HomeMy WebLinkAbout20252727.tiffMariah Higgins
From:
Sent:
To:
Cc:
Subject:
Attachments:
Follow Up Flag:
Flag Status:
Bill Fritz
Friday, September 26, 2025 7:36 AM
CTB
Jason Chessher; Shaun May
WIWO Option Letter #3 for Communication
3 2024-2833 OL3 Exh C - Budget.pdf; 3 Federal Provisions Information Sheet.docx.pdf; 1
2024-2833 OL3_CP.docx.pdf; 2 2024-2833 OL3_SP.docx.pdf
Follow up
Flagged
Good morning, I have attached the option letter for the WIWO (Wisewoman) grant for communication to the board.
Please let me know if you need anything else. Thanks Bill
COUNTY, CO
Bill Fritz
Finance Manager
Weld County Department of Public Health and Environment
Desk: 970-400-2122
1555 North 17th Ave., Greeley, CO 80631
0110 ® O
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.
CeMl.1ue Cot,onS
CC : 1 -IL, ACT(RW/CD)
(O/06/2S 1O%/25
2025-2727
N LOo58'
Docusign Envelope ID: B2A43FDA-7EE6-43A4-BF05-F5D8D6BF5880
STATE OF COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
OPTION LETTER #3
State Agency:
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
2024*2833
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:
2024*2833 Option Letter #3
1150 "O" Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Contract Performance Beginning Date:
January 1, 2024
Current Contract Expiration Date:
September 29, 2026
CONTRACT MAXIMUM AMOUNT TABLE
Document Type
Contract Number
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original
Contract
2024*2833
$9,665.00
$0.00
$0.00
01/01/2024 —
09/29/2024
$9,665.00
Option Letter #1
2024*2833
Option Letter #1
$6 501.00
$0.00
$0.00
09/30/2024 —
09/29/2025
$6 501.00
'
Option Letter #2
2024*2833
Option Letter #2
$5,408.00
$0.00
$0.00
05/30/2025 —
09/29/2025
$5,408.00
Option Letter #3
2024*2833
Option Letter #3
$7,500.00
$0.00
$0.00
09/30/2025 —
09/29/2026
$7,500.00
Current Contract Maximum Cumulative Amount
$29,074.00
1. OPTIONS:
A. Option to extend for an Extension Term
B. Option to change the quantity of Services under the Contract
2. REQUIRED PROVISIONS:
Option Letter Contract Number: 2024*2833 Option Letter #3
Page 1 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: B2A43FDA-7EE6-43A4-BF05-F5D8D6BF5880
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 September 30, 2025 and ending on the
current contract expiration date shown above, at the rates stated in the Original Task Order Contract,
as amended for the following reason: to extend the performance under this contract for another year.
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.
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 September 30,
2025, whichever is later.
Option Letter Contract Number: 2024*2833 Option Letter #3
Page 2 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: B2A43FDA-7EE6-43A4-BF05-F5D8D6BF5880
STATE OF COLORADO
Jared S. Polls, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
r-DocuSgned by:
a,SUL a1�t,viwBA.
.,--2C13912416524B1
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
e�dby:
e-DocuuSign�t
M1.W+.41 ...
`-73365F4A4A084RC
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
Date: 2025-09-12
Title of State Controller Delegate
Option Effective Date: 2025-09-25
Option Letter Contract Number: 2024*2833 Option Letter #3
Page 3 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: B2A43FDA-7EE6-43A4-BF05-F5D8D6BF5880
FOR SUBRECIPIENTS ONLY
This is a supporting document for Contract Number: 2024*2833 Option Letter #3
The updated information provided here does not modify the original contract or original task order in any way.
The information provided here informs the grantee of updated items that are required under 2 CFR 200.332.
Data Required by 2 CFR 200332 (All pass through entities must ensure that every subaward is clearly identified to
the subrecipient as a subaward and includes the following information at the time of the subaward. If any of these
data elements change, the changes are to be reflected in subsequent subaward modification. When some of this
information is not available, the pass -through entity must provide the best available information when some of the
information below is unavailable. A pass -through entity must provide the unavailable information when it is
obtained.):
A. subrecipient name (which must match the name associated with its unique entity identifier):
Shown in Contractor box on cover page of original contract and subsequent modifications.
B. Subrecipient's unique entity identifier: MKIOCT9U9MTV5
C. Federal Award Identification Number (FAIN): NU58DP007665
D. Federal Award Date (when Federal award was signed by authorized official of the Federal
awarding agency): 09/08/2025
E. Subaward Period of Performance Start and End Date: Start date shown on cover page of original
contract and end date shown on cover page of original contract, as updated by any subsequent
modifications.
