HomeMy WebLinkAbout20230166.tiffRESOLUTION
RE: APPROVE GRANT APPLICATION FOR STATE AND LOCAL FISCAL RECOVERY
FUNDS (SLFRF) FOR CHILDREN, YOUTH, AND FAMILY BEHAVIORAL HEALTH
SERVICES, AND AUTHORIZE CHAIR TO SIGN AND DEPARTMENT OF HUMAN
SERVICES TO SUBMIT ELECTRONICALLY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Grant Application for State and Local
Fiscal Recovery Funds (SLFRF) for Children, Youth and Family Behavioral Health Services from
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Department of Human Services, to the Colorado Department of
Human Services, commencing July 1, 2023, and ending December 30, 2024, with further terms
and conditions being as stated in said grant application, and
WHEREAS, after review, the Board deems it advisable to approve said grant application,
copies of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Grant Application for State and Local Fiscal Recovery Funds
(SLFRF) for Children, Youth and Family Behavioral Health Services from the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf
of the Department of Human Services, to the Colorado Department of Human Services, be, and
hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said grant application, and Julie Witkowski, Manager of Family Resource Division be, and
hereby is, authorized to electronically submit.
cc : HS D, A CT(cP/cD)
02/01 /23
2023-0166
HR0095
GRANT APPLICATION FOR STATE AND LOCAL FISCAL RECOVERY FUNDS (SLFRF) FOR
CHILDREN, YOUTH, AND FAMILY BEHAVIORAL HEALTH SERVICES
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 11th day of January, A.D., 2023.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: dayget) w %,,k
Weld County Clerk to the Board
orney
Date of signature: of/2y/23
Mike Freeman, Chair
2023-0166
HR0095
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: January 3, 2023
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: Colorado Department of Human Services (CDHS)
Children, Youth, and Family Services Grant
Application
Please review and indicate if you would like a work session prior to placing this item on the
Board's agenda.
Request Board Approval of the Department's Colorado Department of Human Services (CDHS)
Children, Youth, and Family Services Grant Application. The Weld County Department of Human
Services (WCDHS) is requesting approval to submit an application for funding for the Colorado
Department of Human Services (CDHS) Children, Youth, and Family Services Grant. This Request for
Application (RFA) seeks to provide state funding to improve the mental health outcomes for children &
youth, birth through age 21, and their families.
The total funding that the Department wilt be requesting in this grant application is $921,466.00 for the
period July 1, 2023 through December 30, 2024, or eighteen (18) months. A 5% match for this grant is
required which would be funded by other state revenue, federal grant funds, and in -kind contributions.
The first round of grant applications must be received by 5:00 p.m. MST Thursday, January 12, 2023.
I do not recommend a Work Session. I recommend approval of this Grant Application, authorize the Chair to sign
the Signature Page and required Exhibits, and delegate authority to the Department to submit all required grant
application documents to the State.
Approve
Recommendation
Perry L. Buck
Mike Freeman, Chair
Scott K. James
Kevin D. Ross
Lori Saine
Schedule
Work Session
Other/Comments:
Pass -Around Memorandum; January 3, 2023 — Not in CMS
2023-0166
CDHS
COLORADO
Department of Human Services
Request for Applications (RFA)
Children, Youth, and Family Services Grants
RFP IBEH 2023000171
December 08, 2022
Page 1 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
a2oa3-o/
Basic Information and Timeline
Single Point of Contact
Raven Lopez
raven.Iopez@state.co.us
Solicitation Description
House Bill (HB) 22-1281: Children, Youth, Family Services
Grants to provide resources to improve the mental health
outcomes for children & youth, birth through age 21 and
their and families (Reference the link to HB 22-1281 in
Section L — References and Resources)
Eligibility
Reference Section B(2) of this RFA.
Service/Delivery Area
Colorado - Statewide
Anticipated Contract Start Date
Upon Execution of a Contract
Anticipated Contract Term
Upon execution of a contract through June 30, 2023. The
resulting contract may be renewed for additional terms at
the sole discretion of the State, contingent upon funds
being appropriated, budgeted, and otherwise made
available, and other contractual requirements, if applicable,
being satisfied.
Submission Method
Electronic. See "How to Submit an Application" below.
Pre -Application Conference
Date
November 29, 2022. Optional. Recording available in Section
L - References and Resources.
Questions Due Date
Questions will be answered according to the schedule in
Section C - Grant Application Process. Questions will be
answered within 10 business days after the question deadline
for each submission group. Answers will be posted in the
Vendor Self Service (VSS) page for this RFA. Please reference
Section D - How to Submit an Application, for further
information.
Application Due Date and Time
Rolling applications accepted until all funds are allocated or
February 1, 2024, whichever comes first
*All dates and times are subject to change and are in Mountain Time.
