HomeMy WebLinkAbout20233783.tiff DO:PARTi\IP.N"1'OIL'PUBLIC I-IE_1L,TE1.1N1
I,:N0IR<)001CMT
CONTRA CT .19''1,45.4
ROUTING NO,
APPROVED TASK ORDER CONTRACT-WAIVER#154
This Cask order contract is issued pit"; to master contract made on 11/23/21)10,.,.touting uutnber 18 FAA 0205,
STATE: CONTRACTOR;
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County
Department of Public Health and Environment 050"0"St.,Greeley,CO 8063 l for the use and benefit of the
Prevention Services Division Weld County Department of Public Health and Envirolunent
Health Promotion&Chronic Disease Prevention Branch 1555 North 17th Avenue
4300 Chesty Creek Drive South,A-5 Greeley,Colorado 80631
Denver,Colorado 80246 C0NrRActoRDUNS:075757955
CONTRACTOR ENTITY TYPE,
CONTRACT MADE DATE;316/2019 Political Subdivision
AILLING c"C,\TEMENI:S RE:CEIV'.).
14'10x1111).
TERM: sTAT,ToRY AU:I:110MTY:NOT AlTpliCabie
This contract shall be effective upon approval by
the State Controller,or designee,or on 04/01/2019, C[.ASsirtc.ATION. Sub cciFient
whichever is later.',the contract shall end on 09.29/2019.
CONTRACT PRICE IVO"1'11 EXCEED:$16,799.00
PROCUREMENT METE) FET,ERAE FUNDING DOLLARS:
S16,799.00
99.00
RFA 11461) grim, INDINGDOLLARS: $0.00
DIERRC'P1LI.ST PRICE A I.EATETI NUMBER: C!"I"1IERFl1ND[NGDOLIARS� $0,00
Specify"Other"
MAXIM MT AMOUNT A UAILAnI E PER FISCAL YEA,
1,AWSPr•.CIr•IED VENDOR STATLrrE: FY19; $16,799.00
STATE REPRESENTATIVE:
Michelle Schultz
Heart Health Consultant
Prevention Services Division PRICEarnuCTI0Re: Cost Reimbursement
4300 Cherry Creek Drive South,A-5 CONTRACTOR REPRESENTATIVE:
Denver,Colorado 80246 Tanya Geiser
Director of Public Health Admin.Services
1555 North 17tH Avenue
Greeley,Colorado 80631
PROEEC r I?E T1tW.IION
1.is l,ic je ,t.€,es')iME,;cif n seraic,T to address crsidin,sv ui:tt d1..ase pree,It..
Page 16Yf 6
2019-3454 0C vex 06.3.19 tl SIB 7( 1 t,16
_:1`£1100,11
Cot M u n Ga.+;o $ 2023-3783
12/27/23 N L-O056
OPTION LETTER#: 1
State Agency: Original Contract Number
Colorado Department Of Public Health and Environment 2019*3454
PSD/HPCDP
4300 Cherry Creek Drive South Option better Contract Number
Denver,CO 80246 2019*3454 Option Letter 41
Contractor
Board of County Commissioners of Weld County
1150"O"St.,Greeley,CO 80631
for the use and benefit of the Weld County Department of
Public Health and Environment
1555 North 17th Avenue
Greeley,Colorado 80631
Contract Performance Beginning Date: Current Contract Expiration Date:
April 1,2019 Se tember 29,2019
CONTRACT MAXIMUM AMOUNT TABLE
Dooument Contract Federal Funding ;t3te.Iunding Other Funding Term(dates) Total
'.Number Amount Amount Amount
rypc
Original 2019*3454 $16,799.00 $0.00 $0.00 4/1/19-929/.19 $16,799.00
Contract
Option Letter Pi 2019*3454 $4,560.00 $0,00 $0.00 7124/19-T29119 $4,568.00
Option
Letter 111
Current Contract Maximum $21,367.00
Cumulative Amount
1)OPTIONS
A.Option to change quantity of services under the Contract
2)REQUIRED PROVISIONS:
A. In accordance with Section(s)8,Exhibit A,Additional Provisions of the Original Contract
referenced above,the Slate hereby exercises its option to increase the quantity of services at the
rates stated in the Original Contract as amended for the following reason:add funds for Fiscal
Year 2020.
B. The Contract Maximum Amount 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 24,
2019 whichever is later.
Optic i(;_tter C onset Numi cr:2014':3G5;t)ption Letter lit Page 1 u1 2 Ver.13.2.19
E.:.: )VE D
1�;I_3 1 2019
P GRAM AI'PROV STATE OF COLORADO
Jared S.Polls,Governor
Department of Public Health and Environment
"Il Flunsaker Ryan,MPH,Executive Director
11y Frith N.ml dk Tittet/!1 1 A
me►JI.V
By:Lisa McGovern,Procurement&Contracts Section
Date; l Director
•
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State Contracts.This
Contract is not valid until signed and dated below by the State Controller or delegate.
Contractor is not authorized to begin performance until such time.If Contractor begins
performing prior thereto,the State of Colorado is not obligated to pay Contractor for
such performance or for any goods and/or services provided hereunder.
STATE CONT I ER
Robert •os,CP Mil JD
By:_
David Norri. roller, DPI
Date: 12 G
Option letter:contract Number.2019"3454 Option Let.. Page 2 of 2 Ver.13.2.19
aH :COLORADO
Department of Public
Health Er Environment
pRkVEN I JUN SERVICES DIVISION-BUDGET JUSTIFICATION FORM
Contract Routing#2019-3454 Option Letter#1
Contractor Name '" Program Contact Name Title,Phone and Emad q{y,r.-„�d.�
Budget Perlad :.,t t.:-0ln ,�.:��..',Jr;ri4 Fiscal Contact Name,Title,Phone and Email '�'u' � -'"
Project Name '`hr U,..r�xp 3-,r t - ContracUEn cumbrance Number
Expenditure Categories Budget Totals
Modification to
Budget in
Personal Services Original Amendment/ Total Amount
Salaried Employees Contract GFCL/Option Requested
Budget Letter from CDPHE
Position Title 0escr.ptipn of Work and Jusllfication for Revision
Modification to
Personal Services Budget in
Hourly Employees Amendment/ Total Amount
Original GFCL/Option Requested
�._._ Budget Letter from CDPHE
Position!We Description uh Work and Justlf cation For Revision
k i_inch. -JV Ciai cn�es.•.;sl,i;ri Pa[r� ...._,r.�.�.>..u.s�o[:_r I�.rrv::w„ ir:sr, Ste'20
I t;
W - Total Personal Services ....... ..
(including fringe benefits). $692,20 $1,078.36 31,730.56
Modification to
Budget in
Supplies&Operating Expenses Amendment/ Total Amount
Original GFCL/Optlon Requested
Budget Letter from CDPHE
Item OescNption of Item and Juslificaliun for Revision
Total Supplies
Operating Expenses $2,ogo,00) So.00 $2,070,00
Modification to
Budget In
Travel Amendment/ Total Amount
Original GFCL/Option Requested
Budget Letter from CDPHE
Item ['owl ption of Item and Justifkation for Revision
(.14 rs'x 4.cps
Total Travel ,5z77.76 $0.00 ,277 76
PREVENTION SERVICES DIVISION-BUDGET JUSTIFICATION FORM
Contract Routing#2014-3454 Option Letter#1
Contractor Name Progranf Contact Name,Title,Phone and Email I.q ty:s�{
z __w......,.......,.,...._._....,..._..»,.._.._._.�....._.,......_ Inc i .r,d .._,_.