F. Subaward Budget Period Start and End Date: Start date shown on cover page of original contract
and end date shown on cover page of original contract, as updated by any subsequent
modifications.
G. Amount of Federal Funds Obligated by this action by the pass -through entity to the subrecipient:
Shown on Budget Exhibit in column matching this contract modification.
H. Total Amount of Federal Funds Obligated to the subrecipient by the pass -through entity including
the current financial obligation: Shown on cover page of this contract modification and on Budget
Exhibit.
I. Total Amount of the Federal Award committed to the subrecipient by the pass -through entity:
Shown on cover page of this contract modification and on Budget Exhibit.
J. Federal award project description, as required to be responsive to the Federal Funding
Accountability and Transparency Act (FFATA): Colorado WISEWOMAN Program
K. Pass -through entity is shown on the cover page in the State Agency box. Name of Federal
awarding agency: Department of Health and Human Services, Centers for Disease Control and
Prevention Contact information for the awarding official of the Pass -through entity: Mr. Kurt
Williams, Authorized Organizational Representative; kurt.williams@state.co.us.
L. Assistance Listing number and Title; the pass -through entity must identify the dollar
amount made available under each Federal award and the Assistance Listing Number at
time of disbursement: 93.436 / WELL -INTEGRATED SCREENING AND EVALUATION
FOR WOMEN ACROSS THE NATION (WISEWOMAN)/ $1,218,319.00
M. Identification of whether the award is R&D: No
N. Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414:
Shown on Budget Exhibit as indicated by indirect rate and amount.
Ver 10/2024
Docusign Envelope ID: B2A43FDA-7EE6-43A48F05-F5D8D6BF5880
Exhibit C Budget
COLORADO
Department of Public
Health £t Environment
PREVENTION SERVICES DIVISION -12 MONTH BUDGET WITH JUSTIFICATION FORM
Original Contract Routing # 2024°2833
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact Name, Title,
Phone and Email
Sonya Oster
Business Operations Manager
970.400.2332
soster@weld.gov
Budget Period
9/30/2025-9/29/2026
Fiscaltontact Name, Title,
Phone and Email
Bill Fritz
Finance Manager
970.400.2122
bfritz@weld.gov
Project Name
WISEWOMAN Clinical and Community -Based
Services
Contract (CF or PO) Number
CT FHLA 2024'2833
Expenditure Categories
Personal Services
Salaried Employees
Position Title
Description of Work
Gross or
Annual Salary
Fringe
Percent of
Time on
Project
Total Amount
Requested from
CDPHE
SDOH Champion
Maintain a network of local social support
services. Continue our bidirectional referral
relationships with local organizations. Monitor
and optimize internal workflows for social needs
assessments and access to the network of
available resources.
72 800.00
27,569.36
1.00%
1,003.69
Program Coordinator
Program coordination to include data prep for
site visits, program meetings and reporting
requirements of the program, including network
resource usage. Help maintain and optimize
social needs processes & workflows.
52,000.00
19,692.40
3.00%
2,150.77
Total Personal Services (including fringe benefits)
- 3,154.46
Supplies & Operating Expenses
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Point of Care Supplies
Alc Cassettes (10 boxes @ $155/box)
155.00
10.00
1,550.00
Point of Care Supplies
Alc Controls ($62/each)
62.00
1.00
62.00
Point of Care Supplies
Lipid Cartridges ($140/each)
140.00
10.00
1,400.00
Point of Care Supplies
Lipid Controls ($16/each)
16.00
4.00
64.00
Point of Care Supplies
Optics Check Cartridge for Lipid PDC ($24/each)
24.00
1.00
24.00
Translation Services
Translation services ($10/hr)
10.00
1.00
10.00
Total Supplies & Operating
3,110.00
Travel
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Line not open
Total Travel
Contractual
Option Letter Contract Number: 2024*2833 Option Letter #3
Page 1 of 2
January 2018
Docusign Envelope ID: B2A43FDA-7EE6-43A4-BF05-F5D8D6BF5880
Exhibit C Budget
Subcontractor Name
Description of Item Rate
Quantity
Total Amount
Requested from
CDPHE
Line not open
Total Contractual
SUB -TOTAL OF DIRECT COSTS
6,264.46
Less: Expenses per OMB 2 CFR 200
Subcontractor in excess of $50,000
$-
Rent
$-
Equipment in excess of $10,000
$-
Other Unallowable expenses
$-
... Total Expenses per OMB 2 CFR 200
$.
