HomeMy WebLinkAbout20250909.tiffResolution
Approve Amendment #3 to Grant Contract for Children, Youth, and Family
Behavioral Health Services and Authorize Chair to Sign
Whereas, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
Whereas, the Board has been presented with Amendment #3 to the Grant Contract for
Children, Youth, and Family Behavioral Health Services between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Department of Human Services, and the Colorado Department of Human
Services, commencing upon full execution of signatures, and ending June 30, 2026, with
further terms and conditions being as stated in said amendment, and
Whereas, after review, the Board deems it advisable to approve said amendment, a copy
of which is attached hereto and incorporated herein by reference.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that Amendment #3 to the Grant Contract for Children, Youth, and Family
Behavioral Health Services between the County of Weld, State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Department
of Human Services, and the Colorado Department of Human Services, be, and hereby is,
approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said amendment.
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 2nd day of April, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppler: Aye
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
Cc ; Hsi), AcT(cp/17 a/co)
05 1°2/25
2025-0909
H R0097
Con-t-vaCk-l00Z30
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Colorado Department of Human Services (CDHS) Behavioral Health
Administration 1281 Grant Contract Amendment #3
DEPARTMENT: Human Services DATE: March 25, 2025
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
Brief description of the problem/issue: In 2023 the Department was awarded the Behavioral Health
Administration 1281 Grant by the Colorado Department of Human Services (CDHS) and entered into
a contract to receive this funding, known to the Board as Tyler# 2023-2546. The purpose of this
Contract is to establish/expand services to address local behavioral health care needs along continuum
of care, including services for Children, Youth, and Family with severe needs.
On June 19, 2024 the Board approved Amendment #1 that renewed the Agreement for FY25 which
added $470,085.09 in new funding for FY25 as well as updated Exhibit B, Exhibit C, Exhibit E, and
Exhibit F.
On December 19, 2024, the Board approved of Amendment #2, which added an additional $9,946.47
to the FY25 funding. Additionally, the Amendment replaced Exhibit A with Exhibit A-1, Exhibit B-2 with
Exhibit B-3, Exhibit E-1 with Exhibit E-2, and Exhibit F-1 with Exhibit E-2.
The Department is now requesting the Board's approval of Amendment #3, which extends the term of
the Contract to June 30, 2026 and replaces Exhibit A-1 with Exhibit A-2, Exhibit B-3 with Exhibit B-4,
Exhibit E-2 with Exhibit E-3, and Exhibit F-2 with Exhibit F-3.
What options exist for the Board?
Approval of the Colorado Department of Human Services (CDHS) Behavioral Health
Administration 1281 Grant Contract Amendment #3.
Deny approval of the Colorado Department of Human Services (CDHS) Behavioral Health
Administration 1281 Grant Contract Amendment #3.
Consequences: WCDHS will not have a current contract with CDHS
Impacts_ : WCDHS contract with CDHS will expire and will not be able to provide the services
to address local behavioral health care needs.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
Total award = Fiscal Year 2024 = $256,570.83
Fiscal Year 2025 = $470,085.09
Amendment #2 = $9,946.47
Amendment #3 = No additional funding
Total = $736,602.39
Funded through Colorado Department of Human Services Behavioral Health Administration
2025-0909
Pass -Around Memorandum; March 25, 2025 - CMS ID 9230
Recommendation:
• Approval of Amendment #3 and authorize the Chair to sign electronically.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck
Scott K. James
Jason S. Maxey
Lynette Peppier
Kevin D. Ross
7fe
6t -
Pass -Around Memorandum; March 25, 2025 - CMS ID 9230
Docusign Envelope ID: 8973BC75-7850-44EE-BF8D-B5C64B309102
State Agency
Colorado Department of Human Services
Behavioral Health Administration
Contractor
Weld County Department of Human Services
Current Contract Maximum Amount
Initial Term
State Fiscal Year 2024
Extension Terms
State Fiscal Year 2025
$256,570.83
$480,031.56
State Fiscal Year 2026 Any unspent funds
remaining from FY25
Total for All State Fiscal Years $736,602.39
COLORADO
Flnancm,�Senn«s c
Contract Amendment #3
Signature and Cover Page
Original Contract Number
24 IBEH 182001
Amendment Contract Number
26 IBEH 197513
Contract Performance Beginning Date
August 31, 2023
Current Contract Expiration Date
June 30, 2026
Signature page begins on next page.
Amendment Contract Number: 26 IBEH 197513 Page 1 of 4 Rev. 1/14/19 / Acc 11.12.24
Docusign Envelope ID: 89736C75-7B50-44EE-BF8D-65C64B309102
AD
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DO
IYiunSR A
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The Parties Hereto Have Executed This Amendment
Each person signing this Amendment represents and warrants that he or she is duly authorized
to execute this Amendment and to bind the Party authorizing his or her signature.
Contractor State of Colorado
Weld County Department of Human Services
Signed by:
wrwr�l`uw
By: Perry L. Buck, Chair"of the Board
of County Commissioners
4/2/2025
Date:
Jared S. Polis, Governor
Colorado Department of Human Services
Michelle Barnes, Executive Director
Signed by:
CST` h. �wlllw
By: Dannette R. Smith, Commissioner
Behavioral Health Administration
4/2/2025
Date:
In accordance with S24-30-202 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
�
t�e�Docu5igned by: f
iw
encoroc4o ►...
By: Telly Belton/Toni Williamson/Amanda Rios
Amendment Effective Date: 4/4/2025
Amendment Contract Number: 26 !BEN 197513 Page 2 of 4 Rev. 1/14/19 / Acc 11.12.24
COLORADO
Fine L SR A
1. Parties
This Amendment (the "Amendment") to the Original Contract shown on the Signature
and Cover Page for this Amendment (the "Contract") is entered into by and between
the Contractor, and the State.
2. Terminology
Except as specifically modified by this Amendment, all terms used in this Amendment
that are defined in the Contract shall be construed and interpreted in accordance with
the Contract.
3. Amendment Effective Date and Term
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment
Effective Date shown on the Signature and Cover Page for this Amendment. The
State shall not be bound by any provision of this Amendment before that
Amendment Effective Date, and shall have no obligation to pay Contractor for
any Work performed or expense incurred under this Amendment either before
or after the Amendment term shown in §3.B of this Amendment.
B. Amendment Term
The Parties' respective performances under this Amendment and the changes
to the Contract contained herein shall commence on the Amendment Effective
Date shown on the Signature and Cover Page for this Amendment and shall
terminate on the termination of the Contract.
4. Purpose
The purpose of this Contract is to establish/expand services to address local
behavioral health care needs along continuum of care, including services for Children,
Youth, and Family with severe needs.
The purpose of this Amendment is to update Exhibit A, Exhibit B, Exhibit E, and Exhibit
F. This Amendment extends the Contract end date to June 30, 2026.
5. Modifications
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover
Page is hereby deleted and replaced with the Current Contract Expiration Date shown
on the Signature and Cover Page for this Amendment.
Amendment Contract Number: 25 IBEH 197513 Page 3 of 4 Rev. 1/14/19 / Acc 11.12.24
,COLORADO
iti Financial Ser..
B. REPLACE Exhibit A-1, Statement of Work, with Exhibit A-2, Statement of Work,
attached and incorporated by reference.
C. REPLACE Exhibit B-3, Budget, with Exhibit B-4, Budget attached and incorporated by
reference.
D. REPLACE Exhibit E-2, Supplemental Provisions for Federal Awards, with Exhibit E-3,
Supplemental Provisions for Federal Awards, attached and incorporated by reference.
E. REPLACE Exhibit F-2, SLFRF Subrecipient Provisions, with Exhibit F-3, SLFRF
Subrecipient Provisions, attached and incorporated by reference.
6. Limits Of Effect and Order of Precedence
This Amendment is incorporated by reference into the Contract, and the Contract and
all prior amendments or other modifications to the Contract, if any, remain in full
force and effect except as specifically modified in this Amendment. Except for the
Special Provisions contained in the Contract, in the event of any conflict,
inconsistency, variance, or contradiction between the provisions of this Amendment
and any of the provisions of the Contract or any prior modification to the Contract,
the provisions of this Amendment shall in all respects supersede, govern, and control.
The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment
specifically modifies those Special Provisions.
THE REMAINDER OF THIS PAGE WAS INTENTIONALLY LEFT BLANK
Amendment Contract Number: 25 IBEH 197513 Page 4 of 4 Rev. 1/14/19 / Acc 11.12.24
Exhibit A-2
Exhibit A-2 - Statement of Work
Children, Youth, and Family Behavioral Health Services Grants
Article 1
Purpose and Target Population
1.1 Purpose
In accordance with 27-60-502, C.R.S., the Behavioral Health Administration (BHA) awards
grants to local governments, community -based organizations, federally -recognized Indian
tribes, local collaborative management programs, local juvenile services planning
committees, and nonprofit organizations for programs and services along the behavioral
health care continuum in areas of highest need and to address gaps in services, including
children -oriented, youth- oriented, and family -oriented behavioral health care services. The
purpose of the grant program is to expand or implement services that have been identified as
gaps in Child, Youth, and Family (CYF)-oriented behavioral health care and to improve
outcomes for individuals served.
1.2 Target Population
The target population includes persons eighteen (18) years of age or younger and their
families and persons twenty-one (21) years of age or younger who are receiving special
education services and their families pursuant to Part 1 of Article 20 of Title 22 s who have
behavioral health problems, including parent -child dyads, with acute, complex, and/or severe
conditions and needs.
Article 2
Definitions and Acronyms
2.1 Administrative Services Organizations (ASO) are organizations contracted by the
Behavioral Health Administration to administer and manage regional behavioral health crisis
services.
2.2 Behavioral Health Administration (BHA) means the Behavioral Health Administration
established in section 27-60-203.
2.3 Behavioral Health Administrative Services Region means a Behavioral Health
Administrative Services Region designated by the BHA Commissioner after consultation with
the Department of Health Care Policy and Financing and consideration of the regional
structure that serves the Medicaid population.
Page 1 of 5
Exhibit A-2
2.4 Behavioral Health -Care Services Assessment Tool means the assessment tool described in
section 27-60-502 (1)(c) developed by the BHA to identify regional gaps in behavioral health-
care services.
2.5 Care Access Point means a location at which a person seeking behavioral health care can
receive care coordination.
2.6 Community -Based Organization means a nonprofit or for-profit organization that provides
behavioral health-care services.
2.7 Grant Program means the community behavioral health-care continuum gap grant program
established in C.R.S 27-60-502.
2.8 Local Education Provider means a school district, a charter school authorized pursuant to
part 1 of article 30.5 of Title 22, and Institute charter school authorized pursuant to part 5 of
Article 30.5 of title 22, or a Board of Cooperative Services as defined in C.R.S. 22-5-103.
2.9 Local Government means a county, municipality, city and county, or local education
provider.
2.10 Managed Services Organizations (MSO) are organizations designated and contracted by
the Behavioral Health Administration to administer and manage a full continuum of SUD
prevention, intervention, treatment, recovery, and harm reduction services on a regional
basis.
2.11 Nonprofit Organization means an organization that is exempt from taxation under
Section 501(c)(3) of the federal "Internal Revenue Code of 1986, as amended.
2.12 Regional Accountability Entity (RAE) are organizations in Health First Colorado,
Colorado's Medicaid program. They are responsible for coordinating members' care, ensuring
they are connected with primary and behavioral health care, and developing regional
strategies to serve Colorado Medicaid members.
2.13 SOW is Statement of Work.
2.14 SCAO is State Court Administrator's Office.
Article 3
Objectives of Grant
3.1 The Contractor shall provide one or more of the following services related to the following
grant objectives outlined below.
3.1.1 To expand Child, Youth, and Family (CYF) oriented behavioral health care
services.
Page 2 of 5
Exhibit A-2
3.1.2 To address identified local behavioral health needs; to establish care access
points in each behavioral health administrative services region.
3.1.3 To provide care navigation and coordination services.
3.1.4 To expand evidence -based or evidence -informed behavioral health treatment,
including substance use disorder treatment.
3.1.5 To provide intensive outpatient services, including high-fidelity wraparound,
youth mobile response, and expanded caregiver interventions.
3.1.6 And to fund capital expenditures related to providing the above treatment
services.
Article 4
Roles and Responsibilities
4.1 The Grant Application submitted in the RFA shall also serve as a work plan to be used with
this SOW and followed upon execution of the contract to monitor the grant project
performance The activities and services identified in the Grant Application/ work plan are
incorporated into this Contract by reference.