Budget Period ,2J: BFI r__�i.9,'pl`i Ffscol Contact Name,T[tle,Phone and Email ,nv r tt7,c<t n I_i,>>_....._
E �
Project Name ..�a r `f t '�'1 r "�' ContrdctJEncumbrance Number
p�(
Modification to
Budget in
Contractual(payments to third parties or entitles) Amendment/ Total Amount
Original GFCL/Option Requested
Budget Letter from COME
Item — Subcontractor Ent,Name aodic,Description or Item
Total Contractual
50,00 So. Saga
eCaST Original Modification to Total Amount
Budget Budget In Requested
Item Subcontractor Entity Name.and,.Orscrlptlon of Item
.....,._.-..,,..... i'..r,c,ir. nil,rl J,asui ttrt..-.,tI,�5� -J:nrpL
Total eCaST
03,170.00 $3,300.00 $0.00
SUBTOTAL BEFORE INDIRECT $16.169.96 $4,348.36 520,518.32
Modification to
Budget in
Indirect Amendment/ Total Amount
Original GFCL/Option Requested
Budget Letter from COPHE
Item Oescriplion of Item
,,;i 5"'_Y Od C'tY u$ iR4F.fi9
Total Indirect $629.44 $219.fi4 $848.66
TOTAL S16,9.00 $4.566.00 $21,362.00
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CONTRACT 2019*3454
ROUTING NO.
APPROVED TASK ORDER CONTRACT-WAIVER#154
This task order contract is issued pursuant to master contract made on 11/23/2016,with routing number 18 FAA 00051.
STATE: CONTRACTOR:
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County
Department of Public Health and Environment 1150"O"St.,Greeley,CO 80631 for the use and benefit of the
Prevention Services Division Weld County Department of Public Health and Environment
Health Promotion&Chronic Disease Prevention Branch 1555 North 17th Avenue
4300 Cheny Creek Drive South,A-5 Greeley,Colorado 80631
Denver,Colorado 80246 CONTRACTOR DUNS:075757955
CONTRACTOR ENTITY TYPE:
CONTRACT MADE DATE:3/6/2019 Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
TERM: STATUTORY AUTHORITY:Not Applicable
This contract shall be effective upon approval by
the State Controller,or designee,or on 04/01/2019, CLASSIFICATION: SubreCiplent
whichever is later.The contract shall end on 09/29/2019.
CONTRACT PRICE NOT TO EXCEED:$16,799.00
PROCUREMENT METHOD: FEDERAL FUNDING DOLLARS:$16,799.00
RFA 11460 STATE FUNDING DOLLARS: $0.00
BID/RFP/LIST PRICE AGREEMENT NUMBER: OTHER FUNDING DOLLARS: $0.00
N/A Specify"Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
LAW SPECIFIED VENDOR STATUTE: FY19: $16,799.00
N/A
STATE REPRESENTATIVE:
Michelle Schultz
Heart Health Consultant
Prevention Services Division PRICESTRUCIURE: Cost Reimbursement
4300 Cherry Creek Drive South,A-5 CONTRACTOR REPRESENTATIVE:
Denver,Colorado 80246 Tanya Geiser
Director of Public Health Admin.Services
1555 North 17th Avenue
Greeley,Colorado 80631
PROJECT DESCRIPTION:
This project serves to implement strategies to address cardiovascular disease prevention.
Page 1 of 6
2019-3454 OC ver 06.3.19
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
OPTION LETTER#:2
State Agency: Original Contract Number:
Colorado Department Of Public Health and Environment 2019°3454
PSD/HPCDP
4300 Cherry Creek Drive South Option Letter Contract Number:
Denver,Colorado 80246 2019*3454 Option Letter#2
Contractor:
Board of County Commissioners of Weld County
1150"O"St.,Greeley,CO 80631
for the use and benefit of the Weld County Department of Public
Health and Environment
1555 North 17th Avenue
Greeley,Colorado 80631
Contract Performance Beginning Date: Current Contract Expiration Date:
April 1,2019 September 29,2022
CONTRACT MAXIMUM AMOUNT TABLE
Document Contract Federal Funding State Funding Other Funding Term(dates) Total
Number Amount Amount Amount
Type
Original 2019*3454 $16,799.00 $0.00 $0.00 4/1/19-9/29/19 $16,799.00
Contract
Option Letter#1 2019*3454 $4,568.00 $0.00 $0.00 7/24/19-9/29/19 $4,568.00
Option Letter#1
Amendment#1 2019*3454 $3,000.00 $0.00 $0.00 9/30/19-9/29/20
Amendment#1 $3,000.00
Amendment#2 2019*3454 $3,000.00 $0.00 $0.00 9/30/20-9/29/21
Amendment#2 $3,000.00
Option Letter#2 2019*3454 $9,081.00 $0.00 $0.00 9/30/21-9/29/22
Option Letter
#2 $9,081.00
Current Contract Maximum $36,448.00
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(s)7,Additional Provisions,Exhibit E of the Original Contract,as
amended,referenced above,the State hereby exercises its option for an additional term,beginning
September 30,2021 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 the next year of
the project.
Page 1of3
Option Letter Contract Number:2019*3454 Option Letter#2 Ver.27.01.20
DocuSign Envelope ID:FA98F621-2C8D-4938-A1 D7-D895FCBFB5F4
SIGNATURE PAGE
STATE OF COLORADO In accordance with§24-30-202 C.R.S.,this Option is not
Jared S.Polis,Governor valid until signed and dated below by the State Controller or
Colorado Department of Public Health and Environment an authorized delegate.
Jill Hunsaker Ryan,MPH,Executive Director STATE CONTROLLER
Robert Jaros,CPA,MBA,JD
LDocuSigned by: t-DocuSigned by:
arvcsncu,ceuuccvtn,. v ccacC5428006401...
By:Signature By:Signature
Lisa McGovern Andi Hardy
Name of Executive Director Delegate Name of State Controller Delegate
Procurement&Contracts Section Director ft controller, Environmental Divisions
Title of Executive Director Delegate Title of State Controller Delegate
2021-09-24 2021-09-29
Date: Option Effective Date:
--Signature Page End--
Page 3 of 3
Option Letter Contract Number:2019*3454 Option Letter 112 Ver.03.01.20
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
B.In accordance with Section(s)8,Additional Provisions,Exhibit E of the Original Contract,as
amended,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,G,Budget,is deleted
and replaced in its entirety with Exhibit,G,Budget,attached to this Option Letter,for the
following reason:to include funding for the next year of the project.
C.Exhibit H,Federal Provisions—Colorado's WISEWOMAN Program,is deleted and replaced in its
entirety with Exhibit H,Federal Provisions-Colorado's WISEWOMAN Program,attached to this
Option Letter,for the following reason:To reflect changes to the federal award identification
information.
D.The Contract Maximum Amount table is deleted and replaced with the Current Contract Maximum
Amount table shown above.
3)OPTION EFFECTIVE DATE:
A.The effective date of this Option Letter is upon approval of the State Controller or September
30,2021,whichever is later.
