The URL can be used to link to this page

Browse Search

Home My WebLink About20242452.tiffMariah Higgins From: Sent: To: Subject: Attachments: Follow Up Flag: Flag Status: Bill Fritz Monday, June 2, 2025 11:30 AM CTB FW: Completed: Notification of Executed Contract - 2022*0289 OL4 for communication 1 2022-0289 OL4 CP.pdf; 2 2022-0289 OL4 SP.pdf; 3 2022-0289 OL4 Budget.pdf Follow up Flagged Good morning, for communication, here is Option Letter #4 for Child fatality grant. COUNTY, CO Bill Fritz Finance Manager Department of Public Health and Environment Desk: 970-400-2122 1555 North 17th Ave., Greeley, CO 80631 Oa000 Join Our Team IMPORTANT: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: DocuSign NA3 System <dse_NA3@docusign.net> Sent: Wednesday, May 28, 2025 2:57 PM To: Bill Fritz <bfritz@weld.gov> Subject: Completed: Notification of Executed Contract - 2022*0289 OL4 This Message is From an External Sender This email was sent by someone outside Weld County Government. Do not dick links or open attachments unless you recognize the sender and know the content is safe. �1i1YwfN COLORADO Department of Public Health Et Environment Co vntiCo.-{';ons o6/oct /z5 2�2y - 2H52 {-ILOo5-7 Your document has been completed VIEW COMPLETED DOCUMENTS Claire Shea claire.shea@state.co.us All parties have completed Notification of Executed Contract - 2022*0289 OL4. You are receiving notification that a contract from the Colorado Department of Public Health and Environment (CDPHE) is fully executed. CDPHE authorizes work to begin on the effective date of the attached contract. If you have any questions or concerns, please contact Claire Shea at claire.sheaAstate.co.us state.co.us Powered by docusign. Do Not Share This Email This email contains a secure link to Docusign. Please do not share this email, link, or access code with others. Alternate Signing Method Visit Docusign.com, click 'Access Documents', and enter the security code: 215CEA9BC70243B4B38A9194F0392D373 About Docusign Sign documents electronically in just minutes. It's safe, secure, and legally binding. Whether you're in an office, at home, on -the -go -- or even across the globe -- Docusign provides a professional trusted solution for Digital Transaction ManagementT*' 2 Questions about the Document? If you need to modify the document or have questions about the details in the document, please reach out to the sender by emailing them directly. Stop receiving this email Report this email or read more about Declining to sign and Managing notifications. If you have trouble signing, visit "How to Sign a Document" on our Docusign Support Center, or become part of the Docusign Community to access tips and guidance from peers. !'Download the Docusign App This message was sent to you by Claire Shea who is using the Docusign Electronic Signature Service. if you would rather not receive email from this sender you may contact the sender with your request. 3 Docusign Envelope ID: 774ECDA8-O5E6-4271-BA52-0FABDA959D5F STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT OPTION LETTER #4 State Agency: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2022*0289 Main Task Order Contract Number: 23 FAA 00051 Contractor: Board of County Commissioners of Weld County (a political subdivision of the state of Colorado) Option Letter Contract Number: 2022*0289 Option Letter #4 1150 "O" Street Greeley CO 80631 for the use and benefit of the Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley CO 80631 Contract Performance Beginning Date: July 1, 2021 Current Contract Expiration Date: June 30, 2026 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding Amount StateFunding AmoFuunt Other Funding Amount Term (dates) Total Original Contract 2022*0289 $0.00 $13,450.00 $0.00 07/01/2021 - 06/30/2022 $13,450.00 Amendment #1 2022*0289 Amendment #1 $0.00 $0.00 $0.00 10/29/2021 06/30/2022 $0.00 Option Letter #1 2022*0289 Option Letter #1 $0.00 $15,500.00 $0.00 07/01/2022 - 06/30/2023 $15,500.00 Option Letter #2 2022*0289 Option Letter #2 $0.00 $17,000.00 $0.00 07/01/2023 06/30/2024 $17,000.00 Option Letter #3 2022*0289 Option Letter #3 $0.00 $13,750.00 $0.00 07/01/2024 - 06/30/2025 $13,750.00 Option Letter #4 2022*0289 Option Letter #4 $0.00 $14,050.00 $0.00 07/01/2025 - 06/30/2026 $14,050.00 Current Contract Maximum Cumulative Amount $73,750.00 1. OPTIONS: A. Option to extend for an Extension