Modified Total Direct Costs (MTDC)
$6,264.46
Indirect
Item
Description of Item Percentage
Total Amount
Requested from
CDPHE-Negotiated Indirect Cost Rate
Weld County's CDPHE-negotiated indirect cost rate for CY2025 is 19.74%
Modified total direct costs, consisting of all salaries and wages, fringe benefits,
materials and supplies.
19.74%
1,235.54
Total Indirect
1,235.54
TOTAL
7,500.00
Option Letter Contract Number: 2024*2833 Option Letter.
Page 2 of 2 January 2018
Docusign Envelope ID: 9AEC6384-9C37-4E18-8A45-6D8C16E32766
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:
2024*2833
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:
2024*2833 Option Letter #2
1150 "O" Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Contract Performance Beginning Date:
January 1, 2024
Current Contract Expiration Date:
September 29, 2025
CONTRACT MAXIMUM AMOUNT TABLE
Document Type
Contract Number
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original
Contract
2024*2833
$9,665.00
$0.00
$0.00
01/01/2024 —
09/29/2024
$9,665.00
Option Letter #1
2024*2833
Option Letter #1
$6,501.00
$0.00
$0.00
09/30/2024 —
09/29/2025
$6,501.00
Option Letter #2
2024*283
Option Letter #2
$5,408.00
$0.00
$0.00
05/15/2025 —
09/29/2025
$5,408.00
Current Contract Maximum Cumulative Amount
$21,574.00
1. OPTIONS:
A. Option to change the quantity of Services under the Contract
2. REQUIRED PROVISIONS:
A. In accordance with Section 5Bv of the Original Main Task Order Contract referenced above, the State
hereby exercises its option to increase the quantity of the services at the rates stated in the Original
Task Order Contract, as amended. Exhibit C - Budget is deleted and replaced in its entirety with
Exhibit C - Budget attached to this Option Letter, for the following reason: to add funds supporting
the current term.
Option Letter Contract Number: 2024*2833 Option Letter #2
Page 1 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: 9AEC6384-9C37-4E18-8A45-6D8C16E32766
B. The Contract Maximum Amount table on the Contract's Cover Page is hereby deleted and replaced
with the Current Contract Maximum Amount table shown above.
3. OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or May 15, 2025,
whichever is later.
Option Letter Contract Number: 2024*2833 Option Letter #2
Page 2 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: 9AEC6384-9C37-4E18-8A45-6D8C16E32766
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
DocuSigned by: . ' w
2C73972416524R7
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
DocuuSi
ignedby:C73385F4A4A9A4RC
Cletoxtilat...4
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
2025-05-30
Date:
Title of State Controller Delegate
2025-05-30
Option Effective Date:
Option Letter Contract Number: 2024*2833 Option Letter #2
Page 3 of 3 Version OSCA12.24/CDPHE A1.25
Docusign Envelope ID: 9AEC6384-9O37-4E18-8A45-6D8C16E32766
Exhibit C Budget
se.
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
Original Contract Routing # 2024*2833
Contractor Name
Weld County Department of Public Health and
Environment
Budget Period
9/30/2024 - 9/29/2025
WISEWOMAN Clinical and Community -Based
Project Name
Services
Version 6.2024
Program Contact Name, Title, Phone and
Email
Sonya Oster
Business Operations Manager
970.400.2332
soster@weld.gov
Bill Fritz
Fiscal Contact Name, Title, Phone and Email
Finance Manager
970.400.2122
bfritz@weld.gov
Contract/Encumbrance Number
CT FHLA 2024*2833
Expenditure Categories
Budget Totals
Personal Services
Salaried Employees
Original ,
Budget
Modification to
Budget in
Amendment/
option Letter
Total Amount
Requested
from CDPHE
Position Title
Description of Work and Justification for Revision
$0.00
Personal Services
Hourly Employees
Original
Budget
Modification to
Budget in
Amendment/
option Letter
Total Amount
Requested
from CDPHE
Position Title
Description of Work and Justification for Revision
5000 Champion
Maintain a network of local social support services. Continue our bidirectional referral
relationships with local organizations. Monitor and optimize internal workflows for social
needs assessments and access to the network of available resources.
$727.36
$0.00
$727.36
Program Coordinator
Program coordination to include data prep for site visits, program meetings and reporting
requirements of the program, including network resource usage. Help maintain and optimize
social needs processes 8, workflows.