Page 2 of 3
Option Letter Contract Number:2019*3454 Option Letter ti2 Ver.27.01.20
DocuSign Envelope ID:FA98F621-2C8O-4938-A1D7-D895FCBFB5F4
Exhibit G Budget
C COLORADO
Department of Public
Health&Environment
PREVENTION SERVICES DIVISION-12 MONTH BUDGET WITH JUSTIFICATION FORM
Original Contract Routing#2019*3454
Cynthia Horn
Weld County Department of Public Health and Program Contact Name, Program Coordinator
Contractor Name
Environment Title,Phone and Entail 970-400-2433
thorn@weldgov.com
Tanya Geiser
Fiscal Contact Name,Title, Finance Director
Budget Period 9/30/2021-9/29/2022
Phone and Email 970-400-2122
tgeiser@weldgov.com
Contract(CT or PO)
Project Name Chronic Disease Grants-WISEWOMAN CT FHLA 2019*3454
Number
Expenditure Categories •
Personal Services
Salaried Employees
Percent of Total Amount
Gross or
Position Title Description of Work Fringe Time on Requested from
Annual Salary Project CDPHE
Implement Medication Therapy Management
(MTM)pilot program-refer and navigate clients 4,914.69 Patient Navigator for MTM,communicate with pharmacy to establish $70,750.65 $27,543.23 5.00%$
workflows and evaluate progress of program
Health Coach 3 Attend Motivational Interviewing training $111,374.02 $43,357.91 0.20%$ 309.46
(approximately 4 hours)
Personal Services
Hourly Employees
Hourly Total#of Total Amount
Position Title Description of Work Hourly Wage Hours on Requested from
Fringe
Protect CDPHE
Health Coach 1 Attend Motivational Interviewing training $ 20.15 $ 7.84 4.0$ 111.96
Health Coach 2 Attend Motivational Interviewing training $ 20.15 $ 7.84 4.0$ 111.96
Total Personal Services(including fringe benefits)$ 5,448.07
Page 1 of 3
Option Letter Contract Number:2019*3454 Option Letter#2 January 2018
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
Exhibit G Budget
PREVENTION SERVICES DIVISION-12 MONTH BUDGET WITH JUSTIFICATION FORM
Original Contract Routing#2019*3454
Cynthia Horn
Weld County Department of Public Health and Program Contact Name, Program Coordinator
Contractor Name Environment Title,Phone and Email 970-400-2433
thorn@weldgov.com
Tanya Geiser
Fiscal Contact Name,Title, Finance Director
Budget Period 9/30/2021-9/29/2022
Phone and Email 970-400-2122
tgeiser@weldgov.com
Contract(CT or PO)
Project Name Chronic Disease Grants-WISEWOMAN CT FHLA 2019*3454
Number
Supplies&Operating Expenses
Total Amount
Item Description of Item Rate Quantity Requested from
CDPHE
Point of service device testing supplies-A1c(4 boxes of
15@$169.00/box),lipid cartridges(6 boxes of 10@$123.00/box),
Point of Service Supplies $ 1,550.00 1.00$ 1,550.00
cassette controls(2@$51.00/each),gloves/alcohol wipes/lancets
(combined 1@$34.00).
Educational materials and patient support items to engage clients
in healthy lifestyles,Items include:5 cookbooks @$15.00/each,20
Patient Support Items water bottles @$5.00/each,10 measuring cups&spoons $ 400.00 1.00$ 400.00
@$4.00/each,25 pedometers @$5.00/each,10 cutting boards
@$6.00/each.
Motivational Interviewing Registration for Motivational Interviewing training($100
Training each/training x 3 health coaches) $ 100.00 3.00$ 300.00
Total Supplies&Operating$ 2,250,00
Travel
Total Amount
Item Description of Item Rate Quantity Requested from
CDPHE
Travel expenses for motivational interviewing training;3 health
coaches may attend on separate days at approximately 61 miles
Mileage each way.366.25 miles x$0.555/mile;Weld County reimburses $ 0.555 366.25$ 203.27
mileage at$0.555/mile.Mileage rate may increase in 2022,but at
this time we are not certain what that rate may be.
Total Travel$ 203.27
Contractual
Total Amount
Subcontractor Name Description of item Rate Quantity Requested from
CDPHE
Total Contractual$ -
Page 2of3
Option Letter Contract Number:2019*3454 Option Letter#2 January 2018
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
Exhibit G Budget
PREVENTION SERVICES DIVISION-12 MONTH BUDGET WITH JUSTIFICATION FORM
Original Contract Routing#2019*3454
Cynthia Horn
Contractor Name Weld County Department of Public Health and Program Contact Name, Program Coordinator
Environment Title,Phone and Entail 970-400-2433
chorn@weldgov.com
Tanya Geiser
Fiscal Contact Name,Title, Finance Director
Budget Period 9/30/2021-9/29/2022
Phone and Email 970-400-2122
tgeiser@weldgov.com
Contract ICT or PO)
Project Name Chronic Disease Grants-WISEW0MAN CT FHLA 2019*3454
Number.
SUB-TOTAL OF DIRECT COSTSI$ 7,901.34
Indirect
Total Amount
Item Description of Item Requested from
CDPHE
CDPHE-Negotiated Indirect For CY2021,Weld County's CDPHE-negotitated indirect rate is 14.93%of total direct costs,
$ 1,179.66
Cost Rate excluding capital expenditures.Weld plans to switch to the CY2022 rate in CY2022.
Total Indirect`$ -.'.1,179.66,
TO
O411
Page 3of3
Option Letter Contract Number:2019*3454 Option Letter#2 January 2018
DocuSign Envelope ID:FA98F621-2C8D-4938-A1 D7-D895FCBFB5F4
Exhibit H
Federal Provisions-Colorado's 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:Board of County Commissioners of Weld County
b.Subrecipient DUNS number:075757955
c.The Federal Award Identification Number(FAIN)is NU58DP006656.
d.The Federal award date is 6/28/21.
e.The subaward period of performance start date is 9/30/2018 and end date is 9/29/2023.
f. Federal Funds:
Federal Budget Period Total Amount of Federal Amount of Federal Funds
Funds Awarded Obligated to CDPHE
9/30/2021 -9/29/2022 $1,060,000.00 $795,000.00.00
g.Federal award title of project or program:Colorado's 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 Deanna Campbell,Public Health Advisor,Fle4@cdc.gov,770-
488-1117;the name of the pass-through entity is the State of Colorado,Department of Public
Health and Environment(CDPHE)1 and the contact information for the CDPHE official is Ms.
Nicole Brasseur Project Director nicole.brasseur@state.co.us 303-691-4919.
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 not 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 1 of 4
Option Letter:2019*3454 Option Letter#2 Ver.25.02 20
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
3) Any additional requirements that CDPHE imposes on Subrecipient in order for CDPHE to meet its
own responsibility to the Federal awarding agency,including identification of any required financial and
performance reports,are stated in the Exhibits.
4) Subrecipient's approved indirect cost rate is as stated in the Exhibits.
5) Subrecipient must permit CDPHE and auditors to have access to Subrecipient's records and financial
statements as necessary for CDPHE to meet the requirements of 2 CFR§200.331 Requirements for pass-
through entities,§§200.300 Statutory and National Policy Requirements through§200.309 Period of
performance,and Subpart F-Audit Requirements of this Part.
6) The appropriate terms and conditions concerning closeout of the subaward are listed in Section 16 of
this Attachment.
7) Performance and Final Status.Subrecipient shall submit all financial,performance,and other
reports to CDPHE no later than 45 calendar days after the period of performance end date or sooner
termination of this Contract containing an evaluation and review of Subrecipient's performance and the
final status of Subrecipient's obligations hereunder.
8) Matching Funds.Subrecipient shall provide matching funds as stated in the Exhibits.Subrecipient
shall have raised the full amount of matching funds prior to the Effective Date and shall report to CDPHE
regarding the status of such funds upon request.Subrecipient's obligation to pay all or any part of any
matching funds,whether direct or contingent,only extends to funds duly and lawfully appropriated for the
purposes of this Contract by the authorized representatives of the Subrecipient and paid into the
Subrecipient's treasury or bank account.Subrecipient represents to CDPHE that the amount designated as
matching funds has been legally appropriated for the purposes of this Contract by its authorized
representatives and paid into its treasury or bank account.Subrecipient does not by this Contract
irrevocably pledge present cash reserves for payments in future fiscal years,and this Contract is not
intended to create a multiple-fiscal year debt of the Subrecipient.Subrecipient shall not pay or be liable for
any claimed interest,late charges,fees,taxes or penalties of any nature,except as required by
Subrecipient's laws or policies.
9) Record Retention Period.The record retention period previously stated in this Contract is replaced
with the record retention period prescribed in 2 CFR§200.333.
10)Single Audit Requirements.If Subrecipient expends$750,000 or more in Federal Awards during
Subrecipient's fiscal year,Subrecipient shall procure or arrange for a single or program-specific audit
conducted for that year in accordance with the provisions of Subpart F-Audit Requirements of the Uniform
Guidance,issued pursuant to the Single Audit Act Amendments of 1996,(31 U.S.C.7501-7507).2 CFR
§200.501.