Page 2 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
Table of Contents
A. Quick Resources
B. Introduction and Background
C. Grant Application Process
D. How to Submit an Application
E. Application Fermat
F. Application Content
G. DemographicForm
H. How Applications are Evaluated
I. Ethics and Commitment to Equity, Diversity, and Inclusion
J. Administrative Information
K. Exhibit List
L. References and Resources
M. Signature Page
A. Quick Resources
1. For questions about this solicitation, contact the Single Point of Contact identified above.
2. For access to the Vendor Self -Service site, please visit: https://codpa-
vss.cloud.cgifederal.com/webapp/PRDVSS2X1/AltSelfService
3
4
5
8
9
10
13
14
14
14
18
18
20
3. For help with Vendor Self Service (ColoradoVSS), contact the Vendor Self Service Help Desk
vsshelp@state.co.us or 303-866-6464.
4. For information about doing business with the state of Colorado generally, go to:
https:/7osc.colorado.gov/spco/accesscolorado.
5. The Department is always interested in improving. Please take this survey at any time:
https:/7docs.google.com/forms/d/e/1 FAIpQLSclgv9IgrT3xSAGzcvT1xkvpu crRh h NSQJ23vLcby
fvc2smew/viewform
(We do actually read the responses)
Page 3 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
B. Introduction and Background
The Behavioral Health Administration (BHA) was established in July of 2022 to be the single entity
responsible for driving coordination and collaboration across state agencies to address behavioral
health needs. It is the lead entity, collaborating across state agencies, to ensure there is a
transparent and accountable system in place that results in better behavioral health outcomes for
people in Colorado.
Access to quality behavioral health services continues to be in high demand throughout Colorado
and the COVID-19 pandemic exacerbated this issue. Colorado has a unique opportunity with
American Rescue Plan Act (ARPA) funds to increase care and support for families by expanding
services to areas in need and addressing gaps in services. The BHA is committed to enhancing
services and supports for children, youth, and families to strengthen resilience and promote
recovery of individuals participating in these services.
In June 2022, Governor Jared Polis signed House Bill (HB) 22-1281 which created a grant program to
expand children -oriented, youth -oriented & family -oriented behavioral health care services to
address identified local needs along the continuum of behavioral health care, including services for
children, youth, and families with acute, complex, or severe behavioral health conditions and needs.
1. Allowable Uses of Funding
This grant may be used for the following purposes:
Establishing and operating a care access point in each behavioral health administrative
services region (see map of BHA Admin. Regions in Section L - References and Resourcesi.
Establishing and operating a child oriented, youth oriented and family oriented care access
point that is physically connected to a family resource center; or a facility that provides
behavioral health care treatment.
o Family resource center is defined as a point of entry where vulnerable families,
individuals, children, and youth in communities can obtain information,
assessment of needs and referral to delivery of family services.
Establishing or expanding children oriented, youth oriented and family oriented Behavioral
health care navigation and coordination services.
Expanding evidence -based or evidence -informed behavioral health care treatment,
including substance use disorder (SUD) treatment, for children, youth, and families.
Establishing or expanding intensive outpatient services, including high fidelity wraparound,
youth mobile response and expanded caregiver interventions.
Capital expenditures related to providing the treatment and services described above.
In order to receive a grant, an entity must use the behavioral health care services
assessment tool link or a county, regional, or community assessment tool to identify gaps in
Page 4 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
behavioral health care services in the BHA services region served by the grant award as
described in Section C(3) - Community Assessment Toolkit.
• Successful Applicants are expected to have an understanding of the need for these services
in their community, the anticipated number of children, youth and families served annually,
and the population of focus.
If an application does not comply with the list above, the application will be disqualified.
2. Eligible Organizations
Per C.R.S. 27-60-502, the following organization types are eligible to apply:
• Local Governments - means a nonprofit or for-profit organization that provides
behavioral health-care services (C.R.S. 27-60-501(8)).
Federally recognized Indian tribes.
Judicial district juvenile services planning committees.
Community -based organizations - means a county, municipality, city, and county, or
local education provider.
Nonprofit organizations - means an organization that is exempt from taxation under
Section 501 (C)(3) of the Federal "Internal Revenue Code of 1986" as amended.
Local Collaborative Management Program - structures and processes that bring together
agencies and services for at -risk, high systems -use children, youth, and families, under
the program described in C.R.S. 24-1.9-102.
In order to receive a grant, an entity must use the behavioral health care services assessment
tool link or a county, regional, or community assessment tool to identify gaps in behavioral
health care services in the BHA services region served by the grant award as described in Section
C(3) - Community Assessment Toolkit.
3. Statement of Work
Please reference Exhibit A, Statement of Work, for full details on project activities, scope, and
responsibilities.
C. Grant Application Process
1. Grant Application Process
a. The BHA has a total of four grant opportunities (including this RFA for HB 22-1281 - Children,
Youth, Family Services Grants) that contain similar project scopes. Each of these grant
opportunities will be published on the Colorado VSS site (link to this site can be found in
Section A — Quick Resources). Please monitor the VSS site for more information on each
grant application process
b. Applicants may apply for more than one of the grants available but must submit separate
applications for each grant opportunity.