$1,143.12
$0.00
$1,143.12
$0.00
Total Personal Services
(including fringe benefits)
$1,870.48
$0.00
$1,870.48
Supplies & Operating Expenses
Original
Budget
Modification to
Budget in
Amendment/
Option Letter
Total Amount
Requested
from CDPHE
Item
Description of Item and Justification for Revision
Point of Care Supplies
Alc Cassettes -10 boxes ($156.00/box)
CHANGE: A1c Cassettes - (10 @$200.00/box)
$1,560.00
$2,000.00
$3,560.00
Point of Care Supplies
A1c Controls - ($61/ea.)
CHANGE: Alc Controls - (3 @$75/ea.)
$183.00
$225.00
$408.00
Point of Care Supplies
Lipid Cartridges - ($141/box)
CHANGE: Lipid Cartridges - (12 @$165/box)
$1,692.00
$1,980.00
$3,672.00
Point of Care Supplies
Lipid Controls - ($16.00/ea)
CHANGE: Lipid Controls - (2 @$20.00/ea)
$32.00
$40.00
$72.00
Point of Care Supplies
Optics Check Cartridge for Lipid POC - ($24/u)
CHANGE: Optics Check Cartridge for Lipid POC - (2 @$30/ea)
$4840
$6040
$108.00
Option Letter Contract Number: 2024"2833 Option Letter #2
Page 1 of 2
Revised -November 2013
Docusign Envelope ID: 9AEC6384-9C37-4E18-8.045-6DBC16E32766
Exhibit C Budget
Point of Care Supplies
Lancets - ($16.00/box)
$16.00
$0.00
$16.00
Point of Care Supplies
Alcohol Wipes - ($3.00/box)
$6.00
$0.00
$6.00
Point of Care Supplies
Gloves - ($7/box)
$7.00
$0.00
$7.00
Translation Services
Translation of materials as needed for culturally and linguistically appropriately relevant small
media and education materials to be distributed for educational benefits for the community.
$50.00
$0.00
$50.00
Participant support items
CHANGE: Additional funding to help reduce barriers WISEW0MAN clients face in reaching
their health goals and participating in WISEW0MAN health coaching, including items to
support Mental Wellbeing and Stress Reduction.
Aromatherapy Shower Steamers (2 Packs of 40 @ $38.00 each = $76), Spanish/English
Affirmation Cards (200 @ $.25 each = $50), resistance bands (4 sets @$8.09/ea = $32.36),
yoga mats (2 @$13.82 = $27.64)
$0.00
$186.00
$186.00
Participant support items
Healthy Snacks for Fasting patients - Fruit & Nut Bags (100 @ $1.00 each)
$0.00
$100.00
$100.00
Total Supplies
& Operating Expenses
$3,594.00
$4,591.00
$8,185.00
Travel
Original
Budget
Modification to
Budget in
Amendment/
Option Letter
Total Amount
Requested
from CDPHE
Item
Description of Item and Justification for Revision
$0.00
$0.00
Total Travel
$0.00
$0.00
$0.00
Contractual (payments to third parties or entities)
Original
Budget
Modification to
Budget in
Amendment/
Option Letter
Total Amount
Requestedm
froCDPHE
Subcontractor Entity Name
Description of Item and Justification for Revision
$0.00
$0.00
Total Contractual
$0.00
$0.00
$0.00
SUB -TOTAL BEFORE INDIRECT
$5,464.48
$4,591.00
$10,055.48
Indirect
Original
Budget
Modification to
Budget in
Amendment/
Option Letter
Total Amount
Requested
from CDPHE
Item
Description of Item
CDPHE Negotiated Indirect Cost
Rate
Weld County's CDPHE-negotiated indirect cost rate for CY2024 is 18.96% of Modified total
direct costs, consisting of all salaries and wages, fringe benefits, materials and supplies,
services, travel, and subgrants and subcontracts up to the first $25,000 of each subgrant or
subcontract (regardless of the period covered by the subgrant or subcontract). Equipment,
capital expenditures, charges for patient care, tuition remission, rental costs, scholarships,
and fellowships, participant support costs and the portion of each subgrant and subcontract
in excess of $25,000 shall be excluded from modified total direct costs.
$1,036.52
$817.00
$1,853.52
Total indirect
$1,036.52
$817.00
$1,853.52
TOTAL
$6,507, 00
$5;408,00 .