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
Option Letter:2019*3454 Option Letter#2 Ver.25.02.20
DocuSign Envelope ID:FA98F621-2C8D-4938-A1D7-D895FCBFB5F4
d. 42 U.S.C.6101 et sue,42 U.S.C.2000d,29 U.S.C.794(regarding discrimination);
e. the"Americans with Disabilities Act"(Public Law 101-336;42 U.S.C.12101,12102,12111
-12117,12131-12134,12141-12150,12161-12165,12181-12189,12201-12213 and 47
U.S.C.225 and 47 U.S.C.611);
f. when applicable,the Contractor shall comply with the provisions of the"Uniform
Administrative Requirements for Grants and Cooperative Agreements to State and Local
Governments"(Common Rule);
g. The Federal Funding Accountability and Transparency Act of 2006(Public Law 109-282),as
amended by§6062 of Public Law 110-252,including without limitation all data reporting
requirements required there under.This Act is also referred to as FFATA.
h. Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act
of 1964,as amended.
i. Except as otherwise provided under 41 CFR Part 60,all contracts that meet the definition of
"federally assisted construction contract"in 41 CFR Part 60-1.3 comply with the equal
opportunity clause provided under 41 CFR 60-1.4(b),in accordance with Executive Order
11246,"Equal Employment Opportunity:(30 FR 12319,12935,3 CFR Part,1964-1965
Comp.,p.339),as amended by Executive Order 11375,"Amending Executive Order 11246
Relating to Equal Employment Opportunity,"and implementing regulations at 41 CFR part
60,"Office of Federal Contract Compliance Programs,Equal Employment Opportunity,
Department of Labor.
j. where applicable,Contract Work Hours and Safety Standards Act(40 U.S.C.3701-3708).
k. if the Federal award meets the definition of"funding agreement"under 37 CFR§401.2(a)
and the recipient or subrecipient wishes to enter into an agreement with a small business firm
or nonprofit organization,comply with the requirements of 37 CFR Part 401,"Rights to
Inventions Made by Nonprofit Organizations and Small Business Firms Under Government
Grants,Contracts and Cooperative Agreements,"and any implementing regulations issued by
the awarding agency.
1. the Clean Air Act(42 U.S.C.7401-7671q.)and the Federal Water Pollution Control Act(33
U.S.C.1251-1387),as amended.
m. if applicable,comply with the mandatory standards and policies on energy efficiency
contained within the State of Colorado's energy conservation plan issued in compliance with
the Energy Policy and Conservation Act,42 U.S.C.6201.
n. the Contractor and all principals are not presently debarred,suspended,proposed for
debarment,declared ineligible,or voluntarily excluded from covered transactions by any
federal department or agency;the Contractor and all principals shall comply with all
applicable regulations pursuant to Executive Order 12549(3 CFR Part 1986 Comp.,p.189)
and Executive Order 12689(3 CFR Part 1989 Comp.,p.235),Debarment and Suspension;
and,
o. the Contractor shall comply where applicable,the Byrd Anti-Lobbying Amendment(31
U.S.C.1352).
12)Compliance.Subrecipient shall comply with all applicable provisions of The Office of Management
and Budget Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal
Awards(Uniform Guidance),including but not limited to these Supplemental Provisions for Federal
Awards.Any revisions to such provisions automatically shall become a part of these Supplemental
Provisions,without the necessity of either party executing any further instrument.CDPHE may provide
Page 3 of 4
Option Letter:2019*3454 Option Letter. Ver.25.02.20
DocuSign Envelope ID:FA98F621-2C8O-4938-A1D7-D895FCBFB5F4
written notification to Subrecipient of such revisions,but such notice shall not be a condition precedent to
the effectiveness of such revisions.
13)Procurement Procedures.Subrecipient shall use its own documented procurement procedures which
reflect applicable State,local,and Tribal laws and regulations,provided that the procurements conform to
applicable Federal law and the standards identified in the Uniform Guidance,including without limitation,
§§200.318 through 200.326 thereof
14)Certifications.Unless prohibited by Federal statutes or regulations,CDPHE may require
Subrecipient to submit certifications and representations required by Federal statutes or regulations on an
annual basis(2 CFR§200.208).Submission may be required more frequently if Subrecipient fails to meet
a requirement of the Federal award.Subrecipient shall certify in writing to CDPHE at the end of the
Contract that the project or activity was completed or the level of effort was expended.2 CFR
§200.201(b)(3).If the required level of activity or effort was not carried out,the amount of the Contract
must be adjusted.
15)Event of Default.Failure to comply with the Uniform Guidance or these Supplemental Provisions for
Federal Awards shall constitute an event of default under the Contract pursuant to 2 CFR§200.339 and
CDPHE may terminate the Contract in accordance with the provisions in the Contract.
16)Close-Out.Subrecipient shall close out this Contract within 45 days after the End Date.Contract
close out entails submission to CDPHE by Subrecipient of all documentation defined as a deliverable in
this Contract,and Subrecipient's final reimbursement request.If the project has not been closed by the
Federal awarding agency within 1 year and 45 days after the End Date due to Subrecipient's failure to
submit required documentation that CDPHE has requested from Subrecipient,then Subrecipient 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
Option Letter:2019*3454 Option Letter#2 Ver.25.02.20
DocuSign Envelope ID:CC81 B337-8F69-487E-B5F4-97C5D84DAD48
OPTION LETTER#:3
State Agency: Original Contract Number:
Colorado Department Of Public Health and Environment 2022°3741
PSD/HSBC-WiWo/CD Option Letter Contract Number:
4300 Cherry Creek Drive South 2022*3741 Option Letter#3
Denver,Colorado 80246
Contractor:
Board of County Commissioners of Weld County
1150"O"St.,Greeley,CO 80631
for the use and benefit of the Weld County Department of Public
Health and Environment
1555 North 17th Avenue
Greeley,Colorado 80631
Contract Performance Beginning Date: Current Contract Expiration Date:
April 1,2019 September 29,2022
CONTRACT MAXIMUM AMOUNT TABLE
Document Type Contract Number Federal Funding State Funding Other Funding Term(dates) Total
Original Contract 2019*3454 $16,799.00 $0.00 $0.00 4/1/19-9/29/19 $16,799.00
Option Letter#1 2019*3454 Option $4,568.00 $0.00 $0.00 7/24/19-9/29/19 $4,568.00
Letter#1
Amendment#1 2019*3454 $3,000.00 $0.00 $0.00 9/30/19-9/29/20 $3,000.00
Amendment#1
Amendment#2 2019*3454 $3,000.00 $0.00 $0.00 9/30/20-9/29/21 $3,000.00
Amendment#2
Option Letter#2 2019*3454 Option $9,081.00 $0.00 $0.00 9/30/21-9/29/22 $9,081.00
Letter#2
Option Letter#3 2022*3741 Option $6,664.00 $0.00 $0.00 4/8/22-9/29/22 $6,664.00
Letter#3
Current Contract Maximum $43,112.00
Cumulative Amount
1)OPTIONS
A.Option to change quantity of services under the Contract
2)REQUIRED PROVISIONS:
A.In accordance with Section(s)8,Additional Provisions,Exhibit E of the Contract,as amended,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,G,Budget,is deleted and replaced in its entirety with Exhibit,G,
Budget,attached to this Option Letter,for the following reason:to include additional funding for the current
fiscal year.
B.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 April 8,2022,
whichever is later.
Page 1of2
Option Letter Contract Number:2022*3741 Option Letter#3 Ver.27 01.20
DocuSign Envelope ID:CC81B337-8F69-487E-B5F4-97C5D84DAD48
SIGNATURE PAGE
STATE OF COLORADO In accordance with§24-30-202 C.R.S.,this Option is not
Jared S.Polis,Governor valid until signed and dated below by the State Controller or
Colorado Department of Public Health and Environment an authorized delegate.