4.2 Contractor will be expected to have the capacity to operationalize the State's contract at
signing and implement delivery of services within sixty (60) days of contract execution.
4.3 Contractor shall maintain clear communication with regards to progress on the submitted
Grant Application Template Work Plan.
4.4 Contractor shall work with providers to identify ongoing payer sources for these services,
to include Medicaid, Medicare, Third -party insurance, etc.
4.5 Contractor shall ensure that any program funded by the grant must comply with the
federal "Americans with Disabilities Act of 1990" and serve individuals with a disability,
regardless of primary diagnosis, co-occurring conditions, if the individual requires assistance
with activities of daily living.
4.6 Contractor shall use the CLAS Standards (https://thinkculturalhealth.hhs.gov/) to help
the organization and programs take into account cultural health beliefs, preferred languages,
health literacy levels, and communication needs.
4.7 Services shall be provided in English and Spanish.
Page 3 of 5
Exhibit A-2
4.8 Period of Performance
4.8.1 Overall grant deadline to expend all funds June 30, 2026. However, renewal of
contract is subject to approval by the Program Manager for each state fiscal year as
funding allows and compliance to contract performance.
4.8.2 State fiscal years end June 30. New fiscal years begin July 1 in which a new
contract will be issued (as funding and contract compliance allow) under guidance and
direction of the Program Manager.
4.9 Annual Report. Contractor shall submit an annual report by June 15, describing the use of
the grant award, on a template to be provided by the BHA, to
cdhs BHAdehverables@state.co.us.
4.10 Final Report. Contractor shall submit an annual report by June 15, describing the use of
the grant award, on a template to be provided by the BHA, to
cdhs BHAdeliverables@state.co.us.
Article 5
Reporting, Deliverables, and Due Dates
5.1 Criteria for Acceptance of Deliverables
5.1.1 The BHA will review the Contractor's deliverables in accordance with all
specifications stated in this SOW and the Grant Application work plan. Deliverables
and overall performance will be monitored, tracked, inspected, and accepted or
rejected by the Program Manager and designated State personnel.
5.1.2 The acceptance of deliverables and satisfactory work performance required
herein shall be based on the timeliness, accuracy, and standards as specified in the
requirements of this statement of work and the Grant Application work plan.
5.1.3 Invoice payment is contingent upon timely receipt and approval of required
program and fiscal deliverables. Missed or incomplete deliverables will result irian
immediate withhold of payment until deliverables are submitted and accepted by the
program.
5.2 When submitting reports please briefly describe the metrics you are using for the Reports
and Deliverables to demonstrate the impact of your grant on the populations you serve. This
may include the specific data points, tools, process, and frequency with which data will be
collected and reported.
Page 4 of 5
Exhibit A-2
5.3 Deliverables Table
Deadline
Article Where Assigned Activity
!Within ten (10) days
following each quarter,
ended in September,
December, March, and June
SOW, Article 6.1
SLFRF Quarterly Report on
the BHA provided template
June 15, 2024 and
June 15, 2025
SOW, Article 4.9
Annual Report
June 15, 2026 , SOW Article 4.10
Final Report
Reports Delivered via email to cdhs BHAdeliverables@state.co.us
Deliverables can be changed administratively
Article 6
Performance Outcome Measures
6.1 Contractor shall measure the metrics identified in the Coronavirus State and Local Fiscal
Recovery Funds (SLFRF) Subrecipient Quarterly Report, as may be amended, on a template to
be distributed by the BHA. The SLFRF Subrecipient Quarterly Report is due to
cdhs_BHAdeliverables@state.co.us ten (10) days following the end of each quarter.
Page 5 of 5
EXHIBIT B-4
BHA Program
COLORADO
Behavioral Health
Administration
EXHIBIT B-4, FY25 & FY26 ANNUAL BUDGET
apacity Budget Template
Children, Youth, Family Services Grants,
HB22-1281
dntaet Ltft
Agency Name
Weld County Department of Human
Services
Budget Period
07/01/2024 - 6/30/2026
Project Name
WCDHS Wraparound Program
Program ConMet'Name, Title
Phone
Email
Julie Witkowski, Family Resource Division Director
970-400-6777
witkowjx@weld.aov
Fiscal Contract Name, Title
Phone
Email
Tanya Geiser, Fiscal Division Director
970-400-6526
,ueiser(aweld.gov
Date Completed
3/15/2024
All budget numbers are estimates. Contract billing will be on a cost reimbursement basis for actual expenses incurred.
EXPENDITURE CATEGORIES
Personnel Services; Salary/Benefits
Annual Budget
Position Title
Description of Work
Gross or Annual
Salary
Fringe.''
Percent
Time onof
Total Amount Requested
from BHA
Wraparound Facilitator
Wraparound Facilitator will work to preserve and
rehabilitate families while addressing mental and behavioral
health needs via the HFW process.
$ 85,214.61
$18,022.89
50%
$ 51,618.75
Wraparound Facilitator
Wraparound Facilitator will work to preserve and
rehabilitate families while addressing mental and behavioral
health needs via the HFW process.
$ 80,806.02
$30,144.91
50%
$ 55,475.47
Wraparound Facilitator
Wraparound Facilitator will work to preserve and
rehabilitate families while addressing mental and behavioral
health needs via the HFW process.
$ 76,763.85
$29,290.00
50%
$ 53,026.93
Wraparound Facilitator
Wraparound Facilitator will work to preserve and
rehabilitate families while addressing mental and behavioral
health needs via the HEW process.
$ 83,230.20
$41,111.19
50%
$ 62,170.70
Wraparound Facilitator
Wraparound Facilitator will work to preserve and
rehabilitate families while addressing mental and behavioral
health needs via the HFW process.
$ 78,304.92
$29,615.93
100%
$ 107,920.85
Wraparound Supervisor
High Fidelity Wraparound Supervisor will serve as a systems
navigator and advocate in addition to supervising the HFW
team.
$ 114,590.07
$24,235.80
50%
$ 69,412.94
Family Resource Division -
Head
The F. Division Head supervises the Wraparound
Supervisor and is an ongoing resource and support to the
WCDHS Wraparound team, and will complete tasks such as
time keeping, invoices, and required reports.
$ 125,340.86
$42,326.20
5%
$ 8,533.35
Adoption Support &
Resource Coordinator _
The Adoption Support & Resource Coordinator opens cases
with families who live in Weld County & have adopted
children, when the family's request resources & assistance
with system navigation & care coordination. They make
referrals to WCDHS Wraparound and will work with
Wraparound Facilitators in managing referred cases.
$ 74,127.31
$25,944.56
2%
$ 2,001.44
Page 1 of 5
Last update 05_31_2022
EXHIBIT B-4
Adoption Support &
Resource Coordinator
The Adoption Support & Resource Coordinator opens cases
with families who live in Weld County & have adopted
children, when the family's request resources & assistance
with system navigation & care coordination. They make
referrals to WCDHS Wraparound and will work with
Wraparound Facilitators in managing referred cases.
$ 74,127.31
$25,944.56
2%
$ 2,001.44
Community Case Manager
The Community Case Managers work within the Prevention
Unit and open voluntary Prevention cases to prevent child
abuse & neglect & to respond to other needs that could result
in further systems involvement if the needs remain
unaddressed. They provide resources & assistance with
system navigation & care coordination. They make referrals
to WCDHS Wraparound and will work with Wraparound
Facilitators in managing referred cases.
$ 71,687.72
$25,090.70
2%
$ 1,935.57
Community Case Manager
The Community Case Managers work within the Prevention
Unit and open voluntary Prevention cases to prevent child
abuse & neglect & to respond to other needs that could result
in further systems involvement if the needs remain
unaddressed. They provide resources & assistance with
system navigation & care coordination. They make referrals
to WCDHS Wraparound and will work with Wraparound
Facilitators in managing referred cases.
$ 71,687.72
$25,090.70
2%
$ 1,935.57
Community Case Manager
The Community Case Managers work within the Prevention
Unit and open voluntary Prevention cases to prevent child
abuse & neglect & to respond to other needs that could result
in further systems involvement if the needs remain
unaddressed. They provide resources & assistance with
system navigation & care coordination. They make referrals
to WCDHS Wraparound and will work with Wraparound
Facilitators in managing referred cases.
$ 71,687.72
$25,090.70
2%
$ 1,935.57
Community Case Manager
The Community Case Managers work within the Prevention
Unit and open voluntary Prevention cases to prevent child
abuse & neglect & to respond to other needs that could result
in further systems involvement if the needs remain
unaddressed. They provide resources & assistance with
system navigation & care coordination. They make referrals
to WCDHS Wraparound and will work with Wraparound
Facilitators in managing referred cases.
$ 71,687.72
$25,090.70
2%
$ 1,935.57
Community Case Manager
The Community Case Managers work within the Prevention
Unit and open voluntary Prevention cases to prevent child
abuse & neglect & to respond to other needs that could result
in further systems involvement if the needs remain
unaddressed. They provide resources & assistance with
system navigation & care coordination. They make referrals
to WCDHS Wraparound and will work with Wraparound
Facilitators in managing referred cases.
$ 71,687.72
$25,090.70
2%
$ 1,935.57
Community Case Manager
The Community Case Managers work within the Prevention
Unit and open voluntary Prevention cases to prevent child
abuse & neglect & to respond to other needs that could result
in further systems involvement if the needs remain
unaddressed. They provide resources & assistance with
system navigation & care coordination. They make referrals
to WCDHS Wraparound and will work with Wraparound
Facilitators in managing referred cases.
$ 71,687.72
$25,090.70
2%
$ 1,935.57
Family Resource Case
Manager
The Family Resource Case Managers provide TANF case
management to families also involved with Child Welfare
and Prevention & who are in their last 12 months of
receiving TANF benefits. They make referrals to WCDHS
Wraparound and will work with Wraparound Facilitators in
managing referred cases.
$ 68,767.60
$24,068.66
2%
$ 1,856.73
Page 2 of 5
Last update 05_31_2022
EXHIBIT B-4
Family Resource Case
Manager
The Family Resource Case Managers provide TANF case
management to families also involved with Child Welfare
and Prevention & who are in their last 12 months of
receiving TANF benefits. They make referrals to WCDHS
Wraparound and will work with Wraparound Facilitators in
managing referred cases.
$ 68,767.60
$24,068.66
2%
$ 1,856.73
Wraparound Coach
Wraparound Coach will serve as a support to the
Wraparound Supervisor to ensure all staff obtain and retain
Colorado Wraparound Credentialing
$ 110,273.34
$23,322.81
25%
$ 33,399.04
Personnel Services -Hourly Employees
Annual Budget
Position Title
Description of Work
Hourly Wage
Hourly Fringe
Total # of
Hours on
Total Amount Requested
from BIIA
$
Total Personnel Services including fringe benefits)
$ 460,887.75
Client Costs
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount Requested
from BHA
Telephones -monthly
Ongoing expenses for cell and desk phones -77.98 monthly x 1 set x 12 months
$ 935.76
1
$ 935.76
Supplies and Marketing
Materials
General office supplies and marketing material for customer and stakeholder
engagement.
$ 12,941.47
1
$ 12,941.47
Total Client Costs
$ 13,877.23
Contract/Consultants Services (Subawards Ss Subcontracts)
Annual Budget
Name
Description of Work
I Rate
Quantity
Total frounom B Requested
from BHA
Michelle Ammerman
Contracted provider to prepare for and facilitate Trust Based Relational
Intervention Training and parent coaching (virtual and in person) for professionals
and caregivers parenting children and youth who have experienced trauma.
$ 200.00
100
$ 20,000.00
Total Contract Services
$ 20,000.00
Occupancy
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount Requested
from BHA
$
Total Occupancy
Operating
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount Requested
from BIIA
Staff Training
Creating Exceptional Customer Experiences (4 hours, in person). Second year
training for the Wraparound team to further discuss strategies that will create
customer service experiences that ensure youth/families are satisfied, feel
comfortable bringing forward concerns and ensure timely follow up and action to
address concerns.
$ 500.00
6
$ 3,000.00
Staff Training
Lead Worker Training (4 hours, in person). Second year training for the
Wraparound team to review the expectations of their positions, balance competing
demands and apply techniques to more effectively carry out their responsibilities
within the Wraparound program. Staff will practice clarifying expectations and
communication strategies for successful interactions with youth, families and
other Wraparound team participants.
$ 500.00
6
$ 3,000.00
Staff Training
Barriers to Effective Communication (1 hour, on demand). Second year training
for the Wraparound team to be empowered with the skills needed to identify and
overcome communication barriers, such as language, cultural differences and
emotional obstacles. They will also learn active listening and nonverbal
communication strategies to foster meaningful connections.
