department of Public Health and Environment 1555 N. 17th Ave., Greeley, CO 80631 (970) 400-2332 soster@weld.gov CoMtAvn:CA+:onS 12/11/24 2024 - 1723 \-1Loo Se Learn more about the important Public Health work we do in Weld County: www.weldhealth.orq 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 e-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. 2 Docusign Envelope ID: 387523D2-DD51-4712-BB72-22672ED7F8E9 STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT OPTION LETTER #3 State Agency: Colorado Department Of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2023 *2330 Option Letter Contract Number: 2023*2330 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: January 1, 2023 Current Contract Expiration Date: June 29, 2025 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Original Contract 2023*2330 $0.00 $19,253.00 $0.00 1/01/2023 - 6/29/2023 $19,253.00 Original Contract 2023*2330 $23,620.00 $0.00 $0.00 1/01/2023 - 6/29/2023 $23,620.00 Contract Amendment #1 2023*2330 Amendment #1 $25,898.00 $0.00 $0.00 6/30/2023 - 6/29/2024 $25,898.00 Contract Amendment #1 2023*2330 Amendment #1 $0.00 $31,271.00 $0.00 7/01/2023 - 6/29/2024 $31,271.00 Option Letter #1 2023*2330 Option Letter #1 $26,090.00 $0.00 $0.00 11/13/2023 - 6/29/2024 $26,090.00 Option Letter #2 2023*2330 Option Letter #2 $62,444.00 $0.00 $0.00 6/30/2024 - 6/29/2025 $62,444.00 Option Letter #2 2023*2330 Option Letter #2 $0.00 $20,815.00 $0.00 7/01/2024 - 6/29/2025 $20,815.00 Option Letter #3 2023*2330 Option Letter #3 $0.00 $1,628.00 $0.00 11/25/2024 - 6/29/2025 $1,628.00 Current Contract Maximum Cumulative Amount $211,019.00 Option Letter Contract Number: 2023*2330 Option Letter #3 Page 1 of 3 Ver.A 27.01.20 Docusign Envelope ID: 387523D2-DD51-4712-BB72-22672ED7F8E9 1) OPTIONS A. Option to change the quantity of services under the Contract. 2) REQUIRED PROVISIONS: A. In accordance with Section 5., Payments to Contractor, Paragraph B., Payment Procedures, Sub- paragraph v., Option to Increase Maximum Amount, of the Original Master Task Order 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, for the following reason: to add funds for the current year. B. 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. Option Letter Contract Number: 2023*2330 Option Letter #3 Page 2 of 3 Ver.A 27.01.20 Docusign Envelope lD: 387523D2-DD51-4712-BB72-22672ED7F8E9 SIGNATURE PAGE STATE OF COLORADO Jared S. Polis, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director DocuSiyned by: al-its-t, Pasta X1301241.2461... By: Signature Chelsea Gilbertson Name of Executive Director Delegate Procurement & Contracts Section Title of Executive Director Delegate 2024-11-18 Date: 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 CDocuSipned by: le4.11 Wat440.4 73365F4A4A084BC By: Signature Kurt Williams Name of State Controller Delegate Controller Title of State Controller Delegate 2024-11-22 Option Effective Date: -- Signature Page End -- Option Letter Contract Number: 2023*2330 Option Letter #3 Page 3 of 3 Ver.A 27.01.20 Docusign Envelope ID387523D2-DD51-4712-8B72-22672ED7F8E9 Exhibit C., Budget COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Weld County Department of Public Health and Environment Budget Period 6/30/2024 - 6/29/2025 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 6.2024 Program Contact Name, Title, Phone and Email Ivonne Tamez Program Coordinator 970-400-6420 itamez@weld.gov Fiscal Contact Name, Title, Phone and Email Sonya Oster Business Operations Manager 970-400-2323 soster@weld.gov Contract/Encumbrance Number CT FHLA 2023*2330 Expenditure Categories Budget Totals Personal Services Salaried Employees Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Position Title Description of Work and Justification for Revision Supervisor For TCO. Provide supervision and oversight to the TCO staff and program; assist with progress reports, participate in webinars and site visits. $1,689.23 $1,689.23 Chief Nursing Officer For HNCS. Provide clinical supervision and grant oversight; assure clinic is prepared to serve clients. $183.42 $183.42 Community Health Worker For TCO. The CHW will be responsible for identifying eligible community members, assessing barriers to screenings, and providing direct assistance to reduce barriers to access breast and cervical cancer screening services in a health system. $57,761.26 $57,761.26 Employees Services Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Personal Hourly Position Title Description of Work and Justification for Revision Program Coordinator For TCO & HNCS. Coordinates prepares for and completes bilingual staff is needed, such as answering phones, Change: Increased time and completes progress reports, participates in webinars, site visits and chart audits. Assists with TCO or events when enters data into the TCO data portal, and provides office support and making copies for TCO. on project. $4,675.58 $1,368.53 $6,044.11 Total Personal Services (including fringe benefits) $64,309.49 $1,368.53 $65,678.02 Supplies & Operating Expenses Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Operating/supplies For HNCS. Allowable purchase and Clinical Services allowable Detection Funding Opportunities grantees/health-navigati on-and-clinical-services/health-navigati of supplies/operating items listed on the Health Navigation purchase document on the Cancer Prevention and Early website: https://cancerplan.colorado.gov/help-for- on-and-clinical-services.0 $2,000.00 $2,000.00 Outreach and Education Expenses For TCO Includes educational materials and outreach supplies to promote awareness of breast and cervical cancer screenings, as well as items to improve engagement of the