Jill Hunsaker Ryan,MPH,Executive Director STATE CONTROLLER
Robert Jaros,CPA,MBA,JD
CDocuSigned by: DocuSigned by:
Sa�11�[a6v�t.Vln. EjtA,SfilA,
2EDF870AtA7D4FC._ n n G e n
C 8G5 0 B.79 X15...
By:Signature By:Signature
Lisa McGovern Justin Weigle
Name of Executive Director Delegate Name of State Controller Delegate
Procurement&Contracts Section Director ft Health Divisions Controller
Title of Executive Director Delegate Title of State Controller Delegate
2022-04-07 2022-04-08
Date: Option Effective Date:
--Signature Page End--
Page 2 of 2
Option Letter Contract Number:2022*3741 Option Letter#3 Ver.03.01.20
DocuSign Envelope ID:CC81B337-8F69-487E-B5F4-97C5D84DAD48
Exhibit G Budget
COLORADO
Department of Pukslic
Health&Envumnment
PREVENTION SERVICES DIVISION-BUDGET JUSTIFICATION FORM
Original Contract Routing#2022*3741
Cynthia Horn
Weld County Department of Public Health and Program Contact Name,Title, Program Coordinator
Contractor Name
Environment Phone and Email 970-400-2433
thorn@weldgov.com
Tanya Geiser
Budget Period 9/30/2021-9/29/2022 Fiscal Contact Name,Title, Finance Director
Phone and Email 970-400-2122
tgeiser@weldgov.com
Project Name Chronic Disease Grants-WISEWOMAN Contract/Encumbrance Number CT FHLA 2022*3741
Expenditure Categories Budget Totals
Personal Services Modification to Total Amount
Salaried Employees Original Budget in Requested
Budget Amendment/ from CDPHE
Option Letter
Position Title Description of Work and Justification for Revision
Implement Medication Therapy Management(MTM)pilot program-refer and
navigate clients for MTM,communicate with pharmacy to establish workflows
Patient Navigator and evaluate progress of program $4,914.69 $0.00 $4,914.69
NO CHANGE
Attend Motivational Interviewing training(approximately 4 hours)
Health Coach 3 $309.46 $0.00 $309.46
NO CHANGE
Modification to Total Amount
Personal Services Original Budget in
Hourly Employees Budget Amendment/ Requested
Option Letter from CDPHE
Position Title Description of Work and Justification for Revision
Attend Motivational Interviewing training
Health Coach 1 $111.96 $0.00 $111.96
NO CHANGE
Attend Motivational Interviewing training
Health Coach 2 $111.96 $0.00 $111.96
NO CHANGE
Total Personal Services $5,448.07 $0.00 $5,448.07
(including fringe benefits)
Modification to Total Amount
Supplies&Operating Expenses Original Budget in Requested
Budget Amendment/ from CDPHE
Option Letter
Item Description of Item and Justification for Revision
Option Letter Contract Number:20223741 Option Letter#3 Page 1 of 3
❑omSign Envelope ID:CC818337-8F69-487E-B5F4-97C5D84DAD48
Exhibit G Budget
Point of service device testing supplies-A1c(4 boxes of 15@$169.00/box),
lipid cartridges(6 boxes of 10@$123.00/box),cassette controls(2@
$51.00/each),gloves/alcohol wipes/lancets(combined 1@$34.00).
CHANGE:Additional supplies needed for WISEWOMAN testing using point of
Point of Service Supplies service devices.Increases are as follows:lipid cartridges(6 boxes of $1,550.00 $1,310.00 $2,860.00
10@$123/box),Alc cartridges(4 boxes of 15@$102/box),lipid controls
(1@$35/each),Alc controls(1@$75/each),gloves/alcohol wipes/lancets
(combined 1@$34/each),optics checks cartridge for lipid point of service device
(1@$20%ooch).
Educational materials and patient support items to engage clients in healthy
lifestyles,Items include:5 cookbooks @$15.00/each,20 water bottles
Patient Support Items @$5.00/each,10 measuring cups&spoons @$4.00/each,25 pedometers
PP @$5.00/each,10 cutting boards @$6.00/each. $400.00 $0.00 $400.00
NO CHANGE
Registration for Motivational Interviewing training($100 each/training x 3
Motivational Interviewing health coaches)
$300.00 $0.00 $300.00
Training
NO CHANGE
Point of service devices for lipid(1 @$2650)and Alc(1 @$665)testing.
Point of Service Devices NEW COST:Additional budget added to purchase new point of service devices to $0.00 $3,315.00 $3,315.00
replace outdated devices used for WISEWOMAN clinical testing.
Blood pressure devices for WISEWOMAN participants enrolled in healthy
behavior support services(10 devices@$55/each).
Blood pressure cuffs $0.00 $550.00 $550.00
NEW COST.:Additional budget added to support a newly identified need among
program participants.
Health coach training for WISEWOMAN health coaches(2@$100/each)and
continuing education for WISEW0MAN medical providers through the
American Association of Nurse Practitioners annual conference
Staff training (1@$300/each). $0.00 $500.00 0500.00
NEW COST:Additionalbudget added to address the need for staff training to
meet WISEWOMAN health coach training requirements and maintain medical
provider knowledge of current chronic disease topics.
Total Supplies $2,250.00 $5,675.00 $7,925.00
&Operating Expenses
Modification to Total Amount
Travel Original Budget in Requested
Budget Amendment/ from OOP.
Option Letter
Item Description of Item and Justification for Revision
Travel expenses for motivational interviewing training;3 health coaches may
attend on separate days at approximately 61 miles each way.366.25 miles x
$0.555/mile;Weld County reimburses mileage at$0.555/mile.Mileage rate
Mileage may increase in 2022,but at this time we are not certain what that rate may be. $203.27 $0.00 $203.27
NO CHANGE
Total Travel $203.27 $0.00 $203.27
Option Letter Contract Number:20223741 Option Letter#3 Page 2 of 3
DonSign Envelope ID:CC818337-BF69-487E-B5F4-97C5D84DAD48
Exhibit G Budget
Modification to Total Amount
Contractual(payments to third parties or entities) Original Budget in Requested
Budget Amendment/ from CDPHE
Option Letter
Subcontractor Entity Name Description of Item and Justification for Revision
Total Contractual $0.00 $0.00 $0.00
SUB-TOTAL BEFORE INDIRECT $7,90,34 $5,675.00 $13,576.34
Modification to Total Amount
Indirect Original Budget in Requested
Budget Amendment/ from CDPHE
Option Letter
Item Description of Item
For CY2022,Weld County's CDPHE-negotitated indirect rate is 19.29,of
modified total direct costs,consisting of all salaries and wages,fringe benefits,
materials and supplies,services,travel,and subgrants and subcontracts up to
CDPHE Negotiated Indirect Cost the first$25,000 of each subgrant or subcontract(regardless of the period
covered by the subgrant or subcontract).Equipment,capital expenditures, $1,179.66 $989.00 $2,168.66
Rate 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.
Total Indirect $1,179.66 $989.00 $2,168.66
TOTAL $9,081.00 $6,664.00 $15,745.00
Option Letter Contract Number:2022*3741 Option Letter#3 Page 3 of 3
DocuSign Envelope ID:D04DC40B-E805-4869-AC88-A3FC59F17770
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CONTRACT 2019*3454
ROUTING NO.
APPROVED TASK ORDER CONTRACT-WAIVER#154
This task order contract is issued pursuant to master contract made on 11/23/2016,with routing number 18 FAA 00051.
STATE: CONTRACTOR:
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County
Department of Public Health and Environment 1150"O"St.,Greeley,CO 80631 for the use and benefit of the
Prevention Services Division Weld County Department of Public Health and Environment
Health Promotion&Chronic Disease Prevention Branch 1555 North 17th Avenue
4300 Cherry Creek Drive South,A-5 Greeley,Colorado 80631
Denver,Colorado 80246 CONTRACTOR DUNS:075757955
CONTRACTOR ENTITY TYPE:
CONTRACT MADE DATE:3/6/2019 Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
TERM: STATUTORY AUTHORITY:Not Applicable
This contract shall be effective upon approval by
the State Controller,or designee,or on 04/01/2019, cLAssOFICATION: Subrecipient
whichever is later.The contract shall end on 09/29/2019.