$ 40.00
6
$ 240.00
Staff Training
Problem Solving for Business (1.5 hours, on demand). Second year training for
the Wraparound team to leam the components of effective problem solving and
how to better tackle every day obstacles.
$ 40.00
6
$ 240.00
Staff Training
Improve Team Workflow and Personal. Effectiveness (4 hours, virtual). Second
year training for the Wraparound team to learn how identify inefficiencies, create
solutions for improved processes, implement flexible solutions to meet customers'
needs and create actionable efficiency plans to best serve our customers.
$ 400.00
6
$ 2,400.00
Page 3 of 5
Last update 05_31_2022
EXHIBIT B-4
Staff Training
Foundations for Emotional Intelligence (6 hours, virtual). Second year training for
the Wraparound team to learn ways to deliberately use emotions to create optimal
results within the team and with wraparound customers. Staff will learn to define
the five core competencies of emotional intelligence in order to deepen self-
awareness and the impact of their own emotions on the outcomes of their
youth/families.
$ 660.00
6
$ 3,960.00
Total Operating
$ I2,840;011
Depreciation/Amortization
Annual Budget
Item
Description of Item
Total Amount Requested
from BHA
Total. Depreciation/Amortization
$ -
Professional Fees
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount Requested
from BLIA
CANS Recertification
Annual recertification for CANS Assessment
$ 15.00
6
$ 90.00
Clinical Liability Insurance
Annual liability insurance for LCSW for Medicaid Credentialing
$ 199.67
I
$ 199.67
Total Professional Fees
$ 2$9.67
Capital Costs
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount Requested
from BHA
$
Total Capital Costs
$ -
„ . TOTAL DIRECT COSTS (TDC)'
$ *97,1194.6>
Exclusions from Indirect Cost Base expenses per OMB 2CFR § 200
Subaward in excess of $25,000
Rent
Equipment (over $5000)
Other Unallowable Expenses (not allowed a direct cost) such as land, real estate purchase, etc.
Total Expenses per OMB 2CFR § 200
....—
MODIFIED TOTAL DIRECT COSTS on -Do
$ 507,8 .65 -
Indirect Costs
Annual Budget
Item I Description of Item
Percentage
Total Amount Requested
tYf1LIT RNA
I
$
Total Indirect
$ _
Irarid Total lGxpenses
$ 507,1394.65
Page 4 of 5 Last update 05_31_2022
EXHIBIT B-4
Match Requirement Chart: Size of Organization & Award amount
Match Requirement
Organization Annual Budget Size
Percentage Match Requirement on
grant award
large org.
$20,000,000 or more
5%
small
less than $20,000,000
2.5%
Award of $50,000 or less
any size
0%
MATCH AMOUNT REQUIRED
Match Amount Required must be listed below in Revenue Offset and/ or Matching Funds
SELECT YOUR MA'T'CH
AMOUNT
5.0%
25,395.00
Revenue Offset Annual Budget
Client Services
Medicaid Fee for Service Cash
Medicaid Capitation Encounters
BHA Indigent Encounters"'
3rd Party Insurance Cash Receipts
Medicare Cash
Self-Pay/Client Fees
Cash from other Sources: (Specify below)
Total Client Services
$
Matching Funds
Contracts and Grants
Non -Governmental Contracts
Other State Revenue/Accrual
Federal Grant Funds/Accrual
Local Funds/Accrual
Private Grant Funds/Accrual
Public Support
Private Support
In -Kind Donations
Other Funds (Specify below)
Match funding comes from additional staff who work with the Wraparound team, including Family Resource Division Head,
$ 27,863.09
Total Contracts and Grants
-$ 27,863.09
G�ratd Total Revenue Offset:
$ 7,863.09;
Net Cost $ 480,031.56
The Parties may mutually agree, m writing, to modify the Budget administratively using an BHA Budget Reallocation form
Page 5 of 5 Last update 05_31_2022
Exhibit E-3
Exhibit E-3 - Supplemental Provisions for Federal
Awards
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), and/or exhibit regarding SLFRF Federal Provisions, the terms
re FFATA and/or SLFRF shall control. If the source of the funding of the Contract is a grant,
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.
1) Federal Award Identification
i. Subrecipient: Weld County dba Weld County Department of Human Services
ii. Subrecipient Unique Entity ID number: MKKXT9U9MTV5
iii. The Federal Award Identification Number (FAIN) is SLFRP0126;
iv. The Federal award date is May 18, 2021
v. The subaward period of performance start date is July 1, 2024 and end date is June
30, 2026.
vi. Federal Funds:
Contract or Amount of Federal Total amount of
Fiscal funds obligated by this Federal funds
Year Contract obligated to the
Subrecipient
Total amount of the
Federal Award
committed to
Subrecipient by CDHS
FY25-FY26
ARPA
$48,306.63
$48,306.63
$48,306.63
vii. Federal award project description: To establish or expand services along the
behavioral healthcare continuum of care, including services for children,
youth, and families with severe needs.
viii. The name of the Federal awarding agency is U.S. Department of Treasury; the name
of the pass -through entity is the State of Colorado, Department of Human
Services (CDHS). The Catalog of Federal Domestic Assistance (CFDA) number is
21.027, name is Coronavirus State and Local Fiscal Recovery Funds, and dollar
amount is $3,828,761,790.
ix. This award is not for research Et development
Supplemental Provisions for Federal Awards
Revised 01.28.25
Page 1 of 14
Exhibit E-3
x. The indirect cost rate for the Federal award (including if the de minimis rate is
charged per 2 CFR S200.414 Indirect (FEA) costs) is pre -determined based upon the
State of Colorado and CDHS cost allocation plan.
2) All requirements imposed by CDHS on Subrecipient so that the Federal award is used in
accordance with Federal statutes, regulations, and the terms and conditions of the
Federal award, are stated in Exhibit A, Exhibit E, and Exhibit F.
3) Any additional requirements that CDHS imposes on Subrecipient in order for CDHS to meet
its own responsibility to the Federal awarding agency, including identification of any
required financial and performance reports, are stated in Exhibit B, Exhibit C, and
Exhibit D.
4) Subrecipient's approved indirect cost rate is 0%.
5) Subrecipient must permit CDHS and auditors to have access to Subrecipient's records and
financial statements as necessary for CDHS to meet the requirements of 2 CFR 5200.332
Requirements for pass -through entities, SS 200.300 Statutory and National Policy
Requirements through 5200.309 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 15 of this Exhibit and may be further specified in the accompanying Scope of Work
exhibit.
7) Performance and Final Status. Subrecipient shall submit all financial, performance, and
other reports to CDHS no later than 30 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.
i. Subrecipient shall provide matching funds as stated in Exhibit B. Subrecipient shall
have raised the full amount of matching funds prior to the Effective Date and shall
report to CDHS 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 CDHS
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.
Supplemental Provisions for Federal Awards Page 2 of 14
Revised 01.28.25
Exhibit E-3
1. Definitions.
1.1 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.
1.1.1 "Award" means an award of Federal financial assistance, and the
Contract setting forth the terms and conditions of that financial
assistance, that a non -Federal Entity receives or administers.
1.1.1.1 Awards may be in the form of:
1.1.1.1.1 Grants;
1.1.1.1.2 Contracts;
1.1.1.1.3 Cooperative Contracts, which do not include
cooperative research and development Contracts
(CRDA) pursuant to the Federal Technology Transfer
Act of 1986, as amended (15 U.S.C. 3710);
1.1.1.1.4 Loans;
1.1.1.1.5 Loan Guarantees;
1.1.1.1.6 Subsidies;
1.1.1.1.7 Insurance;
1.1.1.1.8 Food commodities;
1.1.1.1.9 Direct appropriations;
1.1.1.1.10 Assessed and voluntary contributions; and
1.1.1.1.11 Other financial assistance transactions that authorize
the expenditure of Federal funds by non -Federal
Entities.
1.1.1.1.12 Any other items specified by OMB in policy
memoranda available at the OMB website or other
source posted by the OMB.
1.1.1.2 Award does not include:
1.1.1.2.1 Technical assistance, which provides services in lieu of
money;
1.1.1.2.2 A transfer of title to Federally -owned property
provided in lieu of money; even if the award is called
a grant;
1.1.1.2.3 Any award classified for security purposes; or
1.1.1.2.4 Any award funded in whole or in part with Recovery
funds, as defined in section 1512 of the American
Recovery and Reinvestment Act (ARRA) of 2009
(Public Law 111-5).
1.1.2 "Contract" means the Contract to which these Federal Provisions are
attached and includes all Award types in S of this Exhibit.
Supplemental Provisions for Federal Awards Page 3 of 14
Revised 01.28.25
Exhibit E-3
1.1.3 "Contractor" means the party or parties to a Contract funded, in whole
or in part, with Federal financial assistance, other than the Prime
Recipient, and includes grantees, subgrantees, Subrecipients, and
borrowers. For purposes of Transparency Act reporting, Contractor does
not include Vendors.
1.1.4 "Unique Entity ID number" or "UEI" is the universal identifier for federal
financial assistance applicants, as well as recipients and their direct
subrecipients (first tier subrecipients).
1.1.5 "Entity" means:
1.1.5.1 If the source of the funding is a Grant:
1.1.5.1.1 a Non -Federal Entity; or
1.1.5.1.2 a non-profit organization or for-profit organization.
1.1.5.2 If the source of funding is not a Grant:
1.1.5.2.1 all of the following as defined at 2 CFR part 25, subpart
C;
1.1.5.2.2 A governmental organization, which is a State, local
government, or Indian Tribe;
1.1.5.2.3 a foreign public entity;
1.1.5.2.4 a domestic or foreign non-profit organization;
1.1.5.2.5 a domestic or foreign for-profit organization; and
1.1.5.2.6 a Federal agency, but only a Subrecipient under an
Award or Subaward to a non -Federal entity.
1.1.6 "Executive" means an officer, managing partner or any other employee in
a management position.
1.1.7 If the source of funding is a Grant, "Federal Awarding Agency" means a
Federal agency providing a Federal Award to a Recipient as described in
2 CFR 200.1. If the source of funding is not a Grant, "Federal Award
Identification Number (FAIN)" means an Award number assigned by a
Federal agency to a Prime Recipient.
1.1.8 "FFATA" means the Federal Funding Accountability and Transparency Act
of 2006 (Public Law 109-282), as amended by 56202 of Public Law 110-
252. FFATA, as amended, also is referred to as the "Transparency Act."
1.1.9 "Federal Provisions" means these Federal Provisions subject to the
Transparency Act and Uniform Guidance, as may be revised pursuant to
ongoing guidance from the relevant Federal or State of Colorado agency
or institutions of higher education.
1.1.10 If the source of funding is a Grant, "Grant" as used herein is the
Contract to which these Federal Provisions are attached.
Supplemental Provisions for Federal Awards Page 4 of 14
Revised 01.28.25
Exhibit E-3
1.1.11 "Grantee" means the party or parties identified as such in the Grant to
which these Federal Provisions are attached if the source of funding is a
Grant. Grantee also means Subrecipient.
1.1.12 "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.
1.1.13 "Nonprofit Organization" means any organization that:
1.1.13.1 Is operated primarily for scientific, educational, service,
charitable, or similar purposes in the public interest;
1.1.13.2 Is not organized primarily for profit;
1.1.13.3 Uses net proceeds to maintain, improve, or expand the
organization's operations; and
1.1.13.4 Is not an IHE.
1.1.14 "OMB" means the Executive Office of the President, Office of
Management and Budget.
1.1.15 "Pass -through Entity" means a recipient or subrecipient that provides a
Subaward to a Subrecipient (including tower 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.
1.1.16 "Prime Recipient" means a Colorado State agency or institution of
higher education that receives an Award, or, of the source of funding is
a Grant it is that agency or institution identified as the Grantor in the
Grant to which these Federal Provisions are attached.
1.1.17 "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.
1.1.18 "Subrecipient" or, if the source of funding is a Grant, "Subgrantee"
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.
1.1.19 "Subrecipient Parent UEI Number" means the subrecipient parent
organization's 12 -digit Unique Entity ID System (UEI) number that
appears in the subrecipient's System for Award Management (SAM)
profile, if applicable.
Supplemental Provisions for Federal Awards Page 5 of 14
Revised 01.28.25
Exhibit E-3
1.1.20 "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.
1.1.21 "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).
1.1.22 "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. The Transparency Act may also be referred to as
FFATA.
1.1.23 "Uniform Guidance" means the Office of Management and Budget
Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, which, unless the source of funding is
a Grant, supersedes requirements from OMB Circulars A-21, A-87, A-110,
and A-122, OMB Circulars A-89, A-102, and A-133, and the guidance in
Circular A-50 on Single Audit Act follow-up. 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.