Term Option Letter Contract Number: 2022*0289 Option Letter #4 Page 1 of 3 Version OSCA12.24/CDPHE A1.25 Docusign Envelope ID: 774ECDA8-D5E6-4271-BA52-0FABDA959D5F B. Option to change the quantity of Services under the Contract 2. REQUIRED PROVISIONS: A. In accordance with Section 2C of the Original Main Task Order Contract referenced above, the State hereby exercises its option for an additional term, beginning July 12025 and ending on the current contract expiration date shown above, at the rates stated in the Original Task Order Contract, as amended for the following reason: to extend the contract into Fiscal Year 2026. B. In accordance with Section 5Bv of the Original Main Task Order Contract referenced above, the State hereby exercises its option to increase the quantity of the services at the rates stated in the Original Task Order Contract, as amended. Exhibit C - Budget is deleted and replaced in its entirety with Exhibit C - Budget attached to this Option Letter, for the following reason: to add funds supporting the renewal term Statement of Work activities and deliverables. C. The Contract Maximum Amount table on the Contract's Cover Page is hereby deleted and replaced with the Current Contract Maximum Amount table shown above. 3. OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller or July 1, 2025, whichever is later. Option Letter Contract Number: 2022*0289 Option Letter #4 Page 2 of 3 Version OSCA12.24/CDPHE A1.25 Docusign Envelope ID: 774ECDA8-05E6-4271-B052-OFABDA959D5F STATE OF COLORADO Jared S. Polis, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director DocuSipned by: (, u l si a alit,riwln. In accordance with §24-30-202 C.R.S., this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jams, CPA, MBA, JD DocuSgned by: Ete4.44 Wt... 7'17nFFAAAAMtARC 2C1J812416�P4Dt... By: Signature Chelsea Gilbertson By: Signature Kurt Williams Name of Executive Director Delegate Procurement & Contracts Section Name of State Controller Delegate Controller Title of Executive Director Delegate 2025-04-23 Date: Title of State Controller Delegate 2025-05-28 Option Effective Date: Option Letter Contract Number: 2022*0289 Option Letter #4 Page 3 of 3 Version OSCA12.24/CDPHE A1.25 Docusign Envelope ID: 774ECDA8-D5E&4271-BA52-0FABDA959D5F Exhibit C Budget COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2022*0289 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Email Cathy Hoover (Program Manager) choover@weld.gov Budget Period July 1, 2025 June 30, 2026 Fiscal Contact Name, Title, Phone and Email Tanya Geiser, (970) 400-2122, tgeiser@weldgov.com Project Name Child Fatality Prevention System Contract (CT or PO) Number 2022*0289 Budget Information Primary Activity / Deliverable Description of Activity Rate Quantity Total Amount Requested from CDPHE Quarter 1 Payment July 1 through September 30 $ 3,512.50 1.0 $ 3,512.50 Quarter 2 Payment October 1 through December 31 $ 3,512.50 1.0 $ 3,512.50 Quarter 3 Payment January 1 through March 31 $ 3,512.50 1.0 $ 3,512.50 Quarter 4 Payment April 1 through June 30 $ 3,512.50 1.0 $ 3,512.50 TOTAL $, 14,050:00 Option Letter Contract Number: 2022*0289 Option Letter #4 Page 1 of 1 Mariah Higgins From: Sent: To: Subject: Attachments: Follow Up Flag: Flag Status: Bill Fritz Wednesday, September 11, 2024 4:34 PM CTB Item of Communication 2022-0289 OL3 (Executed).pdf Follow up Flagged The attached Option Letter #3 for Child Fatality Prevention System is attached. I believe it was missed earlier this year. Please let me know if you have any question. Thanks Bill Bill Fritz Finance Manager Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley, CO 80631 Direct Phone: 970.400.2122 VISION: Everyone in Weld County has the opportunity to live their healthiest lives. MISSION: We serve Weld County by cultivating partnerships to promote public health and environmental quality through the delivery of relevant, innovative, and cost-effective services. Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. cot( M U r1', Co t' i ons /t g/2+l 2024-2452 NL0°57 DocuSign Envelope ID: 3E7EDC7D-1A88-4B02-6063-BC013F7E0B30 OPTION LETTER #: 3 State Agency: Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2022*0289 Option Letter Contract Number: 2022*0289 Option Letter #3 Contractor: Board of County Commissioners of Weld County (a political subdivision of the state of Colorado) 1150 "O" Street Greeley CO 80631 for the use and benefit of the Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley, CO 80631 Contract Performance Beginning Date: July 1, 2021 Current Contract Expiration Date: June 30, 2025 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding Amount State Funding Amount Other Funding Amount Term (dates) Total Original Contract 2022*0289 $0.00 $13,450.00 $0.00 07/01/2021 - 06/30/2022 $13450.00 ' Amendment #1 2022*0289 Amendment #1 $0.00 $0.00 $0.00 10/29/2021 - 06/30/2022 $0.00 Option Letter #1 2022*0289 Option Letter #1 $0.00 $15 50000 . $000 . 07/01/2022 - 06/30/2023 $15 500.00 ' Option Letter #2 2022*0289 Option Letter #2 $0.00 $17,000.00 $0.00 07/01/2023 - 06/30/2024 $17,000.00 Option Letter #3 2022*0289 Option Letter #3 $0.00 $13 75000 . . $000 07/01/2024 - 06/30/2025 $13 750.00 ' Current Contract Maximum $59,700.00 Cumulative Amount 1) OPTIONS A. Option to extend for an Extension Term B. Option to change quantity of services under the Contract 2) REQUIRED PROVISIONS: A. In accordance with Section 2.C. of the Original Master Task Order Contract referenced above, the State hereby exercises its option for an additional term, beginning July 1, 2024 and ending on the current contract expiration date shown above, at the rates stated in the Original Task Order Contract, as amended for the following reason: to continue to provide services under the Child Fatality Prevention Act for the renewal term. Page 1 of 3 Option Letter Contract Number: 2022*0289 Option Letter #3 Ver. 27.01.20 DocuSign Envelope ID: 3E7EDC7D-1A88-4B02-B063-BC013F7E0B30 B. In accordance with Section 5.B.v. of the Original Master Task Order Contract referenced above, the State hereby exercises its option to Increase the quantity of the Services at the rates stated in the Original Task Order Contract, as amended. Exhibit C, Budget, is deleted and replaced in its entirety with Exhibit C, Budget, attached to this Option Letter, for the following reason: to add funding in support of the renewal term. C. The Contract Maximum Amount table is deleted and replaced with the Current Contract Maximum Amount table shown above. 2) OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller or July 1, 2024, whichever is later. Page 2 of 3 Option Letter Contract Number: 2022*0289 Option Letter #3 Ver. 27.01.20 DocuSign Envelope ID: 3E7EDC7D-1A88-4B02-B063-BC013F7E0B30 SIGNATURE PAGE STATE OF COLORADO Jared S. Polls, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director DocuSigned by: Cauisw, akutsetA, 201391241652481... In accordance with §24-30-202 C.R.S., this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD DocuSigned by: W/tat SCAYrik.b rn e ,a a 7a n 8 O B 5 6 8 By: Signature Chelsea Gilbertson By: Signature Jannette Scarpino Name of Executive Director Delegate Director of Procurement and Contracts Name of State Controller Delegate chief Financial Officer Title of Executive Director Delegate 2024-05-21 Date: Title of State Controller Delegate 2024-05-22 Option Effective Date: -- Signature Page End -- Page 3 of 3 Option Letter Contract Number: 2022*0289 Option Letter #3 Ver. 27.01.20 DocuSign Envelope ID: 3E7EDC7D-1A88-4802-B063-BCD13F7E0B30 Exhibit C Budget M�M7M� .M COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2022*0289 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Entail Melanie Cyphers, (970) 400 - 2423, mcyphers@weldgov.com Budget Period July 1, 2024 -June 30, 2025 Fiscal Contact Name, Title, Phone and Email Tanya Geiser, (970) 400-2122, tgeiser@weldgov.com Project Name Child Fatality Prevention System Contract (CT or PO) Number CT FHLA 2022*0289 Budget Information Primary Activity / Deliverable Description of Activity Rate Quantity Total Amount Requested from CDPHE Quarter 1 Payment July 1 through September 30 $ 3,437.50 1.0 $ 3,437.50 Quarter 2 Payment October 1 through December 31 $ 3,437.50 1.0 $ 3,437.50 Quarter 3 Payment January 1 through March 31 $ 3,437.50 1.0 $ 3,437.50 Quarter 4 Payment April 1 through June 30 $ 3,437.50 1.0 $ 3,437.50 $ z� 'YYz3,�`Sc4..P}� �h'"t`� �,� �, 'x?'tY:' 4 Y. f�� 5L l�,[" p J ^ry t 'k } yy Y 4 # �§ ,t k � ` ��e � i 4 S ��: ��•�'. Option Letter Contract Number: 2022*0289 Option Letter #3 Page 1 of 1 DacuSign Envelope ID: 491A5F51-6211-4401-84, .35213FBDF02 OPTION LETTER #: 2 State Agency: Colorado Department of Public Health and Environment VIP/CFPS 