community during outreach events. I?I $160.00 $160.00 Participant Support Costs For TCO. Items to address basic social each).L7 needs such as gift cards for food insecurity (2 x $20 $40.00 $40.00 Page 1 of 3 Option Letter Contract Number: 20232330 Option Letter #3 Revised -November 2013 Docusign Envelope ID: 387523D2-DD51-4712-BB72-22672ED7F8E9 Exhibit C., Budget is COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Weld County Department of Public Health Environment and Budget Period 6/30/2024 - 6/29/2025 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services (HNCS) The Community Outreach (TCO) Version 6.2024 Program Contact Name, Title, Phone and Email Ivonne Tamez Program Coordinator 970-400-6420 itamez@weld.gov Fiscal Contact Name, Title, Phone and Email Sonya Oster Business Operations Manager 970-400-2323 soster@weld.gov Contract/Encumbrance Number CT FHLA 2023*2330 Postage For TCO/HNCS. Postage for reminder letters. $0.63 x 55 clients Fi $34.65 $34.65 Registration For TCO. Registration costs including the Colorado Health credentialling tests. i'l for Community Outreach staff to attend relevant Navigator Assessment for health navigators trainings, and/or $425.00 $425.00 Office Supplies Office supplies for Community Outreach (not included in indirect). VI $100.00 $100.00 Electronic Medical Record (EMR) Fees The TCO worker will take a screening appointments for $1000(?i laptop to outreach events and will utilize clients who qualify for direct assistance. EMR to schedule 1 EMR user license @ $1,000.00 $1,000.00 Cell Phone Services The TCO program will use a cell phone for outreach and contacting clients who qualify for direct assistance; In addition, the phone will be used as a WIFI hot spot when at community events. Estimated at $30.00/month for 12 months.PI $360.00 $360.00 Printing For TCO/HNCS. Printing costs for culturally to be distributed for educational benefits approved education materials for breast and Estimated: 100 prints @ $1.50/each.k and linguistically appropriate relevant small media of the community. This include appropriate and cervical cancer screening and early prevention. $150.00 $150.00 Total Supplies & Operating Expenses $4,269.65 $0.00 $4,269.65 Travel Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Meals For TCO/HNCS. Meals for staff to attend in -person training and meetings. Estimated rate is $60 per person per day x 3 days VI $180.00 $180.00 Mileage For TCO/HNCS. Mileage for staff to provide communty outreach, attend in -person training and meetings, and to travel to other community and clinic locations as needed. Current mileage reimbursement rate is 0.65/mile PI $330.20 $330.20 Lodging For TCO/HNCS. Lodging for staff to attend in -person training and meetings. Estimated 2 number of people @ $250/night x 3 nights. V $750.00 $750.00 Participant travel expenses For TCO/HNCS. Taxi, Uber and Lyft vouchers and assist participants in traveling to health or gas cards system for screening.:?) (5 x $10 each) to reduce barriers $50.00 $50.00 Total Travel $1,310.20 $0.00 $1,310.20 Page 2 of 3 Option Letter Contract Number. 2023"2330 Option Letter #3 Revised -November 2013 Docusign Envelope ID 387523D2-DD51-4712-BB72-22672ED7F8E9 Exhibit C., Budget COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Original Contract Routing 2023*2330 Contractor Name Weld County Department of Public Health and Environment Budget Period 6/30/2024 - 6/29/2025 Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services The Community Outreach (TCO) (HNCS) Version 6.2024 Program Contact Name, Title, Phone and Email Ivonne Tamez Program Coordinator 970-400-6420 itamez@weld.gov Fiscal Contact Name, Title, Phone and Email Sonya Oster Business Operations Manager 970-400-2323 soster@weld.gov Contract/Encumbrance Number CT FHLA 2023"2330 Contractual (payments to third parties or entities) Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Subcontractor Entity Name Description of Item and Justification for Revision CTS LanguageLink For TCO/HNCS. Interpretation services in person or via telephone to assist with education, direct assistance or screening services. Estimated at $10/callf'l $100.00 $100.00 Total Contractual $100.00 $0.00 $100.00 SUB -TOTAL BEFORE INDIRECT $69,989.34 $1,368.53 $71,357.87 Indirect Original Budget Modification to Budget in Amendment/ Option Letter Total Amount Requested from CDPHE Item Description of Item CDPHE Negotiated Indirect Cost Rate Indirect costs. Weld County Health MTDC effective January 1, 2024.[?] Department's approved indirect cost rate is 18.96% of $13,269.66 $259.47 $13,529.13 Total Indirect $13,269.66 $259.47 $13,529.13 TOTAL $83,259.00 $1,628.00 $84,887.00 Page 3 of 3 Option Letter Contract Number: 2023*2330 Option Letter #3 Revised -November 2013 Mariah Higgins From: Sent: To: Cc: Subject: Attachments: Follow Up Flag: Flag Status: Bill Fritz Wednesday, June 5, 2024 12:50 PM CTB Jason Chessher; Shaun May Communication for On Consent task.pdf Follow up Flagged Good afternoon, attached is Option Letter #2 for Cancer Prevention and Early Detection (WWC). Please add to the next available Consent Agenda. 