1.1.24 "Vendor" means a dealer, distributor, merchant or other seller providing
property or services required for a project or program funded by an
Award. A Vendor is not a Prime Recipient or a Subrecipient and is not
subject to the terms and conditions of the Federal award. Program
compliance requirements do not pass through to a Vendor.
2. Compliance.
2.1 Contractor/Grantee shall comply with all applicable provisions of the
Transparency Act and the regulations issued pursuant thereto, all applicable
provisions of the Uniform Guidance, including, but not limited to, 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 Contractor/Grantee of such revisions, but such notice shall not
be a condition precedent to the effectiveness of such revisions.
3. System for Award Management (SAM) and Unique Entity ID System
(UEI) Requirements.
3.1 SAM. Contractor/Grantee must obtain a UEI but are not required to fully register in
Sam.gov. Contractor/Grantee shall maintain the currency of its information in SAM
Supplemental Provisions for Federal Awards Page 6 of 14
Revised 01.28.25
Exhibit E-3
until the Contractor/Grantee submits the final financial report required under the
Award or receives final payment, whichever is later. Contractor/Grantee shall
review and update SAM information at least annually after the initial registration,
and more frequently if required by changes in its information.
3.2 UEI. Contractor/Grantee shall provide its UEI number to its Prime Recipient, and
shall update Contractor's/Grantee's information in www.sam.gov at least annually
after the initial registration, and more frequently if required by changes in
Contractor's/Grantee's information.
4. Total Compensation.
4.1 Contractor/Grantee shall include Total Compensation in SAM for each of its five
most highly compensated Executives for the preceding fiscal year if:
4.1.1 The total Federal funding authorized to date under the Award is $30,000
or more if the source of funding is a Grant, or otherwise $25,000 or
more if the source of funding is not a Grant; and
4.1.2 In the preceding fiscal year, Contractor/Grantee received:
4.1.2.1 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
4.1.2.2 $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
if the source of funding is a Grant or otherwise $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 if the
source of funding is not a Grant; and
4.1.2.3 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.
5. Reporting.
5.1 If Contractor/Grantee is a Subrecipient of the Award pursuant to the Transparency
Act, Grantee shall report data elements to SAM and to the Prime Recipient as
required in this Exhibit. No direct payment shall be made to Grantee for providing
any reports required under these Federal Provisions and the cost of producing such
reports shall be included in the Contract/Grant price. The reporting requirements
in this Exhibit are based on guidance from the US Office of Management and
Supplemental Provisions for Federal Awards Page 7 of 14
Revised 01.28.25
Exhibit E-3
Budget (OMB), and as such are subject to change at any time by OMB. Any such
changes shall be automatically incorporated into this Contract/Grant and shall
become part of Contractor's/Grantee's obligations under this Contract/Grant.
6. Effective Date and Dollar Threshold for Reporting.
6.1 If the source of funding is a Grant, Reporting requirements in S7 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.
6.2 If the source of funding is not a Grant, Reporting requirements in S7 below apply
to new Awards as of October 1, 2010, if the initial award is $25,000 or more. If the
initial Award is below $25,000 but subsequent Award modifications result in a total
Award of $25,000 or more, the Award is subject to the reporting requirements as
of the date the Award exceeds $25,000. If the initial Award is $25,000 or more, but
funding is subsequently de -obligated such that the total award amount falls below
$25,000, the Award shall continue to be subject to the reporting requirements.
6.3 The procurement standards in S8 below are applicable to new Awards made by
Prime Recipient as of December 26, 2015. The standards set forth in S11 below are
applicable to audits of fiscal years beginning on or after December 26, 2014.
7. Subrecipient Reporting Requirements.
7.1 If Contractor/Grantee is a Subrecipient, Contractor/Grantee shall report as set
forth below.
7.2 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
Prime Recipient no later than the end of the month following the month in which
the Subaward was made:
7.2.1 Subrecipient UEI Number;
7.2.2 Subrecipient UEI Number if more than one electronic funds transfer (EFT)
account;
7.2.3 Subrecipient parent's organization UEI Number;
7.2.4 Subrecipient's address, including: Street Address, City, State, Country,
Zip (+ 4 if source of funding is a Grant or as otherwise directed per SAM
directives for proper reporting), and Congressional District;
7.2.5 Subrecipient's top 5 most highly compensated Executives if the criteria in
S4 above are met; and
7.2.6 Subrecipient's Total Compensation of top 5 most highly compensated
Executives if the criteria in S4 above met.
Supplemental Provisions for Federal Awards Page 8 of 14
Revised 01.28.25
Exhibit E-3
7.3 To Prime Recipient. A Subrecipient shall report to its Prime Recipient, upon the
effective date of the Contract/Grant, the following data elements:
7.3.1 Subrecipient's UEI Number as registered in SAM.
7.3.2 Primary Place of Performance Information, including: Street Address,
City, State, Country, Zip code + 4, and Congressional District.
8. Procurement Standards.
8.1 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.
8.2 If the source of funding is a Grant: 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.
8.3 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. Access to Records.
9.1 A Subrecipient shall permit Recipient/Prime 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 200.311-200.332 (Requirements for
pass -through entities), 2 CFR 200.300 (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.
Supplemental Provisions for Federal Awards Page 9 of 14
Revised 01.28.25
Exhibit E-3
9.2 A Subrecipient must collect, transmit, and store information related to this
Subaward in open and machine-readable formats (2 CFR 200.336).
10. Single Audit Requirements.
10.1 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.
10.2 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 Prime 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.
10.3 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.
10.4 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.
11. Contract/Grant Provisions for Subrecipient Contracts.
11.1 In addition to other provisions required by the Federal Awarding Agency or the
Prime Recipient, Contractors/Grantees that are Subrecipients shall comply with
the following provisions. Subrecipients shall include all of the following applicable
provisions in all subcontracts entered into by it pursuant to this Contract/Grant.
Supplemental Provisions for Federal Awards Page 10 of 14
Revised 01.28.25
Exhibit E-3
11.2 {Applicable to federally assisted construction contracts.} Equal Employment
Opportunity. 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 shall include 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.
11.3 (Applicable to on -site employees working on government -funded construction,
alteration and repair projects.) Davis -Bacon Act. Davis -Bacon Act, as amended (40
U.S.C. 3141-3148).
11.4 Rights to Inventions Made Under a contract/grant or agreement. If the Federal
Award meets the definition of "funding agreement"/ "funding Contract" under 37
CFR 401.2 (a) and the Prime Recipient or Subrecipient wishes to enter into a
contract with a small business firm or nonprofit organization regarding the
substitution of parties, assignment or performance of experimental,
developmental, or research work under that "funding agreement,"/"funding
Contract", the Prime Recipient or Subrecipient must 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 Federal Awarding
Agency.
11.5 Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act
(33 U.S.C. 1251-1387), as amended. Contracts and subgrants of amounts in excess
of $150,000 must contain a provision that requires the non -Federal awardee(s) to
agree to comply with all applicable standards, orders or regulations issued
pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water
Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be
reported to the Federal Awarding Agency and the Regional Office of the
Environmental Protection Agency (EPA).
11.6 Debarment and Suspension (Executive Orders 12549 and 12689). A contract award
(see 2 CFR 180.220) must not be made to parties listed on the government wide
exclusions in the System for Award Management (SAM), in accordance with the
OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part
1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and
Suspension." SAM Exclusions contains the names of parties debarred, suspended, or
otherwise excluded by agencies, as well as parties declared ineligible under
statutory or regulatory authority other than Executive Order 12549.
Supplemental Provisions for Federal Awards Page 11 of 14
Revised 01.28.25
Exhibit E-3
11.7 Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). Contractors that apply or bid
for an award exceeding $100,000 must file the required certification. Each tier
certifies to the tier above that it will not and has not used Federal appropriated
funds to pay any person or organization for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, officer or employee
of Congress, or an employee of a member of Congress in connection with obtaining
any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each
tier must also disclose any lobbying with non -Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from
tier to tier up to the non -Federal award.
11.8 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.
11.9 Prohibition on certain telecommunications and video surveillance equipment or
services (2 CFR 200.216). Grantee 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.
11.10 Collection of Unallowable Costs (2CFR 200.410). Payments made for costs
determined to be unallowable by either the awarding Federal agency, cognizant
agency for indirect costs, or pass -through entity must be refunded with interest to
the Federal Government. Unless directed by Federal statute or regulation,
repayments must be made in accordance with the instructions provided by the
Federal agency or pass -through entity that made the allowability determination.
See 55 200.300 through 200.309, and 5200.346.
11.11 Whistle Blower Protections. 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.
Supplemental Provisions for Federal Awards Page 12 of 14
Revised 01.28.25
Exhibit E-3
12. Certifications.
12.1 Unless prohibited by Federal statutes or regulations, Recipient/Prime 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.
13. Exemptions.
13.1 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.
13.2 A Contractor/Grantee 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.
14. Event of Default and Termination.
14.1 Failure to comply with these Federal Provisions shall constitute an event of
default under the Contract/Grant and the State of Colorado may terminate the
Contract/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 Contract/Grant, at law or in equity.
14.2 Termination (2 CFR 200.340). The Federal Award may be terminated in whole or
in part as follows:
14.2.1 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;
14.2.2 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;
14.2.3 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
Supplemental Provisions for Federal Awards Page 13 of 14
Revised 01.28.25
Exhibit E-3
Federal Award was made, the Federal Awarding Agency or Pass -through
Entity may terminate the Federal Award in its entirety; or
14.2.4 By the Federal Awarding Agency or Pass -through Entity pursuant to
termination provisions included in the Federal Award.
15. Additional Terms re Payments to Grantee to Supplement Main Terms
in Contract.
15.1 Federal Recovery: The closeout of a Federal Award does not affect the right of
the Federal Awarding Agency or the State 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, as defined below.
15.2 Close -Out: Grantee shall close out this Award within 45 days after the Fund
Expenditure End Date shown on the Signature and Cover Page for this Agreement.
To complete closeout, Grantee shall submit to the State all deliverables (including
documentation) as defined in this Agreement and Grantee's final reimbursement
request or invoice. The State will withhold 5% of allowable costs until all final
documentation has been submitted and accepted by the State as substantially
complete. If the Federal Awarding Agency has not closed this Federal Award within
one year and 90 days after the Fund Expenditure End Date shown on the Signature
and Cover Page for this Agreement due to Grantee's failure to submit required
documentation, then Grantee may be prohibited from applying for new Federal
Awards through the State until such documentation is submitted and accepted.
Exhibit End
Supplemental Provisions for Federal Awards Page 14 of 14
Revised 01.28.25
V.7 (Acc) Exhibit F-3
Exhibit F-3 - SLFRF Subrecipient Provisions Exhibit
(CDHS)
This Exhibit and the Appendices hereto apply regarding the use of State and Local Fiscal
Recovery Funds (SLFRF) to comply with requirements established by the U.S. Department of
Treasury and the Colorado Department of Personnel Et Administration, Office of the State
Controller re the Colorado Department of Human Services (CDHS).
This SLFRF Provisions Exhibit may supplement other Exhibit(s) to the instant Agreement. In
the event that terms on prior Exhibit(s) to the instant Agreement conflict with this SLFRF
Provisions Exhibit, this Exhibit shall control and take precedence.
The Contractor/Vendor/Other Agency entity with which the Colorado Department of Human
Services (CDHS) is contracting per this Agreement may be referred to as "Subrecipient"
herein, the designation per controlling law and mandates. This "Subrecipient" designation
shall apply in this context notwithstanding prior definition(s) of any entity to this agreement
as "Contractor" or any other title.
Subrecipient must agree to and comply with the terms of these SLFRF Provisions in order to
receive and use these funds. Subrecipient shall execute not only the instant Agreement, but
also specifically the Certification Agreement appendix to the instant Exhibit. A failure to also
separately execute the Certification Agreement appendix hereto shall not relieve
Subrecipient of the rules/obligations set forth herein; such a clerical error must be promptly
remedied upon discovery by notifying the CDHS office/program contact, who can then assist
with the logistics of mandatory signing, which shall retroactively apply.
In the event that Subrecipient is/was in receipt of SLFRF funding from CDHS prior to
execution of the instant Exhibit, Subrecipient understands that its obligations set forth herein
with regards to that funding shall retroactively apply.
