HomeMy WebLinkAbout20251510.tiffMariah Higgins
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Bill Fritz
Thursday, May 29, 2025 7:56 AM
CTB
Jason Chessher; Shaun May
CDPHE Main Task Order FY25-26
OL #2 Main Task Order fy25-26.pdf
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Please find the Main Task Order Option Letter #2 for the 25-26 year. This allows us to continue to distribute
Fentanyl Test Strips. This is for communication only no signature is required.
COUNTY,
Bill Fritz
Finance Manager
Department of Public Health and Environment
Desk: 970-400-2122
1555 North 17th Ave., Greeley, CO 80631
O G 00
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O 6 /oat /25
2025-1510
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Docusign Envelope ID: 38DC50A1-6211-4670-A235-BC04A267AD2E
STATE OF COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
OPTION LETTER #2
State Agency:
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
2023-14 WELD
Main Task Order Contract Number:
23 FAA 00051
Contractor:
Option Letter Contract Number:
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
2023-14 WELD Option Letter #2
Contract Performance Beginning Date:
Current Contract Expiration Date:
April 27, 2023
June 30, 2026
Document
Type
Contract Number
Federal
Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original
Contract
2023-14 WELD
$0.00
$0.00
$0.00
4/27/2023-
6/30/2024
$0.00
Option
Letter #1
2023-14 WELD
Option Letter #1
$0.00
$0.00
$0.00
7/1/2024-
6/30/2025
$0.00
Option
Letter #2
2023-14 WELD
Option Letter #2
$0.00
$0.00
$0.00
7/1/2025-
6/30/2026
$0.00
Current Contract Maximum
Cumulative Amount
$0.00
1. OPTIONS:
A. Option to extend for an Extension Term
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 1, 2025 and ending on the current
contract expiration date shown above, at the rates stated in the Original Task Order Contract, as
amended for the following reason: to allow the continuation of the Fentanyl Test Strip Program
for an additional term.
B. The Contract Maximum Amount table on the Contract's Cover Page is hereby deleted and replaced
with the Current Contract Maximum Amount table shown above.
3. OPTION EFFECTIVE DATE:
Agreement: 2023-14 WELD Option Letter #2 Page 1 of 2 Version OSCA12.24/CDPHE Al2.24
Docusign Envelope ID: 38DC50M-6211-4670-A235-BC04A267AD2E
A. The effective date of this Option Letter is upon approval of the State Controller or July 1, 2025,
whichever is later.
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
„.--DoeuSigned by:
OALLS(44 Atilt/60W
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
DoeuSigned by:
EK...4 W,.u...a
.-2c,3s,2a,sb24s,._ By: Signature
Chelsea Gilbertson
733ssFanaaaeaec... By. Signature
Kurt williams
Name of Executive Director Delegate
Procurement & Contracts Section
Name of State Controller Delegate
Controller
Title of Executive Director Delegate
Date:2025-05-09
Title of State Controller Delegate
Option Effective Date:2025-05-28
Agreement: 2023-14 WELD Option Letter #2 Page 2 of 2 Version OSCA12.24/CDPHE Al2.24
Docusign Envelope ID: 38DC50A1-6211-4670-A235-BC04A267AD2E
CONTRACT MODIFICATION SUBMITTAL CHECKLIST
Contractor/Subrecipient Name Board of County Commissioners of Weld County
Original Contractor/Subrecipient Name if Assigned: Enter Contractor/Subrecipient Name (previous)
❑ All Contractor name occurrences and Secretary of State Status Summary Page match exactly
Modification Routing ft_ 2023-14 WELD Option Letter#2
CORE#
Ori inal Routing # 2023-14 WELD
or NO ENCUMBRANCE
Modification Term (START and END Date) 7/1/2025-6/30/2026
SOW Pre -Approval or Regents/DDPHE Pre -Review - OnBase Approval # Enter # (if a
Submitter Name/Division Shruti Pandev
SOW Delegate Name Chad Jones
le)
Purpose(s) of Modification (Select all that apply)
❑ Scope of Work ❑ Budget ® Renewal CO No Cost ❑ Assignment ❑ Other If 'Other' Describe
t
i>ikup Docamx
t
`TM
b
btlp.docrments (as regBire
Contract Modification Quality Assurance Checklist
❑
❑ ❑
Contract Modification Submittal Checklist
❑
® ❑
If Subrecipient, Pre -Award Financial Risk Assessment # (See Internal Audit Site) Enter #
❑
❑
(Renewal required each year)
Personal Services Certification Form or Internal HR Waiver: (See CDPHE Human Resources Site for
❑
❑
Information on Modifications)
If Internal HR Waiver: Enter Category or If Waived Service: Enter Category
Secretary of State Status Summary Page (Amendment or Option Letter for a new term)
(Must state the entity is in 'good standing')
(If Assignment, SOS for Assignee only; NOT required for Interagency Agreement, Intergovernmental
Contract)
❑
❑
❑
If 'Doing Business As' (dba), Secretary of State Status Summary Page for dba
❑
❑
■
❑
❑
❑
❑
Signature Authority Letter or Corporate Documentation (If contract signed by other than apparent
authority) (See OSC Policy Signature Authority Delegation)
❑
SAM Exclusion Summary Page (Record verified and no exclusions/restrictions) (See SAM Verification
❑
Guidance
(If Assignment, SAM for Assignee only; NOT required for Interagency Agreement Contract or LPHA)
If Federal funds AND Subrecipient: Contract Federal Provisions Information Sheet.