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 e-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. Co(ANvn,G0.''lQ/1 S 06(26 /24 2024-1723 14L.O 056 DocuSign Envelope ID: D567B775-7785-4583-6F59-CB2E309DACC1 OPTION LETTER #2 State Agency: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2023*2330 Option Letter Contract Number: 2023*2330 Option Letter #2 Contractor Board of County Commissioners of Weld County (a political subdivision of the state of Colorado) 1150 "O" Street Greeley CO 80631 for the me and benefit of the Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley CO 80631 Contract Performance Beginning Date: January 1, 2023 Current Contract Expiration Date: June 29, 2025 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Original Contract 2023*2330 $0.00 $19,253.00 $0.00 1/01/2023 - 6/29/2023 $19,253.00 Original Contract 2023*2330 $23,620.00 $0.00 $0.00 1/01/2023 - 6/29/2023 $23,620.00 Contract Amendment #1 2023*2330 Amendment #1 $25,898.00 $0.00 $0.00 6/30/2023 — 6/29/2024 $25,898.00 Contract Amendment #1 2023*2330 Amendment #1 $0.00 $31,271.00 $0.00 7/01/2023 - 6/29/2024 $31,271.00 Option Letter #i 2023*2330 Option Letter # 1 $26,090.00 $0.00 $0.00 11/13/2023 — 6/29/2024 $26,090.00 Option Letter #2 2023*2330 Option Letter #2 $62,444.00 $0.00 $0.00 6/30/2024 - 6/29/2025 $62,444.00 Option Letter #2 2023*2330 Option Letter #2 $0.00 $20,815.00 $0.00 7/01/2024 - 6/29/2025 $20,815.00 Current Contract Maximum Cumulative Amount $209,391.00 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 2., Term and Effective Date, Paragraph C., Extension Terms — State's Option, of the Master Task Order 23 FAA 00051, the State hereby exercises its option Page 1 of Option Letter Contract Number: 2023*2330 Option Letter #2 Ver. 27.01.20 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 for an additional term, beginning June 30, 2024, and ending on the current contract expiration date shown above, at the rates stated in the Original Contract, as amended for the following reason: extend the performance under this Contract for another term. B. In accordance with Section 5., Payments to Contractor, Paragraph B., Payment Procedures, Sub -paragraph v., Option to Increase Maximum Amount, of the Original Master Task Order 23 FAA 00051, 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: add funds for State Fiscal Year 2025 to support deliverables and services as specified in the Contract's Statement of Work. C. Exhibit D., Federal Provisions — Colorado Cancer Prevention and Control, is deleted and replaced in its entirety with Exhibit D., Federal Provisions — Colorado Cancer Prevention and Control, attached to this Option Letter, for the following reason: To reflect changes to the federal award identification information. D. 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 June 30, 2024, whichever is later. Page 2 of 3 Option Letter Contract Number: 2023*2330 Option Letter #2 Ver. 27.01.20 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 SIGNATURE PAGE STATE OF COLORADO Jared S. Polis, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director [DocuSigned by: ��(, LSLth ai�u t )0IA. 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 DocuSigneed by: CiatUAkth, ( lbl d201391247652461... ar�nnaieua7ean By: Signature Chelsea Gilbertson By: Signature Jannette Scarpino Name of Executive Director Delegate Director of Procurement and Contracts Name of State Controller Delegate Chief Financial Officer Title of Executive Director Delegate 2024-06-03 Date: Title of State Controller Delegate 2024-06-03 Option Effective Date: -- Signature Page End -- Page 3 of 3 Option Letter Contract Number: 2023 *2330 Option Letter #2 Ver. 27.01.20 DocuSign Envelope ID: O567B775-7785-4583-AF59-CB2E309DACC1 Exhibit C., Budget COLORADO Department of Public Health & Environment Version 6.2023 PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2023*2330 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Email Ivonne Tamez Program Coordinator 970-400-6420 itamez@weld.gov Budget Period 6/30/2024 - 6/29/2025 Fiscal Contact Name, Title, Phone and Email Sonya Oster Business Operations Manager 970-400-2323 soster@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services The Community Outreach (TCO) (HNCS) Contract (CT Number or PO) CT FHLA 2023*2330 Expenditure Categories Personal Salaried Employees Services Position Title Description of Work Gross or Annual Salary Fringe 44.34% Percent of Time on Project Total Amount Requested from CDPHE Supervisor For TCO. Provide supervision and oversight to the TCO staff and program; assist with progress reports, participate in webinars and site visits. $ 117,031.00 $ 51,891.55 1.000% 1,689.23 $ Chief Nursing Officer For HNCS. Provide clinical supervision and grant oversight; assure clinic is prepared to serve clients. $ 169,435.00 $ 75,127.48 0.075% $ 183.42 Community Health Worker For TCO. The CHW will be responsible for identifying eligible community members, assessing barriers to screenings, and providing direct assistance to reduce barriers to access breast and cervical cancer screening services in a health system. $ 80,035.00 $ 35,487.52 50.000% $ 57,761.26 Personal Hourly Employees Services Position Title Description of Work Hourly Wage Hourly Fringe 44.34% Total # of Hours on Project Total Amount Requested from CDPHE Program Coordinator For TCO & HNCS. Coordinates and completes progress reports, participates in webinars, prepares for and completes site visits and chart audits. Assists with TCO or events when bilingual staff is needed, enters data into the TCO data portal, and provides office support such as answering phones, and making copies for TCO. $ 24.54 $ 10.88 132.0 $ 4,675.58 Total Personal Services (including fringe benefits) $ 64,309.49 Option Letter Contract Number: 2023*2330 Option Letter #2 Page 1of3 January 2018 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 Exhibit C., Budget COLORADO Department of Public Health & Environment Version 6.2023 PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2023*2330 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Email Ivonne Tamez Program Coordinator 970-400-6420 itamez@weld.gov Budget Period 6/30/2024 - 6/29/2025 Fiscal Contact Name, Title, Phone