The regulations and requirements surrounding receipt and use of SLFRF funding is an evolving
subject matter as established by the U.S. Department of Treasury and put into established
policy by the Colorado Department of Personnel Et Administration, Office of the State
Controller for use with CDHS Agreements. As such, Subrecipient agrees to execute any
additional Agreements/Amendments as required by CDHS to establish and/or update these
procedures. Subrecipient agrees to accept written notice from CDHS of updates to these
requirements and to comply with same forthwith, even if prior to or without a formal
Amendment to the Agreement to update this Exhibit or the rules/requirements established
herein. Regardless, if CDHS requests that Subrecipient execute an Amendment to formalize
implementation of and/or acknowledgment of updates to this Exhibit, Subrecipient shall
promptly comply.
Page 1 of 33
V.7 (Acc)
Exhibit F-3
Subrecipient agrees to stay abreast of and comply with the most current iterations of the
requirements re SLFRF funding set forth on https:Hosc.colorado.Rov/american-rescue-plan-
act (see SLFRF Grant Agreement Templates Tab).
Table 1: Federal Award(s) Applicable to this Grant Award
Federal Awarding Office
US Department of the Treasury
Grant Program
Coronavirus State and Local Fiscal Recovery Funds
Assistance Listing Number
21.027
Federal Award Number
SLFRP0126
Federal Award Date'
May 18, 2021
Federal Award End Date
December 31, 2026
Federal Statutory Authority
Title VI of the Social Security Act, Section 602
Total Amount of Federal Award (this is
not the amount of this grant agreement)
$3,828,761,790
Funds may not be available through the Federal Award End Date subject to the provisions in §2 and §5
below.
Table 2: State Award (if applicable) to this Grant Award
State Statutory Authority
HB24-1466 - Refinance Federal Coronavirus Recovery Funds
State Award Date
July 1, 2024
State Award End Date
June 30, 2026
Page 2 of 33
V.7 (Acc)
Appendix 1 To SLFRF Exhibit - Budget Supplement
1. Budget By US Treasury Expenditure Category
2. Expenditure Categories identified in this Appendix will determine what is
reported on as outlined in the all following Appendices to this Exhibit.
Project
Number
PH1340
Project Title
Exhibit F-3
US Treasury Expenditure Category
Budget
Number and Name
Children, Youth, and
Family Behavioral Health 1.14 Other Public Health Services $48,306.63
Services Grants
Total
$48,306.63
3. Budget By Function
4. Expenditure Category Modifications
Increases or decreases in any Expenditure Category must be requested and approved by
the State Agency by using the SLFRF Expenditure Modification Form. This form can be
found at: https://osc.colorado.Rov/american-rescue-plan-act (see SLFRF Grant Agreement
Templates Tab). In no event may this be used to modify the overall total of this
Agreement or otherwise any non SLFRF expenditures.
Page 3 of 33
V.7 (Acc) Exhibit F-3
Appendix 2 To SLFRF Exhibit - Federal Provisions Supplement
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 The State of Colorado is accountable to Treasury for oversight of their subrecipients,
including ensuring their subrecipients comply with the SLFRF statute, SLFRF Award
Terms and Conditions, Treasury's Final Rule, and reporting requirements, as
applicable.
1.3 Additionally, any subrecipient that issues a subaward to another entity (2nd tier
subrecipient), must hold the 2nd tier subrecipient accountable to these provisions and
adhere to reporting requirements.
1.4 These Federal Provisions are subject to the Award as defined in S2 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.
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 foreign public entity;
2.1.2.3. a foreign organization;
2.1.2.4. a non-profit organization;
2.1.2.5. a domestic for-profit organization (for 2 CFR parts 25 and 170 only);
2.1.2.6. a foreign non-profit organization (only for 2 CFR part 170) only);
2.1.2.7. a Federal agency, but only as a Subrecipient under an Award or Subaward
to a non -Federal entity (or 2 CFR 200.1); or
2.1.2.8. a foreign for-profit organization (for 2 CFR part 170 only).
2.1.3. "Executive" means an officer, managing partner or any other employee in a
management position.
2.1.4. "Expenditure Category (EC)" means the category of eligible uses as defined by
the US Department of Treasury in "Appendix 1 of the Compliance and Reporting
Guidance, State and Local Fiscal Recovery Funds" report available at
www.treasury.Rov.
Page 4 of 33
V.7 (Acc) Exhibit F-3
2.1.5. "Federal Awarding Agency" means a Federal agency providing a Federal Award
to a Recipient as described in 2 CFR 200.1
2.1.6. "Grant" means the Grant to which these Federal Provisions are attached.
2.1.7. "Grantee" means the party or parties identified as such in the Grant to which
these Federal Provisions are attached. Grantee also means Subrecipient.
2.1.8. "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.
2.1.9. "Nonprofit Organization" means any corporation, trust, association,
cooperative, or other organization, not including IHEs, that:
2.1.9.1. Is operated primarily for scientific, educational, service, charitable, or
similar purposes in the public interest;
2.1.9.2. Is not organized primarily for profit; and
2.1.9.3. Uses net proceeds to maintain, improve, or expand the operations of the
organization.
2.1.10. "OMB" means the Executive Office of the President, Office of Management and
Budget.
2.1.11. "Pass -through Entity" means a non -Federal Entity that provides a Subaward to
a Subrecipient to carry out part of a Federal program.
2.1.12. "Prime 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.
2.1.13. "Subaward" means an award by a Prime Recipient to a Subrecipient funded in
whole or in part by a Federal Award. The terms and conditions of the Federal
Award flow down to the Subaward unless the terms and conditions of the Federal
Award specifically indicate otherwise in accordance with 2 CFR 200.101. The term
does not include payments to a Contractor or payments to an individual that is a
beneficiary of a Federal program.
2.1.14. "Subrecipient" or "Subgrantee" means a non -Federal Entity (or a Federal
agency under an Award or Subaward to a non -Federal Entity) receiving Federal
funds through a Prime Recipient to support the performance of the Federal project
or program for which the Federal funds were awarded. A Subrecipient is subject to
the terms and conditions of the Federal Award to the Prime Recipient, including
program compliance requirements. The term does not include an individual who is
a beneficiary of a federal program. For SLFRF Grants, a subrecipient relationship
continues to exist for Expenditure Category 6.1 Revenue Replacement.
2.1.15. "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. "Total Compensation" means the
cash and noncash dollar value earned by an Executive during the Prime Recipient's
Page 5 of 33
V.7 (Acc) Exhibit F-3
or Subrecipient's preceding fiscal year (see 48 CFR 52.204-10, as prescribed in 48
CFR 4.1403(a)) and includes the following:
2.1.15.1. Salary and bonus;
2.1.15.2. Awards of stock, stock options, and stock appreciation rights, using the
dollar amount recognized for financial statement reporting purposes with
respect to the fiscal year in accordance with the Statement of Financial
Accounting Standards No. 123 (Revised 2005) (FAS 123R), Shared Based
Payments;
2.1.15.3. Earnings for services under non -equity incentive plans, not including
group life, health, hospitalization or medical reimbursement plans that do not
discriminate in favor of Executives and are available generally to all salaried
employees;
2.1.15.4. Change in present value of defined benefit and actuarial pension plans;
2.1.15.5. Above -market earnings on deferred compensation which is not tax -
qualified;
2.1.15.6. Other compensation, if the aggregate value of all such other
compensation (e.g., severance, termination payments, value of life insurance
paid on behalf of the employee, perquisites or property) for the Executive
exceeds $10,000.
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. "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.
2.1.18. "Unique Entity ID Number" means the Unique Entity ID established by the
federal government for a Grantee or Subrecipient at
https: / /sam.eov/content/home.
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 Grantee of such revisions, but such notice shall not be a condition
precedent to the effectiveness of such revisions.
Page 6 of 33
V.7 (Acc) Exhibit F-3
3.2 Per US Treasury Final Award requirements, grantee programs or services must not
include terms or conditions that undermine efforts to stop COVID-19 or discourage
compliance with recommendations and CDC guidelines.
4. System for Award Management (SAM) and Unique Entity Identifier (UEI)
Requirements.
4.1 SAM. Subrecipient shall maintain the currency of its information in SAM until the
Grantee 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 UEI. Grantee shall provide its UEI Number to its Prime Recipient, and shall update
Grantee's information in SAM at least annually.
5. Total Compensation.
5.1 Grantee shall include Total Compensation in SAM for each of its five most highly
compensated Executives for the preceding fiscal year if:
5.2 The total Federal funding authorized to date under the Award is $30,000 or more; and
5.3 In the preceding fiscal year, Grantee received:
5.4 80% or more of its annual gross revenues from Federal procurement Agreements and
Subcontractors and/or Federal financial assistance Awards or Subawards subject to the
Transparency Act; and
5.5 $30,000,000 or more in annual gross revenues from Federal procurement Agreements
and Subcontractors and/or Federal financial assistance Awards or Subawards subject
to the Transparency Act; and
5.6 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 5 6104 of the Internal Revenue Code
of 1986.
6. Reporting.
6.1 If Grantee is a Subrecipient of the Award pursuant to the Transparency Act, Grantee
shall report data elements to SAM and to the Prime Recipient as required in this
Exhibit. No direct payment shall be made to Grantee 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 Grantee's obligations under this Grant.
Page 7 of 33
V.7 (Acc) Exhibit F-3
7. Effective Date and Dollar Threshold for Federal Reporting.
7.1 Reporting requirements in S8 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. If the total award is below $30,000 no reporting required; if
more than $30,000 and less than $50,000 then FFATA reporting is required; and,
$50,000 and above SLFRF reporting is required.
7.2 The procurement standards in S9 below are applicable to new Awards made by Prime
Recipient as of December 26, 2015. The standards set forth in S11 below are
applicable to audits of fiscal years beginning on or after December 26, 2014.
8. Subrecipient Reporting Requirements.
Grantee shall report as set forth below.
Grantee shall use the SLFRF Subrecipient Quarterly Report Workbook as referenced in
Appendix 4 to report to the State Agency within ten (10) days following each quarter
ended September, December, March and June. Additional information on specific
requirements are detailed in the SLFRF Subrecipient Quarterly Report Workbooks and
"Compliance and Reporting Guidance, State and Local Fiscal Recovery Funds" report
available at www.treasury.Qov.
A. EC 1 - Public Health
i. All Public Health Projects
a. Description of structure and objectives
b. Description of relation to COVID-19
c. Identification of impacted and/or disproportionately impacted
communities
d. Capital Expenditures
(a) Presence of capital expenditure in protect
(b) Total projected capital expenditure
(c) Type of capital expenditure
(d) Written justification
(e) Labor reporting
ii. COVID-19 Interventions and Mental Health (1.4, 1.11, 1.12, 1.13)
a. Amount of total project used for evidence -based programs
b. Evaluation plan description
COVID-19 Small Business Economic Assistance (1.8)
Page 8 of 33
V.7 (Acc) Exhibit F-3
a. Number of small businesses served
iv. COVID-19 Assistance to Non -Profits (1.9)
a. Number of non -profits served
v. COVID-19 Aid to Travel, Tourism, and Hospitality or Other Impacted
Industries (1.10)
a. Sector of employer
b. Purpose of funds
B. EC 2 - Negative Economic Impacts
i. All Negative Economic Impacts Projects
a. Description of project structure and objectives
b. Description of project's response to COVID-19
C. Identification of impacted and/or disproportionately impacted communities
D. Amount of total project used for evidence -based programs and description of
evaluation plan (not required for 2.5, 2.8, 2.21-2.24, 2.27-2.29, 2.31, 2.34-
2.36)
a. Number of workers enrolled in sectoral job training programs
b. Number of workers completing sectoral job training programs
E. Number of people participating in summer youth employment programs
a. Capital Expenditures
(a) Presence of capital expenditure in project
(b) Total projected capital expenditure
(c) Type of capital expenditure
(d) Written justification
(e) Labor reporting
ii. Household Assistance (2.1-2.8)
a. Number of households served
b. Number of people or households receiving eviction prevention
services (2.2 £t 2.5 only) (Federal guidance may change this
requirement in July 2022)
c. Number of affordable housing units preserved or developed (2.2
It 2.5 only) (Federal guidance may change this requirement in
July 2022)
iii. Healthy Childhood Environments (2.11-2.13)
a. Number of children served by childcare and early learning
(Federal guidance may change this requirement in July 2022)
Page 9 of 33
V.7 (Acc) Exhibit F-3
b. Number of families served by home visiting (Federal guidance
may change this requirement in July 2022)
iv. Education Assistance (2.14, 2.24-2.27)
a. National Center for Education Statistics ("NCES") School ID or
NCES District ID
F. Number of students participating in evidence -based programs (Federal
guidance may change this requirement in July 2022)
i. Housing Support (2.15, 2.16, 2.18)
a. Number of people or households receiving eviction prevention
services (Federal guidance may change this requirement in July
2022)
b. Number of affordable housing units preserved or developed
(Federal guidance may change this requirement in July 2022)
ii. Small Business Economic Assistance (2.29-2.33)
a. Number of small businesses served
G. Assistance to Non -Profits (2.34)
a. Number of non -profits served
ii. Aid to Travel, Tourism, and Hospitality or Other Impacted Industries
(2.35-2.36)
a. Sector of employer
b. Purpose of funds
H. If other than travel, tourism and hospitality (2.36) - description of hardship
I. EC 3 - Public Health - Negative Economic Impact: Public Sector Capacity
i. Payroll for Public Health and Safety Employees (EC 3.1)
a. Number of government FTEs responding to COVID-19
ii. Rehiring Public Sector Staff (EC 3.2)
a. Number of FTEs rehired by governments
J. EC 4 - Premium Pay -
i. All Premium Pay Projects
K. List of sectors designated as critical by the chief executive of the jurisdiction,
if beyond those listed in the final rule
a. Numbers of workers served
b. Employer sector for all subawards to third -party employers
c. Written narrative justification of how premium pay is responsive
to essential work during the public health emergency for non -
Page 10 of 33
V.7 (Acc) Exhibit F-3
exempt workers or those making over 150 percent of the
state/county's average annual wage
d. Number of workers to be served with premium pay in K-12
schools
L. EC 5 - Infrastructure Projects
i. All Infrastructure Projects
a. Projected/actual construction start date (month/year)
b. Projected/actual initiation of operations date (month/year)
c. Location (for broadband, geospatial data of locations to be
served)
d. Projects over $10 million
(a) Prevailing wage certification or detailed project
employment and local impact report
(b) Project labor agreement certification or project
workforce continuity plan
(c) Prioritization of local hires
(d) Community benefit agreement description, if applicable
ii. Water and sewer projects (EC 5.1-5.18)
a. National Pollutant Discharge Elimination System (NPDES) Permit
Number (if applicable; for projects aligned with the Clean Water
State Revolving Fund)
b. Public Water System (PWS) ID number (if applicable; for projects
aligned with the Drinking Water State Revolving Fund)
c. Median Household Income of service area
d. Lowest Quintile Income of the service area
iii. Broadband projects (EC 5.19-5.21)
a. Confirm that the project is designed to, upon completion,
reliably meet or exceed symmetrical 100 Mbps download and
upload speeds.