$11,909.00
Option Letter Contract Number: 202,2833 Option Letter #2 Page 2 of 2
Revised -November 2013
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
STATE OF COLORADO GRANT AGREEMENT
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
OPTION LETTER #1
State Agency:
Colorado Department Of Public Health and Environment
4300 Cherry Creek Dr S
Denver, CO 80246
Original Agreement Number:
2024*2833
Option Letter Agreement Number:
2024*2833 Option Letter #1
Grantee:
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
1150 "O" Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Agreement Performance Beginning Date:
January 1, 2024
Current Agreement Expiration Date:
September 29, 2025
Agreement Authority:
FAIN & Short Description: NU58DP007665
Colorado WISEWOMAN Program
Federal Award Date: 06/27/2024
Subaward Period of Performance: 09/30/2023-09/29/2028
Subaward Budget Period: 09/30/2024-09/29/2025
Total Federal Funds Obligated: $1,993,333.00
CFDA # & Title: 93.436
WELL -INTEGRATED SCREENING AND EVALUATION FOR WOMEN
ACROSS THE NATION
(WISEWOMAN)
Solicitation Information: RFA 41969
Fund Expenditure End Date:
September 29, 2025
Document
Type
Agreement
Number
Federal
Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original
Agreement
2024*2833
$9,665.00
$0.00
$0.00
01/01/2024-
09/29/2024
$9,665.00
Option Letter
#1
2024*2833
Option
Letter #1
$6,501.00
$0.00
$0.00
09/30/2024-
09/29/2025
$6,501.00
Current Agreement Maximum
Cumulative Amount
$16,166.00
1) OPTIONS
A. Option to extend for an Extension Term.
B. Option to change quantity of services under the Agreement.
2) REQUIRED PROVISIONS:
A. In accordance with Section 2C of the Original Main Task Order Contract referenced above,
Page 1 of 3
Grant Agreement Option Letter Number: 2024*2833 Option Letter #1
Ver.A 27.01.20
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077F814C3A
the State hereby exercises its option for an additional term, beginning September 30, 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 performance under
this Contract for another term.
B. In accordance with Section 5Bv of the Original Main Task Order Contract referenced above,
the State hereby exercises its option to increase the quantity of the services at the rates stated
in the Original Task Order Contract, as amended. Exhibit C, Budget, is deleted and replaced in
its entirety with Exhibit C, Budget, attached to this Option Letter, for the following reason: to
add funds supporting the renewal term.
C. Exhibit D - Federal Provisions, is deleted and replaced in its entirety with Exhibit D - Federal
Provisions, attached to this Option Letter, for the following reason: to reflect changes to the
federal award identification information.
D. The Agreement Maximum Amount table is deleted and replaced with the Current Agreement
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 September
30, 2024, whichever is later.
Page 2 of 3
Grant Agreement Option Letter Number: 2024*2833 Option Letter #1 Ver.A 27.01.20
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
SIGNATURE PAGE
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
[DocuSigned by:
� w
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:
Li,,./..."
73365F4A4V84.
2.3912410524B1
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
2024-07-29
Date:
Title of State Controller Delegate
2024-07-29
Option Effective Date:
-- Signature Page End --
Page 3 of 3
Grant Agreement Option Letter Number: 2024.2833 Option Letter #1 Ver.A 27.01.20
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
Exhibit D
Federal Provisions — Colorado WISEWOMAN Program
For the purposes of this Exhibit only, Contractor is also identified as "Subrecipient." This Contract has
been funded, in whole or in part, with an award of Federal funds. In the event of a conflict between the
provisions of these Supplemental Provisions for Federal Awards, the Special Provisions, the Contract or
any attachments or exhibits incorporated into and made a part of the Contract, the Supplemental
Provisions for Federal Awards shall control. In the event of a conflict between the Supplemental
Provisions for Federal Awards and the FFATA Supplemental Provisions (if any), the FFATA
Supplemental Provisions shall control.
1) Federal Award Identification.
a. Subrecipient: Weld County Department of Public Health and Environment
b. Subrecipient Unique Entity Identification Number:
• SAM Unique Entity ID (UEI): MKKXT9U9MTV5
c. The Federal Award Identification Number (FAIN) is NU58DP007665
d. The Federal award date is 06/27/2024.
e. The subaward period of performance start date is 09/30/2023 and end date is 09/29/2028.
f. Federal Funds:
Federal Budget Period
Total Amount of Federal
Funds Awarded
Amount of Federal Funds
Obligated to CDPHE
09/30/2024 - 09/29/2025
$1,993,333.00
$1,143,333.00
g. Federal award title of project or program: Colorado WISEWOMAN Program.
h. The name of the Federal awarding agency is: Department of Health and Human Services,
Centers for Disease Control and Prevention and the contact information for the awarding
official is Letia Baseman (lgb8@cdc.gov); the name of the pass -through entity is the State of
Colorado, Department of Public Health and Environment (CDPHE), and the contact
information for the CDPHE official is Nicole Brasseur (nicole.brasseur@state.co.us).
i. The Catalog of Federal Domestic Assistance (CFDA) number is 93.436 and the grant name is
WELL -INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE
NATION (WISEWOMAN).
j. This award is not for research & development.
k. Subrecipient is required to provide matching funds. In the event the Subrecipient is required to
provide matching funds, Section 8 of this Attachment applies.