CONTRACT PRICE NOT TO EXCEED:$16,799.00
PROCUREMENT METHOD: FEDERAL.FUNDING DOLLARS:$16,799.00
RFA 11460 STATE FUNDING DOLLARS: $0.00
BID/REP/LIST PRICE AGREEMENT NUMBER: OTHER FUNDING DOLLARS: $0.00
N/A Specify"Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
LAW SPECIFIED VENDOR STATUTE: FY19: $16,799.00
N/A
STATE RFPRFSENTATIVE:
Michelle Schultz
Heart Health Consultant
Prevention Services Division PRICE STRUCTURE: Cost Reimbursement
4300 Cherry Creek Drive South,A-5 CONTRACTOR REPRESENTATIVE:
Denver,Colorado 80246 Tanya Geiser
Director of Public Health Admin.Services
1555 North 17th Avenue
Greeley,Colorado 80631
PROJECT DESCRIPTION:
This project serves to implement strategies to address cardiovascular disease prevention.
Page 1 of 6
2019-3454 OC ver 06.3.19
DocuSign Envelope ID:D04DC406-E805-4869-AC88-A3FC59F17770
OPTION LETTER#:4
State Agency: Original Contract Number:
Colorado Department Of Public Health and Environment 2019*3454
WiWo/CD
4300 Cherry Creek Drive South Option Letter Contract Number:
Denver,Colorado 80246 2022*3741 Option Letter#4
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 17th Avenue
Greeley,Colorado 80631
Contract Performance Beginning Date: Current Contract Expiration Date:
April 1,2019 September 29,2023
CONTRACT MAXIMUM AMOUNT TABLE
Document Type Contract Number Federal Funding State Funding Other Funding Term(dates) Total
Original Contract 2019*3454 $16,799.00 $0.00 $0.00 4/1/19-9/29/19 $16,799.00
Option Letter#1 2019*3454 $4,568.00 $0.00 $0.00 7/24/19-9/29/19 $4,568.00
Option Letter#1
Amendment#1 2019*3454 $3,000.00 $0.00 $0.00 9/30/19-9/29/20 $3,000.00
Amendment#1
Amendment#2 2019*3454 $3,000.00 $0.00 $0.00 9/30/20-9/29/21 $3,000.00
Amendment 62
Option Letter#2 2019°3454 $9,081.00 $0.00 $0.00 9/30/21-9/29/22
Option Letter#2 $9,081.00
Option Letter#3 2022*3741 $6,664.00 $0.00 $0.00 4/8/22-9/29/22 $6,664.00
Option Letter#3
Option Letter#4 2022*3741 $2,500.00 $0.00 $0.00 9/30/22-9/29/23 $2,500.00
Option Letter#4
Current Contract Maximum $45,612.00
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 Exhibit E,Additional Provisions,Paragraph 7 of the Original Contract
referenced above,the State hereby exercises its option for an additional term,beginning
September 30,2022 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 implementing
strategies to address cardiovascular disease prevention.
B. In accordance with Exhibit E,Additional Provisions,Paragraph 8 of the Original Contract
Page 1 of 3
Option Letter Contract Number:2022*3741 Option Letter#4 Ver.27,01.20
DocuSign Envelope ID:D04DC40B-E805-4869-AC86-A3FC59F17770
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 G,Budget,is deleted and replaced in
its entirety with Exhibit G,Budget,attached to this Option Letter,for the following reason:
To provide funding for the new term.
C. Exhibit H,Federal Provisions,is deleted and replaced in its entirety with Exhibit H,
Federal Provisions,attached to this Option Letter,for the following reason:To reflect
changes to the federal award identification information.
D. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown above.
3)OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or September
30,2022,whichever is later.
Page 2 of 3
Option Letter Contract Number:2022.3741 Option Letter#4 Ver.27.01.20
DocuSign Envelope ID:D04DC40I3-E805-4809-AC88-A3FC59F17770
SIGNATURE PAGE
STATE OF COLORADO In accordance with§24-30-202 C.R.S.,this Option is not
Jared S.Polls,Governor valid until signed and dated below by the State Controller or
Colorado Department of Public Health and Environment an authorized delegate.
Jill Hunsaker Ryan,MPH,Executive Director STATE CONTROLLER
Robert Jaros,CPA,MBA,JD
®ocu3tenad b>~: DocuBfenad ey,5S114 ttaiMatk riofitA,20.70A1A704F.. C49A5doa0 vo�
By:Signature By:Signature
Lisa McGovern Justin Weigle
Name of Executive Director Delegate Name of State Controller Delegate
Procurement&Contracts Section Director ft Health Divisions controller
Title of Executive Director Delegate Title of State Controller Delegate
2022-08-18 2022-09-19
Date: Option Effective Date:
--Signature Page End--
Page 3 of 3
Option Letter Contract Number:2022*3741 Option Letter#4 Ver.03,01,20
DocuSign Envelope ID:D04DC40B-E805-4869-AC88-A3FC59F17770
Exhibit H
Federal Provisions-Colorado's 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:Board of County Commissioners of Weld County
b.Subrecipient Unique Entity Identification Number:
• SAM Unique Entity ID(UEI):MKKXT9U9MTV5
c.The Federal Award Identification Number(FAIN)is NU58DP006656
d.The Federal award date is TBD.
e.The subaward period of performance start date is 9/30/2018 and end date is 9/29/2023.
f. Federal Funds:
Federal Budget Period Total Amount of Federal Amount of Federal Funds
Funds Awarded Obligated to CDPHE
09/30/2022-09/29/2023 $795,000.00 $795,000.00
g.Federal award title of project or program:Colorado's WISEWOMAN Program.
h. The name of the Federal awarding agency is:United States Department of Health and
Human Services(USDHHS)Centers for Disease Control and Prevention
(CDC)and the contact information for the awarding official is Deanna Campbell,Public
Health Advisor,fle4 a@cdc.gov,770-488-1117;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(CDPHE)Project Director.
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 not 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.
Page 1 of 4
Option Letter Contract Number:2022.3741 Option Letter#4 Ver.25.02.20
DocuSign Envelope ID:0040C40B-E805-4869-AC88-A3FC59F17770
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.
3) Any additional requirements that CDPHE imposes on Subrecipient in order for CDPHE to meet its
own responsibility to the Federal awarding agency,including identification of any required financial and
performance reports,are stated in the Exhibits.
4) Subrecipient's approved indirect cost rate is as stated in the Exhibits.
5) Subrecipient must permit CDPHE and auditors to have access to Subrecipient's records and financial
statements as necessary for CDPHE to meet the requirements of 2 CFR§200.331 Requirements for pass-
through entities,§§200.300 Statutory and National Policy Requirements through§200.309 Period of
performance,and Subpart F-Audit Requirements of this Part.
6) The appropriate terms and conditions concerning closeout of the subaward are listed in Section 16 of
this Attachment.
7) Performance and Final Status.Subrecipient shall submit all financial,performance,and other
reports to CDPHE no later than 45 calendar days after the period of performance end date or sooner
termination of this Contract containing an evaluation and review of Subrecipient's performance and the
final status of Subrecipient's obligations hereunder.