(a) If the project is not designed to reliably meet or exceed
symmetrical 100 Mbps download and upload speeds,
explain why not, and
(b) Confirm that the project is designed to, upon completion,
meet or exceed 100 Mbps download speed and between
at least 20 Mbps and 100 Mbps upload speed, and be
scalable to a minimum of 100 Mbps download speed and
100 Mbps upload speed.
Page 11 of 33
V.7 (Acc) Exhibit F-3
M. Additional programmatic data will be required for broadband projects and will
be defined in a subsequent version of the US Treasury Reporting Guidance,
including, but not limited to (Federal guidance may change this requirement in
July 2022):
(a) Number of households (broken out by households on
Tribal lands and those not on Tribal lands) that have
gained increased access to broadband meeting the
minimum speed standards in areas that previously lacked
access to service of at least 25 Mbps download and 3
Mbps upload, with the number of households with access
to minimum speed standard of reliable 100 Mbps
symmetrical upload and download and number of
households with access to minimum speed standard of
reliable 100 Mbps download and 20 Mbps upload
(b) Number of institutions and businesses (broken out by
institutions on Tribal lands and those not on Tribal lands)
that have projected increased access to broadband
meeting the minimum speed standards in areas that
previously lacked access to service of at least 25 Mbps
download and 3 Mbps upload, in each of the following
categories: business, small business, elementary school,
secondary school, higher education institution, library,
healthcare facility, and public safety organization, with
the number of each type of institution with access to the
minimum speed standard of reliable 100 Mbps
symmetrical upload and download; and number of each
type of institution with access to the minimum speed
standard of reliable 100 Mbps download and 20 Mbps
upload.
(c) Narrative identifying speeds/pricing tiers to be offered,
including the speed/pricing of its affordability offering,
technology to be deployed, miles of fiber, cost per mile,
cost per passing, number of households (broken out by
households on Tribal lands and those not on Tribal lands)
projected to have increased access to broadband meeting
the minimum speed standards in areas that previously
lacked access to service of at least 25 Mbps download and
3 Mbps upload, number of households with access to
minimum speed standard of reliable 100 Mbps
symmetrical upload and download, number of households
Page 12 of 33
V.7 (Acc) Exhibit F-3
with access to minimum speed standard of reliable 100
Mbps download and 20 Mbps upload, and number of
institutions and businesses (broken out by institutions on
Tribal lands and those not on Tribal lands) projected to
have increased access to broadband meeting the
minimum speed standards in areas that previously lacked
access to service of at least 25 Mbps download and 3
Mbps upload, in each of the following categories:
business, small business, elementary school, secondary
school, higher education institution, library, healthcare
facility, and public safety organization. Specify the
number of each type of institution with access to the
minimum speed standard of reliable 100 Mbps
symmetrical upload and download; and the number of
each type of institution with access to the minimum
speed standard of reliable 100 Mbps download and 20
Mbps upload.
ii. All Expenditure Categories
N. Program income earned and expended to cover eligible project costs
To SAM. A Subrecipient shall register in SAM and report the following data elements in SAM
for each Federal Award Identification Number (FAIN) assigned by a Federal Agency to
Prime Recipient no later than the end of the month following the month in which the
Subaward was made.
Subrecipient Unique Entity ID ("UEI");
Subrecipient UEI if more than one electronic funds transfer (EFT) account;
Subrecipient parent's organization UEI;
Subrecipient's address, including: Street Address, City, State, Country, Zip + 4, and
Congressional District;
Subrecipient's top 5 most highly compensated Executives if the criteria in S4 above are
met; and
Subrecipient's Total Compensation of top 5 most highly compensated Executives if the
criteria in 54 above met.
To Prime Recipient. A Subrecipient shall report to its Prime Recipient, the following data
elements:
Subrecipient's UEI as registered in SAM.
Primary Place of Performance Information, including: Street Address, City, State, Country,
Zip code + 4, and Congressional District.
Narrative identifying methodology for serving disadvantaged communities. See the
"Project Demographic Distribution" section in the "Compliance and Reporting
Guidance, State and Local Fiscal Recovery Funds" report available at
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V.7 (Acc) Exhibit F-3
www.treasurv.Qov. This requirement is applicable to all projects in Expenditure
Categories 1 and 2.
Narrative identifying funds allocated towards evidenced -based interventions and the
evidence base. See the "Use of Evidence" section in the "Compliance and Reporting
Guidance, State and Local Fiscal Recovery Funds" report available at
www.treasury.gov. See section 8.1.1 for relevant Expenditure Categories.
Narrative describing the structure and objectives of the assistance program and in what
manner the aid responds to the public health and negative economic impacts of
COVID-19. This requirement is applicable to Expenditure Categories 1 and 2. For aid to
travel, tourism, and hospitality or other impacted industries (EC 2.11-2.12), also
provide the sector of employer, purpose of funds, and if not travel, tourism and
hospitality a description of the pandemic impact on the industry.
Narrative identifying the sector served and designated as critical to the health and well-
being of residents by the chief executive of the jurisdiction and the number of workers
expected to be served. For groups of workers (e.g., an operating unit, a classification
of worker, etc.) or, to the extent applicable, individual workers, other than those
where the eligible worker receiving premium pay is earning (with the premium pay
included) below 150 percent of their residing state or county's average annual wage
for all occupations, as defined by the Bureau of Labor Statistics Occupational
Employment and Wage Statistics, whichever is higher, OR the eligible worker receiving
premium pay is not exempt from the Fair Labor Standards Act overtime provisions,
include justification of how the premium pay or grant is responsive to workers
performing essential work during the public health emergency. This could include a
description of the essential workers' duties, health or financial risks faced due to
COVID-19 but should not include personally identifiable information. This requirement
applies to EC 4.1, and 4.2.
For infrastructure projects (EC 5) or capital expenditures in any expenditure category,
narrative identifying the projected construction start date (month/year), projected
initiation of operations date (month/year), and location (for broadband, geospatial
location data).
For projects over $10 million:
Certification that all laborers and mechanics employed by Contractors and Subcontractors
in the performance of such project are paid wages at rates not less than those
prevailing, as determined by the U.S. Secretary of Labor in accordance with
subchapter IV of chapter 31 of title 40, United States Code (commonly known as the
"Davis -Bacon Act"), for the corresponding classes of laborers and mechanics employed
on projects of a character similar to the Agreement work in the civil subdivision of the
State (or the District of Columbia) in which the work is to be performed, or by the
appropriate State entity pursuant to a corollary State prevailing -wage -in -construction
law (commonly known as 'baby Davis -Bacon Acts"). If such certification is not
Page 14 of 33
V.7 (Acc) Exhibit F-3
provided, a recipient must provide a project employment and local impact report
detailing (1) the number of employees of Contractors and sub -contractors working on
the project; (2) the number of employees on the project hired directly and hired
through a third party; (3) the wages and benefits of workers on the project by
classification; and (4) whether those wages are at rates less than those prevailing.
Recipients must maintain sufficient records to substantiate this information upon
request.
A Subrecipient may provide a certification that a project includes a project labor
agreement, meaning a pre -hire collective bargaining agreement consistent with
section 8(f) of the National Labor Relations Act (29 U.S.C. 158(f)). If the recipient does
not provide such certification, the recipient must provide a project workforce
continuity plan, detailing: (1) how the Subrecipient will ensure the project has ready
access to a sufficient supply of appropriately skilled and unskilled labor to ensure high -
quality construction throughout the life of the project; (2) how the Subrecipient will
minimize risks of labor disputes and disruptions that would jeopardize timeliness and
cost-effectiveness of the project; and (3) how the Subrecipient will provide a safe and
healthy workplace that avoids delays and costs associated with workplace illnesses,
injuries, and fatalities; (4) whether workers on the project will receive wages and
benefits that will secure an appropriately skilled workforce in the context of the local
or regional labor market; and (5) whether the project has completed a project labor
agreement.
Whether the project prioritizes local hires.
Whether the project has a Community Benefit Agreement, with a description of any such
agreement.
Subrecipient also agrees to comply with any reporting requirements established by the US
Treasury, Governor's Office and Office of the State Controller. The State of Colorado
may need additional reporting requirements after this agreement is executed. If there
are additional reporting requirements, the State will provide notice of such additional
reporting requirements via Appendix 5- SLFRF Reporting Modification Form.
9. Procurement Standards.
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
Page 15 of 33
V.7 (Acc) Exhibit F-3
requirements of this section must be included in all subawards including all
Agreements and purchase orders for work or products under this award.
9.3 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.
10. Access to Records.
10.1 A Subrecipient shall permit Prime 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
200.300 (Statutory and national policy requirements) through 2 CFR 200.309 (Period of
performance), and Subpart F -Audit Requirements of the Uniform Guidance.
11. Single Audit Requirements.
11.1 If a Subrecipient expends $750,000 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.
11.2 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 Prime
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.
11.3 Exemption. If a Subrecipient expends less than $750,000 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
Page 16 of 33
V.7 (Acc) Exhibit F-3
records shall be available for review or audit by appropriate officials of the Federal
agency, the State, and the Government Accountability Office.
11.4 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. Grant Provisions For Subrecipient Agreements.
12.1 In addition to other provisions required by the Federal Awarding Agency or the Prime
Recipient, Grantees that are Subrecipients shall comply with the following provisions.
Subrecipients shall include all of the following applicable provisions in all
Subcontractors entered into by it pursuant to this Grant.
12.2 {Applicable to federally assisted construction Agreements.} Equal Employment
Opportunity. Except as otherwise provided under 41 CFR Part 60, all Agreements that
meet the definition of "federally assisted construction Agreement" in 41 CFR Part 60-
1.3 shall include 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 Agreement
Compliance Programs, Equal Employment Opportunity, Department of Labor.
12.3 {Applicable to on -site employees working on government -funded construction,
alteration and repair projects.} Davis -Bacon Act. Davis -Bacon Act, as amended (40
U.S.C. 3141-3148).
12.4 Rights to Inventions Made Under a grant or agreement. If the Federal Award meets
the definition of "funding agreement" under 37 CFR 401.2 (a) and the Prime Recipient
or Subrecipient wishes to enter into an Agreement with a small business firm or
nonprofit organization regarding the substitution of parties, assignment or
performance of experimental, developmental, or research work under that "funding
agreement," the Prime Recipient or Subrecipient must comply with the requirements
of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small
Business Firms Under Government Grants, Agreements and Cooperative Agreements,"
and any implementing regulations issued by the Federal Awarding Agency.