1. The indirect cost rate for the Federal award (including if the de minimis rate is charged per 2
CFR §200.414 Indirect (F&A) costs) is pre -determined based upon the State of Colorado and
CDPHE cost allocation plan.
2) Subrecipient shall at all times during the term of this contract strictly adhere to the requirements under
the Federal Award listed above, and all applicable federal laws, Executive Orders, and implementing
regulations as they currently exist and may hereafter be amended.
Page l of 4
Grant Agreement Option Letter Number: 2024'2833 Option Letter # 1 Ver. 25.02.20
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
Exhibit D
3) Any additional requirements that CDPHE imposes on Subrecipient in order for CDPHE to meet its
own responsibility to the Federal awarding agency, including identification of any required fmancial and
performance reports, are stated in the Exhibits.
4) Subrecipient's approved indirect cost rate is as stated in the Exhibits.
5) Subrecipient must permit CDPHE and auditors to have access to Subrecipient's records and fmancial
statements as necessary for-CDPHE to meet the requirements of 2 CFR §200.331 Requirements for pass -
through entities, §§ 200.300 Statutory and National Policy Requirements through §200.309 Period of
performance, and Subpart F —Audit Requirements of this Part.
6) The appropriate terms and conditions concerning closeout of the subaward are listed in Section 16 of
this Attachment.
7) Performance and Final Status. Subrecipient shall submit all financial, performance, and other
reports to CDPHE no later than 45 calendar days after the period of performance end date or sooner
termination of this Contract containing an evaluation and review of Subrecipient's performance and the
final status of Subrecipient's obligations hereunder.
8) Matching Funds. Subrecipient shall provide matching funds as stated in the Exhibits. Subrecipient
shall have raised the full amount of matching funds prior to the Effective Date and shall report to CDPHE
regarding the status of such funds upon request. Subrecipient's obligation to pay all or any part of any
matching funds, whether direct or contingent, only extends to funds duly and lawfully appropriated for the
purposes of this Contract by the authorized representatives of the Subrecipient and paid into the
Subrecipient's treasury or bank account. Subrecipient represents to CDPHE that the amount designated as
matching funds has been legally appropriated for the purposes of this Contract by its authorized
representatives and paid into its treasury or bank account. Subrecipient does not by this Contract
irrevocably pledge present cash reserves for payments in future fiscal years, and this Contract is not
intended to create a multiple -fiscal year debt of the Subrecipient. Subrecipient shall not pay or be liable for
any claimed interest, late charges, fees, taxes or penalties of any nature, except as required by
Subrecipient's laws or policies.
9) Record Retention Period. The record retention period previously stated in this Contract is replaced
with the record retention period prescribed in 2 CFR §200.333.
10) Single Audit Requirements. If Subrecipient expends $750,000 or more in Federal Awards during
Subrecipient's fiscal year, Subrecipient shall procure or arrange for a single or program -specific audit
conducted for that year in accordance with the provisions of Subpart F -Audit Requirements of the Uniform
Guidance, issued pursuant to the Single Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR
§200.501.
11) Contract Provisions. Subrecipient shall comply with and shall include all of the following applicable
provisions in all subcontracts entered into by it pursuant to this Contract:
a. Office of Management and Budget Circulars and The Common Rule for Uniform
Administrative Requirements for Grants and Cooperative Agreements to State and Local
Governments, as applicable;
b. when required by Federal program legislation, the "Davis -Bacon Act", as amended (40
U.S.C. 3141-3148) as supplemented by Department of Labor Regulations (29 CFR Part 5,
"Labor Standards Provisions Applicable to Contracts Covering Federally Financed and
Assisted Construction");
c. when required by Federal program legislation, the Copeland "Anti -Kickback" Act (40 U.S.C.
3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors
and Subcontractors on Public Building of Public Work Financed in Whole or in Part by Loans
or Grants from the United States").