and Email Sonya Oster Business Operations Manager 970-400-2323 soster@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services The Community Outreach (TCO) (HNCS) Contract (CT Number or PO) CT FHLA 2023'2330 Supplies & Operating Expenses Item Description of Item Rate Quantity Total Amount Requested from CDPHE Operating/supplies For HNCS. Allowable purchase of supplies/operating items listed on the Health Navigation and Clinical Services allowable purchase document on the Cancer Prevention and Early Detection Funding Opportunities website: https://cancerplan.colorado.gov/help-for-grantees/health-navigation-and- clinical-services/health-navigation-and-clinical-services. $ 2,000.00 1.0 $ 2,000.00 Outreach and Education Expenses For TCO Includes educational materials and outreach supplies to promote awareness of breast and cervical cancer screenings, as well as items to improve engagement of the community during outreach events. $ 160.00 1.00 $ 160.00 Participant Support Costs For TCO. Items to address insecurity (2 x $20 each). basic social needs such as gift cards for food $ 20.00 2.00 $ 40.00 Postage For TCO/HNCS. Postage for reminder letters. $0.63 x 55 clients $ 0.63 55.00 $ 34.65 Registration For TCO. Registration costs for Community Outreach staff to attend relevant trainings, including the Colorado Health Navigator Assessment for health navigators and/or credentialing tests. $ 425.00 1.00 $ 425.00 Office Supplies Office supplies for Community Outreach (not included in indirect). $ 100.00 1.00 $ 100.00 Electronic Medical Record (EMR) Fees The TCO worker will take schedule screening appointments 1 EMR user license @ $1000 a laptop to outreach events and will utilize EMR to for clients who qualify for direct assistance. $1,000.00 1.00 $ 1,000.00 Cell Phone Services The TCO program will use a cell phone for outreach and contacting clients who qualify for direct assistance; In addition, the phone will be used as a WIFI hot spot when at community events. Estimated at $30.00/month for 12 months. $30.00 12.00 $ 360.00 Printing For TCO/HNCS. Printing costs for culturally and linguistically appropriate relevant small media to be distributed for educational benefits of the community. This include appropriate and approved education materials for breast and cervical cancer screening and early prevention. Estimated: 100 prints @ $1.50/each. $1.50 100.00 $ 150.00 Total Supplies & Operating $ 4,269.65 Option Letter Contract Number: 2023*2330 Option Letter #2 Page 2 of 3 January 2018 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 Exhibit C., Budget COLORADO Department of Public Health & Environment Version 6.2023 PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2023*2330 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Email Ivonne Tamez Program Coordinator 970-400-6420 itamez@weld.gov Budget Period 6/30/2024 - 6/29/2025 Fiscal Contact Name, Title, Phone and Email Sonya Oster Business Operations Manager 970-400-2323 soster@weld.gov Project Name Cancer Prevention and Early Detection: Health Navigation and Clinical Services The Community Outreach (TCO) (HNCS) Contract (CT Number or PO) CT FHLA 2023*2330 Travel Item Description of Item Rate Quantity Total Amount Requested from CDPHE Meals For TCO/HNCS. Meals for staff to attend in -person training and meetings. Estimated rate is $60 per person per day x 3 days $ 60.00 3.0 $ 180.00 Mileage For TCO/HNCS. Mileage for staff to provide community outreach, attend in - person training and meetings, and to travel to other community and clinic locations as needed. Current mileage reimbursement rate is 0.65/mile 5 0.65 508.00 $ 330.20 Lodging For TCO/HNCS. Lodging for staff to attend in -person training and meetings. Estimated 2 number of people @ $250/night x 3 nights. $ 250.00 3.00 $ 750.00 Participant travel expenses For TCO/HNCS. Taxi, Uber and Lyft vouchers or gas cards reduce barriers and assist participants in traveling to health screening. (S x $10 each) system for to $ 10.00 5.00 $ 50.00 Total Travel $ 1,310.20 Contractual Subcontractor Name Description of Item Rate Quantity Total Amount Requested from CDPHE For TCO/HNCS. Interpretation services in person or via telephone to assist with education, direct assistance or screening services. Estimated at $10/call $ 10.00 10.00 $ 100.00 CTS LanguageLink Total Contractual $ 100.00 SUB -TOTAL OF DIRECT COSTS $ 69,989.34 Indirect Item Description of Item Total Amount Requested from CDPHE CDPHE-Negotiated Indirect Cost Rate Indirect costs. Weld County Health Department's approved indirect cost rate is 18.96% of MTDC effective January 1, 2024. $ 13,269.66 Total Indirect $ 13,269.66 TOTAL $ 83,259.00 Option Letter Contract Number: 2023*2330 Option Letter #2 Page 3 of 3 January 2018 DocuSign Envelope ID: D567B775-7785-4503-AF59-CB2E309DACC1 Exhibit D Federal Provisions — Colorado Cancer Prevention and Control For the purposes of this Exhibit only, Contractor is also identified as "Subrecipient." This Contract has been funded, in whole or in part, with an award of Federal funds. In the event of a conflict between the provisions of these Supplemental Provisions for Federal Awards, the Special Provisions, the Contract or any attachments or exhibits incorporated into and made a part of the Contract, the Supplemental Provisions for Federal Awards shall control. In the event of a conflict between the Supplemental Provisions for Federal Awards and the FFATA Supplemental Provisions (if any), the FFATA Supplemental Provisions shall control. 