12.5 Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act
(33 U.S.C. 1251-1387), as amended. Agreements and subgrants of amounts in excess of
$150,000 must contain a provision that requires the non -Federal awardees to agree to
Page 17 of 33
V.7 (Acc) Exhibit F-3
comply with all applicable standards, orders or regulations issued pursuant to the
Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as
amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal Awarding
Agency and the Regional Office of the Environmental Protection Agency (EPA).
12.6 Debarment and Suspension (Executive Orders 12549 and 12689). A Agreement award
(see 2 CFR 180.220) must not be made to parties listed on the government wide
exclusions in SAM, in accordance with the OMB guidelines at 2 CFR 180 that implement
Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989
Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of
parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Order
12549.
12.7 Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). Contractors that apply or bid for an
award exceeding $100,000 must file the required certification. Each tier certifies to
the tier above that it will not and has not used Federal appropriated funds to pay any
person or organization for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, officer or employee of Congress, or
an employee of a member of Congress in connection with obtaining any Federal
Agreement, grant or any other award covered by 31 U.S.C. 1352. Each tier must also
disclose any lobbying with non -Federal funds that takes place in connection with
obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the
non -Federal award.
12.8 Never Agreement with the enemy (2 CFR 200.215). Federal awarding agencies and
recipients are subject to the regulations implementing "Never Agreement with the
enemy" in 2 CFR part 183. The regulations in 2 CFR part 183 affect covered
Agreements, grants and cooperative agreements that are expected to exceed $50,000
within 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.
12.9 Prohibition on certain telecommunications and video surveillance services or
equipment (2 CFR 200.216). Grantee 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.
12.10 Title VI of the Civil Rights Act. The Subgrantee, Contractor, Subcontractor,
transferee, and assignee shall comply with Title VI of the Civil Rights Act of 1964,
which prohibits recipients of federal financial assistance from excluding from a
program or activity, denying benefits of, or otherwise discriminating against a person
on the basis of race, color, or national origin (42 U.S.C. S 2000d et seq.), as
implemented by the Department of Treasury's Title VI regulations, 31 CFR Part 22,
which are herein incorporated by reference and made a part of this Agreement (or
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V.7 (Acc) Exhibit F-3
agreement). Title VI also includes protection to persons with "Limited English
Proficiency" in any program or activity receiving federal financial assistance, 42 U.S.
C. § 2000d et seq., as implemented by the Department of the Treasury's Title VI
regulations, 31 CRF Part 22, and herein incorporated by reference and made part of
this Agreement or agreement.
13. Certifications.
13.1 Subrecipient Certification. Subrecipient shall sign a "State of Colorado Agreement
with Recipient of Federal Recovery Funds" Certification Form in separate Appendix
hereto and submit to State Agency with signed grant agreement.
13.2 Unless prohibited by Federal statutes or regulations, Prime Recipient 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 the State at the end of the Award that the
project or activity was completed or the level of effort was expended. 2 CFR
200.201(3). 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 Grantee 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.
Event of Default and Termination.
14.3 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.
14.4 Termination (2 CFR 200.340). The Federal Award may be terminated in whole or in
part as follows:
14.5 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;
14.6 By the Federal awarding agency or Pass -through Entity, to the greatest extent
authorized by law, if an award no longer effectuates the program goals or agency
priorities;
14.7 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
Page 19 of 33
V.7 (Acc) Exhibit F-3
conditions, including the effective date and, in the case of partial termination, the
portion to be terminated;
14.8 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
14.9 By the Federal Awarding Agency or Pass -through Entity pursuant to termination
provisions included in the Federal Award.
The rest of this page is intentionally left blank.
Page 20 of 33
V.7 (Acc) Exhibit F-2
Appendix 3 To SLFRF Exhibit - Subrecipient Certification Agreement
Agreement with Subrecipient of Federal Recovery Funds
Section 602(b) of the Social Security Act (the Act), as added by section 9901 of the American
Rescue Plan Act (ARPA), Pub. L. No. 117-2 (March 11, 2021), authorizes the Department of the
Treasury (Treasury) to make payments to certain Subrecipients from the Coronavirus State
Fiscal Recovery Fund. The State of Colorado has signed and certified a separate agreement
with Treasury as a condition of receiving such payments from the Treasury. This agreement is
between your organization and the State and your organization is signing and certifying the
same terms and conditions included in the State's separate agreement with Treasury. Your
organization is referred to as a Subrecipient.
As a condition of your organization receiving federal recovery funds from the State, the
authorized representative below hereby (i) certifies that your organization will carry out the
activities listed in section 602(c) of the Act and (ii) agrees to the terms attached hereto. Your
organization also agrees to use the federal recovery funds as specified in bills passed by the
General Assembly and signed by the Governor.
Under penalty of perjury, the undersigned official certifies that the authorized representative
has read and understood the organization's obligations in the Assurances of Compliance and
Civil Rights Requirements, that any information submitted in conjunction with this assurances
document is accurate and complete, and that the organization is in compliance with the
nondiscrimination requirements.
Subrecipient Name:
Authorized Representative
Title
Signature
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V.7 (Acc) Exhibit F-3
Agreement with Subrecipient of Federal Recovery Funds
Terms and Conditions
1. Use of Funds.
a. Subrecipient understands and agrees that the funds disbursed under this award may
only be used in compliance with section 602(c) of the Social Security Act (the Act) and
Treasury's regulations implementing that section and guidance.
b. Subrecipient will determine prior to engaging in any project using this assistance that it
has the institutional, managerial, and financial capability to ensure proper planning,
management, and completion of such project.
2. Period of Performance. The period of performance for this subaward is shown on page one
of this Agreement. Subrecipient may use funds to cover eligible costs incurred, as set
forth in Treasury's implementing regulations, during this period of performance.
3. Reporting. Subrecipient agrees to comply with any reporting obligations established by
Treasury as they relate to this award. Subrecipient also agrees to comply with any
reporting requirements established by the Governor's Office and Office of the State
Controller. The State will provide notice of such additional reporting requirements via
separate Appendix hereto - Reporting Modification Form.
4. Maintenance of and Access to Records
a. Subrecipient shall maintain records and financial documents sufficient to evidence
compliance with section 602(c), Treasury's regulations implementing that section, and
guidance issued by Treasury regarding the foregoing.
b. The Treasury Office of Inspector General and the Government Accountability Office, or
their authorized representatives, shall have the right of access to records (electronic
and otherwise) of Subrecipient in order to conduct audits or other investigations.
c. Records shall be maintained by Subrecipient for a period of five (5) years after all funds
have been expended or returned to Treasury, whichever is later.
5. Pre -award Costs. Pre -award costs, as defined in 2 C.F.R. S 200.458, may not be paid with
funding from this award.
6. Administrative Costs. Subrecipient may use funds provided under this award to cover both
direct and indirect costs. Subrecipient shall follow guidance on administrative costs issued
by the Governor's Office and Office of the State Controller.
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V.7 (Acc) Exhibit F-3
7. Cost Sharing. Cost sharing or matching funds are not required to be provided by
Subrecipient.
8. Conflicts of Interest. The State of Colorado understands and agrees it must maintain a
conflict of interest policy consistent with 2 C.F.R. 5 200.318(c) and that such conflict of
interest policy is applicable to each activity funded under this award. Subrecipient and
Contractors must disclose in writing to the Office of the State Controller or the pass -
through entity, as appropriate, any potential conflict of interest affecting the awarded
funds in accordance with 2 C.F.R. S 200.112. The Office of the State Controller shall
disclose such conflict to Treasury.
9. Compliance with Applicable Law and Regulations.
a. Subrecipient agrees to comply with the requirements of section 602 of the Act,
regulations adopted by Treasury pursuant to section 602(f) of the Act, and guidance
issued by Treasury regarding the foregoing. Subrecipient also agrees to comply with all
other applicable federal statutes, regulations, and executive orders, and Subrecipient
shall provide for such compliance by other parties in any agreements it enters into
with other parties relating to this award.
b. Federal regulations applicable to this award include, without limitation, the following:
i. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards, 2 C.F.R. Part 200, other than such provisions as Treasury may
determine are inapplicable to this Award and subject to such exceptions as may be
otherwise provided by Treasury. Subpart F - Audit Requirements of the Uniform
Guidance, implementing the Single Audit Act, shall apply to this award.
ii. Universal Identifier and System for Award Management (SAM), 2 C.F.R. Part 25,
pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 25 is
hereby incorporated by reference.
iii. Reporting Subaward and Executive Compensation Information, 2 C.F.R. Part 170,
pursuant to which the award term set forth in Appendix A to 2 C.F.R. Part 170 is
hereby incorporated by reference.
iv. OMB Guidelines to Agencies on Government wide Debarment and Suspension
(Nonprocurement), 2 C.F.R. Part 180, including the requirement to include a term
or condition in all lower tier covered transactions (Agreements and Subcontractors
described in 2 C.F.R. Part 180, subpart B) that the award is subject to 2 C.F.R.
Part 180 and Treasury's implementing regulation at 31 C.F.R. Part 19.
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V.7 (Acc) Exhibit F-3
v. Subrecipient Integrity and Performance Matters, pursuant to which the award term
set forth in 2 C.F.R. Part 200, Appendix XII to Part 200 is hereby incorporated by
reference.
vi. Government wide Requirements for Drug -Free Workplace, 31 C.F.R. Part 20.
vii. New Restrictions on Lobbying, 31 C.F.R. Part 21.
viii. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42
U.S.C. SS 4601-4655) and implementing regulations.
ix. Generally applicable federal environmental laws and regulations.
c. Statutes and regulations prohibiting discrimination applicable to this award include,
without limitation, the following:
i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. SS 2000d et seq.) and Treasury's
implementing regulations at 31 C.F.R. Part 22, which prohibit discrimination on the
basis of race, color, or national origin under programs or activities receiving
federal financial assistance;
ii. The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. SS 3601 et
seq.), which prohibits discrimination in housing on the basis of race, color,
religion, national origin, sex, familial status, or disability;
iii. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. S 794), which
prohibits discrimination on the basis of disability under any program or activity
receiving federal financial assistance;
iv. The Age Discrimination Act of 1975, as amended (42 U.S.C. SS 6101 et seq.), and
Treasury's implementing regulations at 31 C.F.R. Part 23, which prohibit
discrimination on the basis of age in programs or activities receiving federal
financial assistance; and
v. Title II of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. SS
12101 et seq.), which prohibits discrimination on the basis of disability under
programs, activities, and services provided or made available by state and local
governments or instrumentalities or agencies thereto.
10. Remedial Actions. In the event of Subrecipient's noncompliance with section 602 of the
Act, other applicable laws, Treasury's implementing regulations, guidance, or any
reporting or other program requirements, Treasury may impose additional conditions on
the receipt of a subsequent tranche of future award funds, if any, or take other available
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V.7 (Acc) Exhibit F-3
remedies as set forth in 2 C.F.R. § 200.339. In the case of a violation of section 602(c) of
the Act regarding the use of funds, previous payments shall be subject to recoupment as
provided in section 602(e) of the Act and any additional payments may be subject to
withholding as provided in sections 602(b)(6)(A)(ii)(III) of the Act, as applicable.
11. Hatch Act. Subrecipient agrees to comply, as applicable, with requirements of the Hatch
Act (5 U.S.C.S5 1501-1508 and 7324-7328), which limit certain political activities of State
or local government employees whose principal employment is in connection with an
activity financed in whole or in part by this federal assistance.
12. False Statements. Subrecipient understands that making false statements or claims in
connection with this award is a violation of federal law and may result in criminal, civil,
or administrative sanctions, including fines, imprisonment, civil damages and penalties,
debarment from participating in federal awards or Agreements, and/or any other remedy
available by law.
13. Publications. Any publications produced with funds from this award must display the
following language: "This project [is being] [was] supported, in whole or in part, by
federal award number SLFRF0126 awarded to the State of Colorado by the U.S.
Department of the Treasury."
14. Debts Owed the Federal Government.
a. Any funds paid to the Subrecipient
i. in excess of the amount to which the Subrecipient is finally determined to be
authorized to retain under the terms of this award;
ii. that are determined by the Treasury Office of Inspector General to have been
misused; or
iii. that are determined by Treasury to be subject to a repayment obligation pursuant
to sections 602(e) and 603(b)(2)(D) of the Act and have not been repaid by the
Subrecipient shall constitute a debt to the federal government.
b. Any debts determined to be owed to the federal government must be paid promptly by
Subrecipient. A debt is delinquent if it has not been paid by the date specified in
Treasury's initial written demand for payment, unless other satisfactory arrangements
have been made or if the Subrecipient knowingly or improperly retains funds that are
a debt as defined in paragraph 14(a). Treasury will take any actions available to it to
collect such a debt.