Page 2 of 4
Grant Agreement Option Letter Number: 2024*2833 Option Letter # 1 Ver. 25.02.20
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
Exhibit D
d. 42 U.S.C. 6101 et sue, 42 U.S.C. 2000d, 29 U.S.C. 794 (regarding discrimination);
e. the "Americans with Disabilities Act" (Public Law 101-336; 42 U.S.C. 12101, 12102, 12111
-12117,12131-12134,12141-12150,12161-12165,12181-12189,12201-12213 and 47
U.S.C. 225 and 47 U.S.C. 611);
f. when applicable, the Contractor shall comply with the provisions of the "Uniform
Administrative Requirements for Grants and Cooperative Agreements to State and Local
Governments" (Common Rule);
g. The Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282), as
amended by §6062 of Public Law 110-252, including without limitation all data reporting
requirements required there under. This Act is also referred to as FFATA.
h. Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act
of 1964, as amended.
i. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the defmition of
"federally assisted construction contract" in 41 CFR Part 60-1.3 comply with the equal
opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order
11246, "Equal Employment Opportunity: (30 FR 12319, 12935, 3 CFR Part, 1964-1965
Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246
Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR part
60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity,
Department of Labor.
j. where applicable, Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708).
k. if the Federal award meets the defmition of "funding agreement" under 37 CFR § 401.2 (a)
and the recipient or subrecipient wishes to enter into an agreement with a small business firm
or nonprofit organization, comply with the requirements of 37 CFR Part 401, "Rights to
Inventions Made by Nonprofit Organizations and Small Business Firms Under Government
Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by
the awarding agency.
I. the Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33
U.S.C. 1251-1387), as amended.
m. if applicable, comply with the mandatory standards and policies on energy efficiency
contained within the State of Colorado's energy conservation plan issued in compliance with
the Energy Policy and Conservation Ad, 42 U.S.C. 6201.
n. the Contractor and all principals are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from covered transactions by any
federal department or agency; the Contractor and all principals shall comply with all
applicable regulations pursuant to Executive Order 12549 (3 CFR Part 1986 Comp., p. 189)
and Executive Order 12689 (3 CFR Part 1989 Comp., p. 235), Debarment and Suspension;
and,
o. the Contractor shall comply where applicable, the Byrd Anti -Lobbying Amendment (31
U.S.C. 1352).
12) Compliance. Subrecipient shall comply with all applicable provisions of The Office of Management
and Budget Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards (Uniform Guidance), including but not limited to these Supplemental Provisions for Federal
Awards. Any revisions to such provisions automatically shall become a part of these Supplemental
Provisions, without the necessity of either party executing any further instrument. CDPHE may provide
Page 3 of 4
Grant Agreement Option Letter Number: 2024*2833 Option Letter # 1 Ver. 25.02.20
Docusign Envelope ID: 9F6012F1-5968-4O65-9350-05077FB14C3A
Exhibit D
written notification to Subrecipient of such revisions, but such notice shall not be a condition precedent to
the effectiveness of such revisions.
13) Procurement Procedures. Subrecipient shall use its own documented procurement procedures which
reflect applicable State, local, and Tribal laws and regulations, provided that the procurements conform to
applicable Federal law and the standards identified in the Uniform Guidance, including without limitation,
§§200.318 through 200.326 thereof.
14) Certifications. Unless prohibited by Federal statutes or regulations, CDPHE may require
Subrecipient to submit certifications and representations required by Federal statutes or regulations on an
annual basis (2 CFR §200.208). Submission may be required more frequently if Subrecipient fails to meet
a requirement of the Federal award. Subrecipient shall certify in writing to CDPHE at the end of the
Contract that the project or activity was completed or the level of effort was expended. 2 CFR
§200.201(b)(3). If the required level of activity or effort was not carried out, the amount of the Contract
must be adjusted.
15) Event of Default. Failure to comply with the Uniform Guidance or these Supplemental Provisions for
Federal Awards shall constitute an event of default under the Contract pursuant to 2 CFR §200.339 and
CDPHE may terminate the Contract in accordance with the provisions in the Contract.
16) Close- Out. Subrecipient shall close out this Contract within 45 days after the End Date. Contract
close out entails submission to CDPHE by Subrecipient of all documentation defined as a deliverable in
this Contract, and Subrecipient's fmal reimbursement request. If the project has not been closed by the
Federal awarding agency within 1 year and 45 days after the End Date due to Subrecipient's failure to
submit required documentation that CDPHE has requested from Subrecipient, then Subrecipient may be
prohibited from applying for new Federal awards through the State until such documentation has been
submitted and accepted.
17) Erroneous Payments. The closeout of a Federal award does not affect the right of the Federal
awarding agency or CDPHE to disallow costs and recover funds on the basis of a later audit or other
review. Any cost disallowance recovery is to be made within the record retention period.