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2022*0289 Option Letter Contract Number: 2022*0289 Option Letter #2 Contractor: Board of County Commissioners of Weld County, (a political subdivision of the state of Colorado) 1150 "O" St, Greeley, CO 80631 for the use and benefit of the Weld County Department of Public Health and Environment 1555 North 17° Avenue Greeley, CO 80631 Contract Performance Beginning Date: July 1, 2021 Current Contract Expiration Date: June 30, 2024 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding State Funding Other Funding Term (dates) Total Original Contract 2022*0289 $0.00 $13,450.00 $0.00 7/1/21-6/30/22 $13,450.00 Amendment #1 2022"0289 Amendment #1 $0.00 $0.00 $0.00 10/29/21-6/30/22 $0.00 Option Letter #1 2022*0289 Option Letter #1 $0.00 $15,500.00 $0.00 7/1/22-6/30/23 $15,500.00 Option Letter #2 2022*0289 Option Letter #2 $0.00 $17,000.00 $0.00 7/1/23-6/30/24 $17,000.00 Current Contract Maximum Cumulative Amount $45,950.00 1) OPTIONS A. Option to extend for an Extension Term B. Option to change quantity of goods under the Contract 2) REQUIRED PROVISIONS: A. In accordance with Exhibit A, Additional Provisions, Paragraph 10, of the Original Contract, as amended and referenced above, the State hereby exercises its option for an additional term, beginning July 1, 2023 and ending on the current contract expiration date shown above, at the rates stated in the Original Contract, as amended for the following reason: To continue to provide services as set forth in the Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes), which is a statewide, multi -agency effort to prevent child deaths. B. In accordance with Exhibit A, Additional Provisions, Paragraph 11 of the Original Contract, as amended and referenced above, the State hereby exercises its option to increase the quantity of services at the rates stated in the Original Contract as amended. Exhibit C, Budget, is deleted and replaced in its entirety with Exhibit C, Budget, attached to this Option Letter, for the following reason: To increase funding in support of the new Term . C. The Contract Maximum Amount table is deleted and replaced with the Current Contract Maximum Amount table shown above. Page I of Option Letter Contract Number: 2022*0289 Option Letter !!2 Ver. 27.01.20 DocuSign Envelope ID: 491A5F51-6211-440D-8451)5213FBDF02 3) OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller or July 1, 2023 , whichever is later. Page 2 of 3 Option Letter Contract Number: 2022,289 Option Letter N2 Ver, 27.01.20 DocuSign Envelope lD: 491A5F51-6211-440O-84s_ .,15213FBDF02 SIGNATURE PAGE STATE OF COLORADO Jared S. Polis, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director Uocalpned by: CS& norompomoo, By: Signature Lisa McGovern Name of Executive Director Delegate In accordance with §24-30-202 C.R.S., this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD -QoauSlyned by: jalA,lh,t,lltt. ScaIi ith \�areneg.esvc�aae By: Signature Jannette Scarpino Name of State Controller Delegate Procurement & Contracts Section Director ft chief Financial officer Title of Executive Director Delegate Date: 2023-05-08 Title of State Controller Delegate Option Effective Date: 2023-05-09 -- Signature Page End -- Page 3 of 3 Option Letter Contract Number: 2022'0289 Option Letter #2 Ver. 03,01,20 Docu Sign Envelope ID: 491ASF51-6211-440D-8459-335213FB Exhibit C Budget COLORADO Department of Public Health & tooirantnent PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2022*0289 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Email Melanie Cyphers, (970) 400-2423, mcyphers@weldgov.com Budget Period July 1, 2023 -June 30, 2024 Fiscal Contact Name, Title, Phone and Email Tanya Geiser, (970) 400-2122, tgeiser@weldgov.com Project Name I Child Fatality Prevention System Contract (CT or PO) Number CT FHLA 2022*0289 Budget Information Primary Activity / Deliverable Description of Activity Rate Quantity Total Amount Requested from CDPHE Quarter 1 Payment July 1 through September 30 $ 4,250.00 1.0 $ 4,250.00 Quarter 2 Payment October 1 through December 31 $ 4,250.00 1.0 $ 4,250.00 Quarter 3 Payment January 1 through March 31 $ 4,250.00 1.0 $ 4,250.00 Quarter 4 Payment April 1 through June 30 $ 4,250.00 1.0 $ 4,250.00 $ TOTAL. $ 17,000.00 Option Letter Contract Number, 2022*0289 Option Letter #2 Page 1 of 1 DocuSign Envelope ID: 53EAB8AA-5BD7-400c. _ .,E-A84B0BA2FA26 OPTION LETTER #: 1 State Agency: Colorado Department of Public Health and Environment VIP/CFPS 4300 Cherry Creek Drive South Denver, Colorado 80246 Original Contract Number: 2022*0289 Option Letter Contract Number: 2022*0289 Option Letter #1 Contractor: Board of County Commissioners of Weld County, (a political subdivision of the state of Colorado) 1150 "O" St, Greeley, CO 80631 for the use and benefit of the Weld County Department of Public Health and Environment 1555 North 17. Avenue Greeley, CO 80631 Contract Performance Beginning Date: July 1, 2021 Current Contract Expiration Date: June 30, 2023 CONTRACT MAXIMUM AMOUNT TABLE Document Type Contract Number Federal Funding State Funding Other Funding Term (dates) Total Original Contract 2022*0289 $0.00 $13,450.00 $0.00 7/1/21-6/30/22 $13,450.00 Amendment #1 2022*0289 Amendment #1 $0.00 $0.00 $0.00 10/29/21-6/30/22 $0.00 Option Letter #1 2022*0289 Option Letter #1 $0.00 $15,500.00 $0.00 7/1/22-6/30/23 $15,500.00 Current Contract Maximum Cumulative Amount $28,950.00 1) OPTIONS A. Option to extend for an Extension Term B. Option to change quantity of goods under the Contract 2) REQUIRED PROVISIONS: A. In accordance with Exhibit A, Additional Provisions, Paragraph 10, of the Original Contract, as amended and referenced above, the State hereby exercises its option for an additional term, beginning July 1, 2022 and ending on the current contract expiration date shown above, at the rates stated in the Original Contract, as amended for the following reason: To continue to provide services as set forth in the Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes), which is a statewide, multi -agency effort to prevent child deaths. B. In accordance with Exhibit A, Additional Provisions, Paragraph 11 of the Original Contract, as amended and referenced above, the State hereby exercises its option to increase the quantity of services at the rates stated in the Original Contract as amended. Exhibit C, Budget, is deleted and replaced in its entirety with Exhibit C, Budget, attached to this Option Letter, for the following reason: To increase funding in support of the new Term . C. The Contract Maximum Amount table is deleted and replaced with the Current Contract Maximum Amount table shown above. 3) OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller or July 1, 2022 , whichever is later. Page 1 of 2 Option Letter Contract Number: 2022.0259 Option Letter #1 Ver. 27.01.20 DocuSign Envelope ID: 53EAB8AA-5BD7-4050. _.iE-A84B08A2FA26 SIGNATURE PAGE STATE OF COLORADO Jared S. Polls, Governor Colorado Department of Public Health and Environment Jill Hunsaker Ryan, MPH, Executive Director LII.iS42E0F870AtA7NFC.: In accordance with §24-30-202 C.R.S., this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD . kir z,. ,...,,,A7.005 By: Signature Lisa McGovern By: Signature Justin Weigle Name of Executive Director Delegate Procurement & Contracts Section Director ft Name of State Controller Delegate Health Divisions Controller Title of Executive Director Delegate 2022-04-24 Date: Title of State Controller Delegate 2022-05-23 Option Effective Date: -- Signature Page End -- Page 2 of 2 Option Letter Contract Number: 2022*0289 Option Letter #1 Ver. 03,01.20 DocuSign Envelope ID. 53EAB8AA-58D7-40BC-6E5E-A848, A26 COLORADO 0npan nru of Pubtlo Health b klzvironment Exhibit C Budget PREVENTION SERVICES DIVISION- FIXED PRICE BUDGET WITH JUSTIFICATION FORM Original Contract Routing # 2022"0289 Contractor Name Weld County Department of Public Health and Environment Program Contact Name, Title, Phone and Email Melanie Cyphers, (970) 400-2423, mcyphers@weldgov.com Budget Period July 1, 2022 -June 30, 2023 Fiscal Contact Name, Title, Phone and Email Tanya Geiser, (970) 400-2122, tgeiser@weldgov.com Project Name Child Fatuity Prevention System Contract (CT or PO) Number CT FHLA 2022*0289 Budget Information Primary Activity / Deliverable Description of Activity Rate Quantity Total Amount Requested from CDPHE Quarter 1 Payment July 1 through September 30 $ 3,875.00 1.0 $ 3,875.00 Quarter 2 Payment October 1 through December 31 $ 3,875.00 1.0 $ 3,875.00 Quarter 3 Payment January 1 through March 31 $ 3,875.00 1.0 $ 3,875.00 Quarter 4 Payment April 1 through June 30 $ 3,875.00 1.0 $ 3,875.00 TOTAL $ is ao Option Letter Contract Number: 2022*0289 Option Letter #1 Page 1 of 1 Hello