❑
❑
❑
Modification Submittal Checklist
Version Al2.10.24
Docusign Envelope ID: 38DC50A1-B211-4670-A235-BC04A267AD2E
Contract Modification and Exhibits (as shown on cover page of modification being submitted)
1. Record Type — Record type chosen is 'Modification'.
(X) _
Completed
❑
2. Linked Record — Record is linked to the Master Record ONLY.
❑
3. Record Title — Title follows the naming convention for a Modification to a Master Record.
❑
4. Data Field: Vendor Name — Has been selected in the 'Contractor/Vendor' field.
❑
5. Data Fields: If this Modification is to renew or extend a contract, has the contractor's work to date been
certified as complying with the terms of the contract AND the Master CMS contract record updated?
Choose 'Yes' when renewing or extending the expiration date and enter 'Yes' in the corresponding field in
the Master Record. If the Modification is not to renew or extend, choose 'N/A' and do not make any
changes in the corresponding field in the Master Record.
❑
6. Data Field: Certification — If applicable, enter date of MOST RECENT annual certification of contractor
work — If contract has been renewed or extended, enter expiration date of the contract. We are using the
expiration date of the contract to represent the last contractor performance evaluation of the contract
period (quarterly or 3x per year). If the Modification is not to renew or extend, leave blank.
If the corresponding field in the Master Record is set to 'Yes' as a result of a previous renewal/extension, do
not change it.
❑
7. Data Fields: All other relevant data fields are completed per CDPHE protocol.
❑
8. Update Master Record — Cumulative Dollar Amount, Latest Performance End Date, and Recertification data
fields have been updated as applicable.
❑
Click here to enter text
Modification Submittal Checklist Version Al2.10.24
DocuSign Envelope ID: 88281F65-5079-412C-A5DD-FABC2253CDAD
OPTION LETTER #1
State Agency:
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
2023-14 WELD
Option Letter Contract Number:
2023-14 WELD Option Letter#1
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:
April 27, 2023
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
2023-14 WELD
$0.00
$0.00
$0.00
4/27/2023-
6/30/2024
$0.00
Option Letter
#1
2023-14 WELD
Option Letter # 1
$0.00
$0.00
$0.00
7/1/2024-
6/30/2025
$0.00
Current Contract Maximum
Cumulative Amount
$0.00
1) OPTIONS
A. Option to extend for an Extension Term
2) REQUIRED PROVISIONS:
A. In accordance with Section 2C 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 extend the contract term for an
additional year.
B. 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 1 of 2
Optics Letter Contract Number: 2023-14 WELD option letter* 1 Ver. 27.01.20
DocuSign Envelope ID'. 88281F65-5079-412C-A5DD-FABC2253CDAD
SIGNATURE PAGE
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
p-DocuSgned by:
' / t - .,,(, `
�S� (�il.:guis u,
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
�D,oeu1S.igneed by:
C. k' seta
\-X1391241652461...
,,,y: signature
Chelsea Gilbertson
BCAU4814546748A... ty Signature
y g
3annette Scarpino
Name of Executive Director Delegate
Director of Procurement and Contracts
Name of State Controller Delegate
Chief Financial Officer
Title of Executive Director Delegate
2024-04-23
Date:
Title of State Controller Delegate
2024-04-23
Option Effective Date:
-- Signature Page End --
Page 2 of 2
Option Letter Contract Number: 2023-14 WELD option letter# 1 Ver. 27.01.20
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