1) Federal Award Identification. a. Subrecipient: Weld County Department of Public Health and Environment. b. Subrecipient Unique Entity Identification Number: • SAM Unique Entity ID (UEI): MKKXT9U9MTV5 c. The Federal Award Identification Number (FAIN) is NU58DP007167. d. The Federal award date is TBD. e. The subaward period of performance start date is 6/30/2022 and end date is 6/29/2027. f Federal Funds: Federal Budget Period Total Amount of Federal Funds Awarded Amount of Federal Funds Obligated to CDPHE 6/30/2024 - 6/29/2025 $12,459,822.00 $4,858,418.00 g. Federal award title of project or program: Colorado Cancer Prevention and Control The name of the Federal awarding agency is: Department Of Health And Human Services and the contact information for the awarding official is Karen Boone, Email: ikn7@cdc.gov, Phone: 770-448-3087; the name of the pass -through entity is the State of Colorado, Department of Public Health and Environment (CDPHE), and the contact information for the CDPHE official is Emily Kinsella, Women's Wellness Connection (WWC) Program Manager, emily.kinsella@state.co.us. h. The Catalog of Federal Domestic Assistance (CFDA) number is 93.898 and the grant name is Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations. i. This award is not for research & development. j. Subrecipient is not required to provide matching funds. In the event the Subrecipient is required to provide matching funds, Section 8 of this Attachment applies. k. The indirect cost rate for the Federal award (including if the de minimis rate is charged per 2 CFR §200.414 Indirect (F&A) costs) is pm -determined based upon the State of Colorado and CDPHE cost allocation plan. 2) Subrecipient shall at all times during the term of this contract strictly adhere to the requirements under the Federal Award listed above, and all applicable federal laws, Executive Orders, and implementing regulations as they currently exist and may hereafter be amended. Page 1 of Option Letter Contract Number: 2023'2330 Option Letter #2 Ver. 25.02.20 DocuSign Envelope ID: O567B775-7785-4583-AF59-CB2E309DACC1 Exhibit D 3) Any additional requirements that CDPHE imposes on Subrecipient in order for CDPHE to meet its own responsibility to the Federal awarding agency, including identification of any required financial and performance reports, are stated in the Exhibits. 4) Subrecipient's approved indirect cost rate is as stated in the Exhibits. 5) Subrecipient must permit CDPHE and auditors to have access to Subrecipient's records and financial statements as necessary for CDPHE to meet the requirements of 2 CFR §200.331 Requirements for pass -through entities, §§ 200.300 Statutory and National Policy Requirements through §200.309 Period of performance, and Subpart F —Audit Requirements of this Part. 6) The appropriate terms and conditions concerning closeout of the subaward are listed in Section 16 of this Attachment. 7) Performance and Final Status. Subrecipient shall submit all financial, performance, and other reports to CDPHE no later than 45 calendar days after the period of performance end date or sooner termination of this Contract containing an evaluation and review of Subrecipient's performance and the final status of Subrecipient's obligations hereunder. 8) Matching Funds. Subrecipient shall provide matching funds as stated in the Exhibits. Subrecipient shall have raised the full amount of matching funds prior to the Effective Date and shall report to CDPHE regarding the status of such funds upon request. Subrecipient's obligation to pay all or any part of any matching funds, whether direct or contingent, only extends to funds duly and lawfully appropriated for the purposes of this Contract by the authorized representatives of the Subrecipient and paid into the Subrecipient's treasury or bank account. Subrecipient represents to CDPHE that the amount designated as matching funds has been legally appropriated for the purposes of this Contract by its authorized representatives and paid into its treasury or bank account. Subrecipient does not by this Contract irrevocably pledge present cash reserves for payments in future fiscal years, and this Contract is not intended to create a multiple -fiscal year debt of the Subrecipient. Subrecipient shall not pay or be liable for any claimed interest, late charges, fees, taxes or penalties of any nature, except as required by Subrecipient's laws or policies. 9) Record Retention Period. The record retention period previously stated in this Contract is replaced with the record retention period prescribed in 2 CFR §200.333. 10) Single Audit Requirements. If Subrecipient expends $750,000 or more in Federal Awards during Subrecipient's fiscal year, Subrecipient shall procure or arrange for a single or program -specific audit conducted for that year in accordance with the provisions of Subpart F -Audit Requirements of the Uniform Guidance, issued pursuant to the Single Audit Act Amendments of 1996, (31 U.S.C. 7501- 7507). 2 CFR §200.501. 1 l) Contract Provisions. Subrecipient shall comply with and shall include all of the following applicable provisions in all subcontracts entered into by it pursuant to this Contract: a. Office of Management and Budget Circulars and The Common Rule for Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments, as applicable; b. when required by Federal program legislation, the "Davis -Bacon Act", as amended (40 U.S.C. 3141-3148) as supplemented by Department of Labor Regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"); c. when required by Federal program legislation, the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building of Public Work Financed in Whole or in Part by Loans or Grants from the United States"). Page 2 of 4 Option Letter Contract Number: 2023*2330 Option Letter #2 Ver. 25.02.20 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 Exhibit D d. 42 U.S.C. 6101 et sue, 42 U.S.C. 2000d, 29 U.S.C. 794 (regarding discrimination); e. the "Americans with Disabilities Act" (Public Law 101-336; 42 U.S.C. 12101, 12102, 12111 - 12117, 12131 - 12134, 12141 - 12150, 12161 - 12165, 12181 - 12189, 12201 - 12213 and 47 U.S.C. 225 and 47 U.S.C. 611); f when applicable, the Contractor shall comply with the provisions of the "Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments" (Common Rule); g. The Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law 110-252, including without limitation all data reporting requirements required there under. This Act is also referred to as FFATA. h. Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act of 1964, as amended. i. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 comply with the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal Employment Opportunity: (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor. j. Where applicable, Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). k. If the Federal award meets the definition of"funding agreement" under 37 CFR § 401.2 (a) and the recipient or subrecipient wishes to enter into an agreement with a small business firm or nonprofit organization, comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. 1. The Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended. m. If applicable, comply with the mandatory standards and policies on energy efficiency contained within the State of Colorado's energy conservation plan issued in compliance with the Energy Policy and Conservation Act, 42 U.S.C. 6201. n. The Contractor and all principals are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency; the Contractor and all principals shall comply with all applicable regulations pursuant to Executive Order 12549 (3 CFR Part 1986 Comp., p. 189) and Executive Order 12689 (3 CFR Part 1989 Comp., p. 235), Debarment and Suspension; and, o. the Contractor shall comply where applicable, the Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). 12) Compliance. Subrecipient shall comply with all applicable provisions of The Office of Management and Budget Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), including but not limited to these Supplemental Provisions for Federal Awards. Any revisions to such provisions automatically shall become a part of these Supplemental Provisions, without the necessity of either party executing any further instrument. Page 3 of 4 Option Letter Contract Number 2023*2330 Option Letter #2 Ver. 25.02.20 DocuSign Envelope ID: D5670775-7785-4583-AF59-CB2E309DACC1 Exhibit D CDPHE may provide written notification to Subrecipient of such revisions, but such notice shall not be a condition precedent to the effectiveness of such revisions. 13) Procurement Procedures. Subrecipient shall use its own documented procurement procedures which reflect applicable State, local, and Tribal laws and regulations, provided that the procurements conform to applicable Federal law and the standards identified in the Uniform Guidance, including without limitation, §§200.318 through 200.326 thereof. 14) Certifications. Unless prohibited by Federal statutes or regulations, CDPHE may require Subrecipient to submit certifications and representations required by Federal statutes or regulations on an annual basis (2 CFR §200.208). Submission may be required more frequently if Subrecipient fails to meet a requirement of the Federal award. Subrecipient shall certify in writing to CDPHE at the end of the Contract that the project or activity was completed or the level of effort was expended. 2 CFR §200.201(b)(3). If the required level of activity or effort was not carried out, the amount of the Contract must be adjusted. 15) Event of Default. Failure to comply with the Uniform Guidance or these Supplemental Provisions for Federal Awards shall constitute an event of default under the Contract pursuant to 2 CFR §200.339 and CDPHE may terminate the Contract in accordance with the provisions in the Contract. 16) Close- Out. Subrecipient shall close out this Contract within 45 days after the End Date. Contract close out entails submission to CDPHE by Subrecipient of all documentation defined as a deliverable in this Contract, and Subrecipient's final reimbursement request. If the project has not been closed by the Federal awarding agency within 1 year and 45 days after the End Date due to Subrecipient's failure to submit required documentation that CDPHE has requested from Subrecipient, then Subrecipient maybe prohibited from applying for new Federal awards through the State until such documentation has been submitted and accepted. 17) Erroneous Payments. The closeout of a Federal award does not affect the right of the Federal awarding agency or CDPHE to disallow costs and recover funds on the basis of a later audit or other review. Any cost disallowance recovery is to be made within the record retention period. EXHIBIT END Page 4 of 4 Option Letter Contract Number: 2023*2330 Option Letter #2 Ver. 25.02.20 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 CONTRACT MODIFICATION SUBMITTAL CHECKLIST Contractor/Subrecipient Name Weld County Department of Public Health and Environment ❑ All Contractor name occurrences and Secretary of State Status Summary Page match exactly Modification Routing # 2023*2330 Option Letter #2 Original Routing # 2023*2330 CORE # CT FHLA 2023*2330 or NO ENCUMBRANCE Modification Start Date 6/30/2024 Modification End Date 6/29/2025 SOW Modification Pre -Approval or Regents Pre -Review (AMD) - OnBase Approval # Enter # (if applicable) Division Acronym PSD Submitter Name Susan Thao SOW Delegate Name Enter SOW