EXHIBIT END
Page 4 of 4
Grant Agreement Option Letter Number: 2024*2833 Option Letter #1 Ver. 25.02.20
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
Exhibit C Budget
COLORADO
Department of Public
Health £t Environment
Version 6.2023
PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM
Original Contract Routing # 2024*2833
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact
Name, Title, Phone
and Email
Sonya Oster
Business Operations Manager
970.400.2332
soster@weld.gov
Budget Period
9/30/2024 - 9/29/2025
Fiscal Contact Name,
Title, Phone and
Email
Bill Fritz
Finance Manager
970.400.2122
bfritz@weld.gov
Project Name
WISEWOMAN Clinical and Community -Based
Services
Contract (CT or PO)
Number
CT FHLA 2024*2833
Expenditure Categories
Personal Services
Salaried Employees
Position Title
Description of Work
Gross or
Annual
Salary
Fringe
35�
Percent of
Time on
Project
Total Amount
Requested from CDPHE
None
$
Personal Services
Hourly Employees
Position Title
Description of Work
Hourly
Wage
Hourly
Fringe
Total # of
Hours on
Project
Total Amount
Requested from CDPHE
SDOH Champion
Maintain a network of local social support
services. Continue our bidirectional referral
relationships with local organizations. Monitor
and optimize internal workflows for social needs
assessments and access to the network of
available resources.
$ 33.67
$ 11.79
16.0
$ 727.36
Program Coordinator
Program coordination to include data prep for
site visits, program meetings and reporting
requirements of the program, including network
resource usage. Help maintain and optimize
social needs processes & workflows.
$ 25.66
$ 8.98
33.0
$ 1,143.12
Total Personal Services (including fringe benefits)
$ 1,870,48;.
Grant Agreement Option Letter Number: 2024*2833 Option Letter #1
Page 1 of 3
January 2018
Docusign Envelope ID: 9F6012F1-5968-4D65-9350-05077FB14C3A
Exhibit C Budget
Supplies & Operating Expenses
Item
Description of Item
Rate
Quantity
Total Amount
Requested from CDPHE
Point of Care Supplies
A1c Cassettes -10 boxes ($156.00/box)
$ 156.00
10.00
$ 1,560.00
Point of Care Supplies
A1c Controls - ($61/ea.)
$' 61.00
3.00
$ 183.00
Point of Care Supplies
Lipid Cartridges - ($141/box)
$ 141.00
12.00
$ 1,692.00
Point of Care Supplies
Lipid Controls - ($16.00/ea)
$ 16.00
2.00
$ 32.00
Point of Care Supplies
Optics Check Cartridge for Lipid POC - ($24/ea)
$ 24.00
2.00
$ 48.00
Point of Care Supplies
Lancets - ($16.00/box)
$ 16.00
1.00
$ 16.00
Point of Care Supplies
Alcohol Wipes - ($3.00/box)
$ 3.00
2.00
$ 6.00
Point of Care Supplies
Gloves - ($7/box)
$ 7.00
1.00
$ 7.00
Translation Services
Translation of materials as needed for culturally and
linguistically appropriately relevant small media and
education materials to be distributed for educational
benefits for the community.0
$ 50.00
1.00
$ 50.00
Total Supplies & Operating
$ 3,594.00
Travel
Item
Description of Item
Rate
Quantity
Total Amount
Requested from CDPHE
None
$
Total Travel
$
Contractual
Subcontractor Name
Description of Item
Rate
Quantity
Total Amount
Requested from CDPHE
None
$
Total Contractual
$
SUB -TOTAL OF DIRECT COSTS
$ 5,464.48
Indirect
Item
Description of Item
Total Amount
Requested from CDPHE
Grant Agreement Option Letter Number: 2024*2833 Option Letter #1
Page 2 of 3
January 2018
Docusign Envelope ID: 9F6012F1-5968-4O65-9350-05077F814C3A
Exhibit C Budget
CDPHE-Negotiated
Indirect Cost Rate
Weld County's CDPHE-negotiated indirect cost rate for CY2024 is 18.96% of Modified
total direct costs, consisting of all salaries and wages, fringe benefits, materials and
supplies, services, travel, and subgrants and subcontracts up to the first $25,000 of each
subgrant or subcontract (regardless of the period covered by the subgrant or
subcontract). Equipment, capital expenditures, charges for patient care, tuition
remission, rental costs, scholarships, and fellowships, participant support costs and the
portion of each subgrant and subcontract in excess of $25,000 shall be excluded from
modified total direct costs.0
$1,036.52
Total Indirect
$ 1,036.52
TOTAL
$ 6,501.00
Grant Agreement Option Letter Number: 2024*2833 Option Letter #1
Page 3 of 3 January 2018
Hello