15. Disclaimer.
Page 25 of 33
V.7 (Acc) Exhibit F-3
a. The United States expressly disclaims any and all responsibility or liability to
Subrecipient or third persons for the actions of Subrecipient or third persons resulting
in death, bodily injury, property damages, or any other losses resulting in any way
from the performance of this award or any other losses resulting in any way from the
performance of this award or any Agreement, or Subcontractor under this award.
b. The acceptance of this award by Subrecipient does not in any way establish an agency
relationship between the United States and Subrecipient.
16. Protections for Whistleblowers.
a. In accordance with 41 U.S.C. S 4712, Subrecipient may not discharge, demote, or
otherwise discriminate against an employee in reprisal for disclosing to any of the list
of persons or entities provided below, information that the employee reasonably
believes is evidence of gross mismanagement of a federal Agreement or grant, a gross
waste of federal funds, an abuse of authority relating to a federal Agreement or grant,
a substantial and specific danger to public health or safety, or a violation of law, rule,
or regulation related to a federal Agreement (including the competition for or
negotiation of an Agreement) or grant.
b. The list of persons and entities referenced in the paragraph above includes the
following:
i. A member of Congress or a representative of a committee of Congress;
ii. An Inspector General;
iii. The Government Accountability Office;
iv. A Treasury employee responsible for Agreement or grant oversight or management;
v. An authorized official of the Department of Justice or other law enforcement
agency;
vi. A court or grand jury; or
vii. A management official or other employee of Subrecipient, Contractor, or
Subcontractor who has the responsibility to investigate, discover, or address
misconduct.
c. Subrecipient shall inform its employees in writing of the rights and remedies provided
under this section, in the predominant native language of the workforce.
Page 26 of 33
V.7 (Acc) Exhibit F-3
17. Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043, 62 FR
19217 (Apr. 18, 1997), Subrecipient should encourage its Contractors to adopt and enforce
on-the-job seat belt policies and programs for their employees when operating company -
owned, rented or personally owned vehicles.
18. Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR 51225
(Oct. 6, 2009), Subrecipient should encourage its employees, Subrecipients, and
Contractors to adopt and enforce policies that ban text messaging while driving, and
Subrecipient should establish workplace safety policies to decrease accidents caused by
distracted drivers.
Page 27 of 33
V.7 (Acc) Exhibit F-2
Assurances of Compliance with Civil Rights Requirements
Assurances of Compliance with Title VI of The Civil Rights Act of 1964
As a condition of receipt of federal financial assistance from the Department of the
Treasury, the Subrecipient provides the assurances stated herein. The federal financial
assistance may include federal grants, loans and Agreements to provide assistance to the
Subrecipient's beneficiaries, the use or rent of Federal land or property at below market
value, Federal training, a loan of Federal personnel, subsidies, and other arrangements with
the intention of providing assistance. Federal financial assistance does not encompass
Agreements of guarantee or insurance, regulated programs, licenses, procurement
Agreements by the Federal government at market value, or programs that provide direct
benefits.
The assurances apply to all federal financial assistance from or funds made available
through the Department of the Treasury, including any assistance that the Subrecipient may
request in the future.
The Civil Rights Restoration Act of 1987 provides that the provisions of the assurances
apply to all of the operations of the Subrecipient's program(s) and activity(ies), so long as any
portion of the Subrecipient's program(s) or activity(ies) is federally assisted in the manner
prescribed above.
1. Subrecipient ensures its current and future compliance with Title VI of the Civil Rights Act
of 1964, as amended, which prohibits exclusion from participation, denial of the benefits
of, or subjection to discrimination under programs and activities receiving federal
financial assistance, of any person in the United States on the ground of race, color, or
national origin (42 U.S.C. S 2000d et seq.), as implemented by the Department of the
Treasury Title VI regulations at 31 CFR Part 22 and other pertinent executive orders such
as Executive Order 13166, directives, circulars, policies, memoranda, and/or guidance
documents.
2. Subrecipient acknowledges that Executive Order 13166, "Improving Access to Services for
Persons with Limited English Proficiency," seeks to improve access to federally assisted
programs and activities for individuals who, because of national origin, have Limited
English proficiency (LEP). Subrecipient understands that denying a person access to its
programs, services, and activities because of LEP is a form of national origin
discrimination prohibited under Title VI of the Civil Rights Act of 1964 and the Department
of the Treasury's implementing regulations. Accordingly, Subrecipient shall initiate
reasonable steps, or comply with the Department of the Treasury's directives, to ensure
that LEP persons have meaningful access to its programs, services, and activities.
Subrecipient understands and agrees that meaningful access may entail providing language
assistance services, including oral interpretation and written translation where necessary,
Page 28 of 33
V.7 (Acc) Exhibit F-3
to ensure effective communication in the Subrecipient's programs, services, and
activities.
3. Subrecipient agrees to consider the need for language services for LEP persons when
Subrecipient develops applicable budgets and conducts programs, services, and activities.
As a resource, the Department of the Treasury has published its LEP guidance at 70 FR
6067. For more information on taking reasonable steps to provide meaningful access for
LEP persons, please visit http://www.lep.Qov.
4. Subrecipient acknowledges and agrees that compliance with the assurances constitutes a
condition of continued receipt of federal financial assistance and is binding upon
Subrecipient and Subrecipient's successors, transferees, and assignees for the period in
which such assistance is provided.
5. Subrecipient acknowledges and agrees that it must require any sub -grantees, contractors,
subcontractors, successors, transferees, and assignees to comply with assurances 1-4
above, and agrees to incorporate the following language in every Agreement or agreement
subject to Title VI and its regulations between the Subrecipient and the Subrecipient's
sub -grantees, Contractors, Subcontractors, successors, transferees, and assignees:
The sub -grantee, Contractor, Subcontractor, successor, transferee, and assignee shall
comply with Title VI of the Civil Rights Act of 1964, which prohibits Subrecipients of
federal financial assistance from excluding from a program or activity, denying
benefits of, or otherwise discriminating against a person on the basis of race, color,
or national origin (42 U.S.C. § 2000d et seq.), as implemented by the Department of
the Treasury's Title VI regulations, 31 CFR Part 22, which are herein incorporated by
reference and made a part of this Agreement (or agreement). Title VI also includes
protection to persons with "Limited English Proficiency" in any program or activity
receiving federal financial assistance, 42
U.S.C. § 2000d et seq., as implemented by the Department of the Treasury's Title VI
regulations, 31 CFR Part 22, and herein incorporated by reference and made a part of
this Agreement or agreement.
6. Subrecipient understands and agrees that if any real property or structure is provided or
improved with the aid of federal financial assistance by the Department of the Treasury,
this assurance obligates the Subrecipient, or in the case of a subsequent transfer, the
transferee, for the period during which the real property or structure is used for a purpose
for which the federal financial assistance is extended or for another purpose involving the
provision of similar services or benefits. If any personal property is provided, this
assurance obligates the Subrecipient for the period during which it retains ownership or
possession of the property.
Page 29 of 33
V.7 (Acc) Exhibit F-3
7. Subrecipient shall cooperate in any enforcement or compliance review activities by the
Department of the Treasury of the aforementioned obligations. Enforcement may include
investigation, arbitration, mediation, litigation, and monitoring of any settlement
agreements that may result from these actions. The Subrecipient shall comply with
information requests, on -site compliance reviews and reporting requirements.
8. Subrecipient shall notify the OSC with copy to CDHS for visibility, the OSC will report to
the Department of Treasury of any complaints of discrimination on the grounds of race,
color, or national origin, and limited English proficiency covered by Title VI of the Civil
Rights Act of 1964 and implementing regulations and provide, upon request, a list of all
such reviews or proceedings based on the complaint, pending or completed, including
outcome.
9. Subrecipient must provide documentation of an administrative agency's or court's findings
of non-compliance of Title VI and efforts to address the non-compliance, including any
voluntary compliance or other agreements between the Subrecipient and the
administrative agency that made the finding. If the Subrecipient settles a case or matter
alleging such discrimination, the Subrecipient must provide documentation of the
settlement. If Subrecipient has not been the subject of any court or administrative agency
finding of discrimination, please so state.
10. If the Subrecipient makes sub -awards to other agencies or other entities, the Subrecipient
is responsible for ensuring that sub-Subrecipients also comply with Title VI and other
applicable authorities covered in this document State agencies that make sub -awards
must have in place standard grant assurances and review procedures to demonstrate that
that they are effectively monitoring the civil rights compliance of sub- Subrecipients.
The United States of America has the right to seek judicial enforcement of the terms of this
assurances document and nothing in this document alters or limits the federal enforcement
measures that the United States may take in order to address violations of this document or
applicable federal law.
Page 30 of 33
V.7 (Acc) Exhibit F-3
Appendix 4 To SLFRF Exhibit - SLFRF Subrecipient Quarterly Report
Requirements
SLFRF Subrecipient Quarterly Report Workbook
The SLFRF Subrecipient Quarterly Report Workbook must be submitted to the State Agency
within ten (10) days following each quarter ended September, December, March and June.
The SLFRF Subrecipient Quarterly Report Workbook can be found at:
https://osc.colorado.Rov/american-rescue-plan-act (see SLFRF Grant Agreement Templates
Tab).
The requirements set forth in this Appendix 4 do not apply if the instant Agreement is
between two Colorado State Agencies.
Page 31 of 33
V.7 (Acc) Exhibit F-3
Appendix 5 To SLFRF Exhibit - Sample SLFRF Reporting Modifications
Form
Grantee
Grant Agreement Number
Project Title
Project Number
Project Duration - To
Project Duration - From
State Agency
This form serves as notification that there has been a change to the SLFRF reporting
requirements set forth in the Agreement.
The following reporting requirements have been (add/remove additional rows as necessary):
Updated Reporting
Requirement
(Add/Delete/Modify)
Project Number
Reporting Requirement
Page 32 of 33
V.7 (Acc) Exhibit F-3
By signing this form, the Grantee/Contractor agrees to and acknowledges the changes to
the SLFRF reporting requirements set forth in the existing Agreement. All other terms and
conditions of the Agreement, with any approved modifications, remain in full force and
effect. Grantee/Contractor shall submit this form to the State Agency within 10 business
days of the date sent by that Agency.
Grantee State Agency Grant Manager
Date Date
Page 33 of 33
try ct F
Entity Information
Entity Name* Entity ID*
COLORADO DEPARTMENT OF @00003650
HUMAN SERVICES
Contract Name* Contract ID
CDHS BHA CHILDREN, YOUTH, FAMILY (CYF) SERVICES 9230
GRANT HB22-1281 HIGH FIDELITY WRAP TEAM
AMENDMENT #3
Contract Status
CTB REVIEW
Contract Lead*
SADAMS
Q New Entity?
Parent Contract ID
20232546
Requires Board Approval
YES
Contract Lead Email Department Project #
sadams@weld.gov;cobbx
xik@weld.gov
Contract Description*
CDHS BHA CHILDREN, YOUTH, FAMILY SERVICES GRANT HB22-1281 HIGH FIDELITY WRAP TEAM AMEND #3.
EXTENDS TERM TO 6/30/26 & UPDATES EXHIBIT A, EXHIBIT B, EXHIBIT E EXHIBIT F. ORIGINAL AGREEMENT
TYLER# 2023-2546; AMEND #1 TYLER# 2024-1624 AMEND #2 2024-3022
Contract Description 2
PA ROUTING THROUGH THE NORMAL PROCESS. ETA TO CTB IS 3/18/25.
Contract Type*
AMENDMENT
Amount*
$0.00
Renewable
NO
Automatic Renewal
Grant
IGA
Department
HUMAN SERVICES
Department Email
CM-
HumanServices@weld.gov
Department Head Email
CM-HumanServices-
DeptHead@weld.gov
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
Requested BOCC Agenda
Date*
04/02/2025
Due Date
03/29/2025
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
04/30/2026
Committed Delivery Date
Renewal Date
Expiration Date*
06/30/2026
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CHERYL PATTELLI ADRIA SCHIEL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
03/27/2025 03/27/2025 03/27/2025
Final Approval
BOCC Approved Tyler Ref #
AG 040225
BOCC Signed Date Originator
SADAMS
BOCC Agenda Date
04/02/2025
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