Delegate Name Unit Acronym WWC Email susan.thao@state.co.us Email Enter Emaill Purpose(s) of Modification (Select all that apply) Scope of Work N Budget X Renewal 1 No Cost Assignment I Other If 'Other' Describe Modification DOCUMENT TYPE Select Only One A B C A. Amendment ❑ B. Option Letter r C. Assignment ■ Modification - DocuSign Backup Documents Mark all that apply for the selected Document Type. Include requested backup documents (as required) and contract in DocuSign envelope in order from 1-11. A B C 1. Contract Modification Quality Assurance Checklist ❑ ❑ ❑ 2. Contract Modification Submittal Checklist ❑ O ❑ 3. Cover Page of original contract document and cover page of most recent assignment, if applicable ❑ ►li ❑ 4. If Subrecipient, Pre -Award Financial Risk Assessment # (See irri.elruai Auui1 :)iie) See FRMS Data ❑ O (Renewal required each year) 5. Insurance Certificate(s) If Assignment, Certificate NOT required for Interagency *** of Insurance Insurance Agreement Policy (COI) or Dates for Assignee Intergovernmental must be current on effective date of contract *** only. Contract. ❑ ❑ ❑ Waiver - OnBase Approval ID# Enter # Insurance Waiver Type: Enter Type of Waiver Granted 6. ❑ Sole Source REVISION (Modification required when increased amount, change in SOW, or date change) New PCS Sole Source Request # Enter PCU Request # ❑ ❑ New PCS Sole Source Term Select SS Term Start Date to Select SS Term End Date New NPSS1 # Enter NPPSS1 # 7. (Must Secretary of state the (If Assignment, State Status Summary Page entity is in 'good standing') SOS for Assignee only; NOT (Amendment required for or Option Letter for Interagency Agreement, a new term) Intergovernmental Contract) ❑ ❑ ❑ If 'Doing Business As' (dba), Secretary of State Status Summary Page for dba ❑ ❑ ❑ 8. Signature Authority See OSC Policy Letter or Corporate Documentation Signature Authority Delegation) (If contract signed by other than apparent authority) ❑ ❑ 9. SAM Exclusion Summary Page (Record verified and no exclusions/restrictions) (See SAM Verification Guidance) ❑ O ❑ (If Assignment, SAM for Assignee only; NOT required for Interagency Agreement Contract or LPHA) 10. Contract Modification (cover page, signature page, main body) ❑ ►:I ❑ 11. Contract Modification Exhibits (as shown on cover page of modification being submitted) ❑ ❑ ❑ Modification Submittal Checklist Version 08.24.23 1 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 Required for contracts CMS $100,000 RECORD 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 certified 'Yes' Record. corresponding Fields: when If as complying renewing the If this field Modification in Modification or the with extending Master the is is terms not the Record. to renew of expiration to renew the or extend contract date or extend, AND and a contract, the enter choose Master 'Yes' 'N/A' has CMS in the and the contract corresponding do contractor's not record make any work updated? field changes to In the date Choose Master in been the ❑ 6. If Data — If date or not the contract 3x change Field: of per corresponding the Certification contract year). it. has If been the to field renewed represent Modification — in If applicable, the or Master the extended, is last not enter contractor to Record date enter renew of expiration performance or is set to MOST extend, 'Yes' RECENT date as evaluation leave a of result the blank. annual contract. of a certification of previous the of We are using contract renewal/extension, contractor period the expiration (quarterly work do ❑ ❑ 7. Data Fields: All other relevant data fields are completed per CDPHE protocol. 8. Update fields have Master Record been updated — Cumulative as applicable. Dollar Amount, Latest Performance End Date, and Recertification data ❑ NOTES: FY25 WWC Renewal - Exh D., Federal Provisions — waiting forNO,a, will update FP when it comes in Modification Submittal Checklist Version 08.24.23 2 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 TASK ORDER State Agency State of Colorado for the use & benefit of the Department of Public Health and Environment 4300 Cherry Creek Drive South Denver CO 80246 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 Master Task Order Contract Number 23 FA 00051 Task Order Number 2023*2330 Task Order Performance Beginning Date The later of the Task Order Effective Date or Janurary 1, 2023 Task Order Maximum Amount Initial Term Fiscal Year 2023 $42,873.00 Total for All Fiscal Years $42,873.00 Task Order Expiration Date June 29, 2023 Except as stated in §2.D., the total duration of this Contract, including the exercise of any options to extend, shall not exceed 5 years from its Performance Beginning Date. Pricing/Funding Price Structure: Cost Reimbustment Contractor Shall Invoice: Monthly Funding Source: State $19,253.00 Federal $23,620.00 Miscellaneous: Authority to enter into this Contract exists in: C.R.S. 25-1.5-101 - C.R.S. 25-1.5-113 Law Specified Vendor Statute (if any): Procurement Method: Request For Application (RFA) Solicitation Number (if any): 40359 State Representative Emily Kinsella Women's Wellness Connection Section Manager Prevention Services Division Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246 emily.kinsella@state.co.us Contractor Representative Tanya Geiser Chair, Weld County Board of County Commissioners 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 tgeisergweldgov.com Exhibits and Order of Precedence The following Exhibits and attachments are included with this Contract: Exhibit A, Additional Provisions Exhibit B, Statement of Work Exhibit C, Budget Exhibit D, Federal Provisions — Colorado Cancer Prevention and Control Task Order Number: 2023*2330 Page 