8) Matching Funds.Subrecipient shall provide matching funds as stated in the Exhibits.Subrecipient
shall have raised the full amount of matching funds prior to the Effective Date and shall report to CDPHE
regarding the status of such funds upon request.Subrecipient's obligation to pay all or any part of any
matching funds,whether direct or contingent,only extends to funds duly and lawfully appropriated for the
purposes of this Contract by the authorized representatives of the Subrecipient and paid into the
Subrecipient's treasury or bank account.Subrecipient represents to CDPHE that the amount designated as
matching funds has been legally appropriated for the purposes of this Contract by its authorized
representatives and paid into its treasury or bank account.Subrecipient does not by this Contract
irrevocably pledge present cash reserves for payments in future fiscal years,and this Contract is not
intended to create a multiple-fiscal year debt of the Subrecipient.Subrecipient shall not pay or be liable for
any claimed interest,late charges,fees,taxes or penalties of any nature,except as required by
Subrecipient's laws or policies.
9) Record Retention Period.The record retention period previously stated in this Contract is replaced
with the record retention period prescribed in 2 CFR§200333.
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");
Page 2 of 4
Option Letter Contract Number:2022"3741 Option Letter#4 Ver.25.02,20
DocuSign Envelope ID:DO4DC40B-E805-4869-AC68-A3FC59F17770
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").
d. 42 U.S.C.6101 et sue,42 U.S.C.2000d,29 U.S.C.794(regarding discrimination);
e. the"Americans with Disabilities Act"(Public Law 101-336;42 U.S.C.12101,12102,12111
-12117,12131-12134,12141-12150,12161-12165,12181-12189,12201-12213 and 47
U.S.C.225 and 47 U.S.C.611);
f. when applicable,the Contractor shall comply with the provisions of the"Uniform
Administrative Requirements for Grants and Cooperative Agreements to State and Local
Governments"(Common Rule);
g. The Federal Funding Accountability and Transparency Act of 2006(Public Law 109-282),as
amended by§6062 of Public Law 110-252,including without limitation all data reporting
requirements required there under.This Act is also referred to as FFATA.
h. Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act
of 1964,as amended.
i. Except as otherwise provided under 41 CFR Part 60,all contracts that meet the definition of
"federally assisted construction contract"in 41 CFR Part 60-13 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.
1. the Clean Air Act(42 U.S.C.7401-7671q.)and the Federal Water Pollution Control Act(33
U.S.C.1251-1387),as amended.
m. if applicable,comply with the mandatory standards and policies on energy efficiency
contained within the State of Colorado's energy conservation plan issued in compliance with
the Energy Policy and Conservation Act,42 U.S.C.6201.
n. the Contractor and all principals are not presently debarred,suspended,proposed for
debarment,declared ineligible,or voluntarily excluded from covered transactions by any
federal department or agency;the Contractor and all principals shall comply with all
applicable regulations pursuant to Executive Order 12549(3 CFR Part 1986 Comp.,p.189)
and Executive Order 12689(3 CFR Part 1989 Comp.,p.235),Debarment and Suspension;
and,
o. the Contractor shall comply where applicable,the Byrd Anti-Lobbying Amendment(31
U.S.C.1352).
Page 3 of 4
Option Letter Contract Number:2022*3741 Option Letter#4 Ver.25.02.20
DocuSign Envelope ID:D04DC40B-E805-4869-AC88-A3FC59F17770
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
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,
§§200318 through 200.326 thereof.
14)Certifications.Unless prohibited by Federal statutes or regulations,CDPHE may require
Subrecipient to submit certifications and representations required by Federal statutes or regulations on an
annual basis(2 CFR§200.208).Submission may be required more frequently if Subrecipient fails to meet
a requirement of the Federal award.Subrecipient shall certify in writing to CDPHE at the end of the
Contract that the project or activity was completed or the level of effort was expended.2 CFR
§200.201(b)(3).If the required level of activity or effort was not carried out,the amount of the Contract
must be adjusted.
15)Event of Default.Failure to comply with the Uniform Guidance or these Supplemental Provisions for
Federal Awards shall constitute an event of default under the Contract pursuant to 2 CFR§200.339 and
CDPHE may terminate the Contract in accordance with the provisions in the Contract.
16)Close-Out.Subrecipient shall close out this Contract within 45 days after the End Date.Contract
close out entails submission to CDPHE by Subrecipient of all documentation defined as a deliverable in
this Contract,and Subrecipient's final reimbursement request.If the project has not been closed by the
Federal awarding agency within 1 year and 45 days after the End Date due to Subrecipient's failure to
submit required documentation that CDPHE has requested from Subrecipient,then Subrecipient 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
Option Letter Contract Number:2022*3741 Option Letter 04 Ver.25 02,20
Dow5ign Envelope ID:D04DC40B-E605-4869-AC68-A3FC59F17770
Exhibit G Budget
,COLORADO
' 0 I Department o!Public
'" I Health h Environment
PREVENTION SERVICES DIVISION-12 MONTH BUDGET WITH JUSTIFICATION FORM
Original Contract Routing#2019.3454
Cynthia Horn
Contractor Name Weld County Department of Public Health and Program Contact Name, Program Coordinator
Environment Title,Phone and Email 970-400-2433
thorn @weldgov.com
Tanya Geiser
Fiscal Contact Name,Title, Directo
r
or
Budget Period 9/30/2022 9/29/2023 Phone and Email 970-400-2122
irect
tgeiser@weldgov.com
Project Name Chronic Disease Grants-WISEWOMAN Contract(CT or PO)Number CT FHLA 2022.3741
Expenditure Categories
Personal Services
Salaried Employees
Percent of Total Amount
Gross or
Position Title Description of Work Fringe Time on Requested from
Annual Salary
Project CDPHE
Health Coach 1 Attend Motivational Interviewing training
$115,829.04 $45,694.56 0.10%$ 161.52
(Approximately 4 hours total)
-
Personal Services
Hourly Employees
Total o of Total Amount
Position Title Description of Work Hourly Wage Hourly Fringe Hours on Requested from
Project CDPHE
Health Coach 2 Attend Motivational Interviewing training $ 21.60 $ 8.52 3.00$ 90.36
(Approximately 3 hours total)
Health Coach 3 Attend Motivational Interviewing training
(Approximately 3 hours total) $ 21.60 $ 8.52 3.00$ 90.36
$ $
Total Personal Services(including fringe benefits)$ 34225
Supplies&Operating Expenses
Total Amount
Item Description of Item Rate Quantity Requested from
CDPHE
Point of service device testing supplies-A1c(3 boxes of 15 each
@$175.00/box),lipid cartridges(3 boxes of 10 each @
lies $130.00/box),Alc controls(1@$75.00/each),lipid controls(1@
Point of Serviee Su PP $40.00/each)gloves/alcohol wipes/lancets(combined 2 boxes @ $ 1,148.00 1.00$ 1,148.00
$34.00/each),optics check cartridge for lipid point of service device
(2 cartridges @$25.00/each).
Educational materials and patient support items to engage clients in
healthy lifestyles,Items include:17 water bottles @$5.00/each,10
Patient Support Items $ 227.00 1.00$ 227.00
measuring cups&spoons @$4.20/each,10 pedometers
@$5.00/each,1 blood pressure cuffs @$50/each
Motivational Interviewing Registration for Motivational Interviewing training($100.00
Training each/trainingx 3 health coaches) $ 100.00 3.00$ 300.00
Option Letter Contract Number:2022.3741 Option Letter#4 Page 1 of 2
DocuSign Envelope ID:D04DC40B-E805-4869-AC88-A3FC59F17770
Exhibit G Budget
Staff trainin Training to maintain medical provider knowledge of current chronic
g diseases.($50.00 x 1 training) $ $0.00 1.00$ 50.00
Total Supplies&Operating_$ 1,725,00
Travel
Total Amount
Item Description of item Rate Quantity Requested from
CDPHE
Travel expenses for motivational interviewing training in-person;118
Mileage miles x$0.555/mile;Weld County reimburses mileage at $ 0.555 118.00$ 65.49
$0.555/mile.
Total Travel$ 65.49
Contractual
Total Amount
Subcontractor Name Description of Item Rate Quantity Requested from
CDPHE
Total Contractual S
SUB-TOTAL OF DIRECT COSTS$ 2,132.74
Indirect
Total Amount
Item Description of Item Requested from
CDPHE
Weld County's CDPHE-negotiated indirect cost rate for CY2022 is 19.29%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
CDPHE-Negotiated Indirect of the period covered b the sub rant or subcontract Equipment,ca ital
Cost Rate (regardless P Y 8p $ 367.27
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.
Total Indirect f 367.26
i. A wM. ... -. .. ....E 'C`',1Oi t
Option Letter Contract Number:2022'3741 Option Letter#4 Page 2 of 2
DocuSign Envelope ID:D04DC408-E805-4869-AC88-A3FC59F17770
CONTRACT MODIFICATION SUBMITTAL CHECKLIST
Board of County Commissioners of Weld County(a political For Purchasing&
Contractor/Subrecipient
subdivision of the state of Colorado)for the use and Benefit of the Contract Unit Use Only
Name: Weld County Department of Public Health and Environment
(Verify that the name on all Contract occurrences and Secretary of State Status Summary Page match exactly)
Modification Routing A: 2022*3741 Original Routing#: 2019*3454
Ovation Letter#4
CMS Number,if required CORE It(if applicable)
Modification Start 9/3o/zozz Modification End 9/29/2023
Date: Date:
SOW Modification Pre-aaprovai-PCS Request Site Approval#(if
applicable):
PCS Request Site Modifietion Contract Routing&Tracking Request
Number: Enter Request ID#
Division Acronym: PSD- Unit Acronym: WiWo/CD
Submitter Name: Ovid Hood Phone: david.hood@state.co.us
SOW Delegate
Phone:
Name:
Purpose(s)of Modification:(Select all that apply)
❑Scope of Work Morification LI Budget Modification ®Renewal ❑No Cost Modification ❑Assignment
❑Other If"Other",
describe:
Modification Document Type(select one only) A B CD
A O Amendment:Two(2)each with original signatures ❑
B 0 Grant Funding.etter:Two(2)letters,each with original signatures ❑
C 0 Option Letter:Two(2)agreements,each with original signatures
D 0 Assignment:Two(2)agreements,each with original signatures ❑
Mod iiCation:ATTACHMENTS—REQUIREMENTS—CERTIFICATIONS AB CD
Enter"X"for all that apply;Enter requested information in shaded fields;Attach forms/documentation I
1. The first(cover)page el the original contract document(Attach) ❑ ❑ ® ❑
2. For Subrecipient OnA(Renewal required each year)- ❑ ❑
III
Enter Pm-Award Financial Risk Assessment number(See Internal Audit Site): -
3. Insurance Certif9cata(s)(RE required for Interagency Agreement or Intergovernmental Contract,Insurance Policy Dates must ❑ ❑ ❑
be current on effective date of contract;if Assignment,COI for Assignee only)
Applicable waiver()and description:enter PCS Request Site ❑ ❑
4. O Sole Source REVISION(A modification is required when there is an increased amount,change in SOW or date change.) ❑ ❑ ❑
New PCS Sole Source Fequest#: New PCS Sole Source Term: to
Enter PCU Requst# Enter SS Term
New NPSS1 Number: Dates El El El
Enter NPPS51#
Date Stamp at bottom of page
$bdef6ce774b1$CEC66F3FD3354AE2A47550970262280E.docx Ver.12.8.22
1
DocuSign Envelope ID:D04DC40B-E805-4869-AC88-A3FC59F17770
5. Secretary of State Status Summary Page(must state the entity is in"good standing")Renewals ONLY ❑ ❑ ❑
(NOT required for Interagency Agreement,Intergovernmental Contract;if Assignment,SOS for Assignee only)
If DBA,Secretary of State Status Summary Page for DBA ❑ ❑ LI
6. Signature Authority Letter or Corporate Documentation(If contract signed by other than the apparent authority)(See ❑
State of Colorado Procurement Manual,p.18,Chapter IV,Section 21)
7. S.A.M.Exclusion Summary Page(Record verified and no exclusions/restrictions)(NOT required for Interagency
Agreement Contractor LPHA;if Assignment,SAM for Assignee only)(see PCS Site:SAM Verification Guidance) ❑ CIAO
CMS.RECORD::Required fir contracts$100,000,over.R o Iifeof the contract J 00=
Completed
1. Record Type—Record type chosen is"Modification". ❑
2. Linked Record—Record is linked to the Master Record ONLY.
3. Record Title-Title follows the naming convention for a Modification to a Master Record. ❑
4. Data Field;Vendor Name—Has been selected in the'Contractor/Vendor'field.
5. Data 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.lithe ❑
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 the
contract has been renewed or extended,enter the 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 the field 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.
NOTES;4,
$bdef6ce774b1$CEC66F3FD3354AE2A47550970262280E.docx Ver.12.8.22
2
Lnct undated by Chricmnher D'(hidin nn Nnv 0/.202/nr 12 X09 PM WELD,COUNTY OF
DocuSign Envelope ID:D04DC40B-E805-4869-AC88-A3FC59F17770
SAM*Gov®
WELD, COUNTY OF
Unique Entity ID CAGE/NCAGE Purpose of Registration
MKKXT9U9MTV5 4KEF9 Federal Assistance Awards Only
Registration Status Expiration Date
Active Registration Dec 1,2022
Physical Address Mailing Address
1150 O 5T 1150 O Street
Greeley,Colorado 80631-1117 Greeley,Colorado 80 63 1-111 7
United States United States
Doing Business es Division Name Division Number
(blank) (blank) (blank)
Congressional District State/Country of Incorporation URL
Colorado 04 (blank)/(blank) (blank)
Registration Dates
Activation Date Submission Date Initial Registration Date
Nov 4,2021 Nov 1,2021 Oct 9,2006
Entity Dates
Entity Start Date Fiscal Year End Close Date
Jan 1,1861 Dec 31
Immediate Owner
CAGE Legal Business Name
(blank) (blank)
Highest Level Owner
CAGE Legal Business Name
(blank) (blank)
Executive Compensation
Registrants in the System for Award Management(SAM)respond to the Executive Compensation questions in accordance with Section 6202 of
P.L.110-252,amending the Federal Funding Accountability and Transparency Act(P.L.109-282).This information is not displayed in SAM.It is
sent to USAspending.gov for display in association with an eligible award.Maintaining an active registration in SAM demonstrates the registrant
responded to the questions.
Proceedings Questions
Registrants in the System for Award Management(SAM)respond to proceedings questions in accordance with FAR 52.209-7,FAR 52.209-9,or
2.C.F.R.200 Appendix XII.Their responses are not displayed in SAM.They are sent to FAPIIS.gov for display as applicable.Maintaining an active
registration In SAM demonstrates the registrant responded to the proceedings questions.
Active Exclusions Records?
No
I authorize my entity's non-sensitive information to be displayed in SAM public search results:
Yes
Business Types
Entity Structure Entity Type Organization Factors
U.S.Government Entity US Local Government (blank)
Profit Structure
Last undated lry Chrisfinher D'(Tvid-�nn Nnv 01.202!at 1209 PM WELD,COUNTY OF
Dss Sign Envelope ID:D04DI 0B-E805-4869-AC88-A3FC59F17770
Socio-Economic Types
Check the registrant's Reps&Carts,if present,under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small
business concern.Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the
SBA supplemental pages daring registration.
Government Types
U.S.Local Government
County
Accepts Credit Card Payment Debt Subject To Offset
No No
EFT Indicator CAGE Code
0000 4KEF9
Points of Conte-;•1
<,
Electronic Business
p 1150 O Street
Chris D'Ovidio Greeley,Colorado 80631
United States
Ryan Rose 1150 0 Street
Greeley,Colorado 80631
United Steles
Government Business
1150®Street
Chris D'Ovidio Greeley,Colorado 80631
United States
Ryan Rose 1150O Street
Greeley,Colorado 80631
United States
Service Classrftc
NAILS Codes
Primary NAGS Codes NAILS Title
This entity does not appear i 1 the disaster response registry.
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