1 of 3 Version 02.24.2022 DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 Contract Purpose This project serves to reduce cancer health disparities, and morbidity and mortality rates in Colorado. Cancer screening will increase in Colorado Department of Public Health and Environment (CDPHE)-identified priority populations, especially women who are eligible for CDPHE-paid Clinical Services, by implementing one or more approved strategies (community outreach, health navigation, CDPHE-paid clinical services) to address cancer prevention and early detection. In accordance with §4.B of the Master Task Order Contract referenced above, Contractor shall complete the following Project: 1. PROJECT DESCRIPTION Contractor shall complete the Project described in Exhibit B Statement of Work (SOW) that is attached hereto and incorporated herein ("the SOW"). All terminology used in this Task Order and the Statement of Work shall be interpreted in accordance with the Master Task Order Contract unless specifically defined differently in this Task Order. The Statement of Work and Budget are incorporated herein, made a part hereof and attached hereto as Exhibit B - Statement of Work and Exhibit C - Budget. 2. PAYMENT The State shall pay Contractor the amounts shown in Exhibit C - Budget that is attached hereto and incorporated herein, in accordance with the requirements of the Statement of Work and the Master Task Order Contract. The State shall not make any payment for a State Fiscal Year that exceeds the Task Order Maximum Amount shown above for that State Fiscal Year. 3. PERFORMANCE PERIOD Contractor shall complete all Work on the Project described in this Task Order by the Task Order Expiration Date stated above. Contractor shall not perform any Work described in the Statement of Work prior to the Task Order Performance Beginning Date or after the Task Order Expiration Date stated above. 4. TASK ORDER EFFECTIVE DATE: The Effective Date of this Task Order is upon approval of the State Controller or January 1, 2023, whichever is later. Task Order Number: 2023*2330 Page 2 of 3 Version 02.24.2022 DocuSign Envelope ID 05676775-7785-4583-AF59-CB2E309DACCi i _ FRMS Data on Demand Solution Select an Agency Name to view activities and current risk rating. Click here to view FRMS Activity Documents. Agency Name, Weld County Department of Public Health & Environment (1) i Agency Name Current Risk Supporting Rating • Documents Weld County Department of Public... Low Not Required Agency Name Weld County Department of ... Weld County Department of ... Weld County Department of Weld County Department of Weld County Department of ... Weld County Department of ... Weld County Department of .. Weld County Department of Weld County Department of .,. Weld County Department of ... Weld County Department of .. Weld County Department of ... Assessment Type Invoice Sample Invoice Sample Invoice Sample Site Visit Questionnaire Questionnaire Invoice Sample Invoice Sample Questionnaire Site Visit Questionnaire Site Visit Assessor Name No data No data Kevin Slevin Celeste White Kevin Stem Kevin Slevin Kevin Slevin Kimra Coons C©rrina Quintana Kevin Slevin No data No data Completion Date Nov 15, 2013 Sep 15, 2014 Oct 20, 2015 Sep 1,2016 May 12, 2016 Jun 6, 2017 No data Oct 15, 2019 No data May 29, 2018 Mar 1, 2014 Mar 6, 2013 Identified Concern(s) Assessment Type None None None None NIA N/A No data None None None N/A None Invoice Sample Invoice Sample Invoice Sample Site Visit Questionnaire Questionnaire Invoice Sample Invoice Sample Questionnaire Site Visit Questionnaire Site Visit Weld County Department of .. Questionnaire Celeste White Jun 28, 2012 N/A Questionnaire l.art undated by Christnnher D'Ovidin on Nov 20 2023 at 12:32 PM DocuSign Envelope ID: D567B775-7785-4583-AF59-CB2E309DACC1 WELD COUNTY GOVERNMENT souov WELD COUNTY GOVERNMENT Unique Entity ID MKKXT9U9MTV5 Registration Status Active Registration Physical Address 1150O ST Greeley, Colorado 80631-9596 United States CAGE / NCAGE 4KEF9 Expiration Date Nov 19, 2024 Mailing Address 1150 O Street Greeley, Colorado 80631-1117 United States Purpose of Registration Federal Assistance Awards Only Business Information 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 Nov 24, 2023 Submission Date Nov 20, 2023 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.1.. 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. Exclusion Summary Active Exclusions Records? No SAM Search Authorization I authorize my entity's non -sensitive information to be displayed in SAM public search results: Yes Entity Types Business Types Entity Structure U.S. Government Entity Profit Structure (blank) Entity Type US Local Government Organization Factors (blank) May 05, 2024 10:24:53 PM GMT https://sam.gov/entity'/MKKXT9U9MTVS/coreData?status=null Page 1 of 2 tact undated by C.hri.ctnnher D'Ovidin nn Nnv 20. 2023 at 12:32 PM DocuSign Envelope ID. D567B775-7785-4583-AF59-CB2E309DACC1 Socio-Economic Types WELD COUNTY GOVERNMENT Check the registrant's Reps & Certs, if present, under FAR 52.212-3 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 Financial Information Accepts Credit Card Payments No Debt Subject To Offset No EFT Indicator 0000 CAGE Code 4KEF9 Points of Contact 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 • Chris D'Ovidio Ryan Rose 1150 O Street Greeley, Colorado 80631 United States 1150 O Street Greeley, Colorado 80631 United States Service Classifications NAICS Codes Primary NAICS Codes NAICS Title Disaster Response This entity does not appear in the disaster response registry. May 05, 2024 10:24:53 PM GMT https: //sam.gov/entity/MKKXT9U9MTVS/coreData?status=null Page 2 of 2 Hello