Page 5 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
c. Grant applications may be submitted according to the instructions in Sections D - F of this
RFA on a rolling basis per the schedule below until all funding is awarded, or until 5:00 pm
on February 1, 2024, whichever comes first.
d. Grants will be reviewed periodically on the following schedule. The following timeframes are
estimates for planning purposes only and are subject to change:
Group
Applications
received between
Questions due by /
Answered by
Award by
Contract execution
by
Group 1
Dec 8, 2022 -
Jan 15,2023
Dec 19, 2022 / Jan
4, 2023
March 1, 2023
April 28, 2023
Projects can cover April 28, 2023 - December 30, 2024.
Group 2
Jan 16, 2023 - May
1, 2023
March 31, 2023 /
April 14, 2023
June 15, 2023
Sept 1, 2023
Projects can cover September 1, 2023 - December 30, 2024.
Group 3
May 2, 2023 - Aug
1, 2023
July 3, 2023 / July
18, 2023
Sept 15, 2023
Dec 1, 2023
Projects can cover December 1, 2023 - December 30, 2024.
Group 4
Aug 2, 2023 - Nov 1,
2023
Dec 15, 2023 / Jan
2, 2024
Dec 15, 2023
Feb 1, 2024
Projects can cover February 1, 2024 - December 30, 2024.
Group 5
Nov 2, 2023 - Feb 1,
2024
Jan 8, 2024 / Jan 23,
2024
March 15,2023
July 1, 2024
Projects can cover July 1, 2024 - December 30, 2024.
i. Not all award groups above are guaranteed to occur - the applications will close when
grant funds are fully awarded, so we recommend that Applicants submit as early as they
can.
Page 6 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
e. Applicants only need to apply once for the life of their project (you do not need to reapply for
each grant year).
f. Grants will be reviewed and awarded according to the process in Section H — How Applications
are Evaluated.
g. The first round of awards are expected to be executed (when work may officially begin) by April
28, 2023. All awarded projects must conclude by December 30, 2024.
h. No work can commence until the applicant and the BHA have executed a final agreement.
Upon Award, a Notice of Intent to Award Letter will be sent out to awarded Applicants. Please
note that this Notice of Intent to Award Letter does not constitute a final agreement.
i. Applicants that receive "Letter of Non -Award" are highly encouraged to contact the
single point of contact listed in the Basic Information and Timeline section, to request
feedback of their declined application. Applicants are also encouraged to re -apply.
2. Budget & Funding Information
This funding is dependent on Colorado House Bill (HB)22- 1281 ARPA approval by the
Colorado Governor's Office and on other state budget approvals as necessary
Approximately $39,000,000 will be awarded between eligible applicants during the
funding period.
Applicants may request any grant amount for their overall project period.
Funding period - total grant funds must be expended by December 30, 2024.
The number and amount of awards will be determined based on the quality of
applications, best value, and avaiability of funds.
3. Community Assessment Toolkit
In order to receive a grant, applicants must complete an assessment to identify gaps in
behavioral health services for the relevant geographic areas and describe in the application how
the assessment was used to inform the grant proposal, as outlined in Section F - Application
Content.
The BHA has developed a community assessment toolkit (reference Section L - References and
Resources) that compiles a variety of relevant data resources, needs assessments, guidance for
stakeholder engagement, and examples of services across the continuum to assist applicants in
assessing local strengths, gaps and solutions. The toolkit is not exhaustive, but representative of
the types of data and approaches that are expected from applicants. Alternatively, an entity
may use an existing county, regional, or community assessment if it identifies gaps in behavioral
health services for the relevant geographic area.
Technical assistance is available to eligible entities needing assistance with using the assessment
tool through the BHA. Services will be prioritized based on applicant need and resources. Please
Page 7 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
open and complete this form to request technical assistance (reference Section L — References
and Resources).
4. Grant Writing Assistance
The Colorado Consortium for Prescription Drug Abuse Prevention is accepting applications for
its grant writing assistance program to address an expansion in behavioral health services
(inclusive of mental health, substance use, and co-occurring disorders) including prevention,
treatment, crisis, recovery, harm reduction, diversion for criminal justice in accordance with this
RFA.
• The Consortium prioritizes organizations located in or serving rural and frontier counties
in Colorado (reference the link to this list in Section L — References and Resources), as
well as small nonprofits in urban counties.
Eligible applicants are local government and nonprofit organizations with operating
budgets under $1 million annually and without in-house grant writing capacity, inclusive
of the following:
o A federally recognized Indian Tribe with a government seat within the boundaries of
the State of Colorado.
o A county government or an agency thereof.
o A municipal government or agency thereof.
o A nonprofit organization that provides community based services related to the
scope of this RFA, or a community coalition with a mission to address behavioral
health as either a S01(C)3 status, or a fiscal agent that is a government agency.
o Entities must be in good standing with the Colorado Secretary of State (reference
the link in Section J(11) — Administration Information).
At this time, for-profit corporations are not eligible applicants, for grant writing
assistance.
Find more information on the grant writing assistance program and apply here
(reference link in Section L — References and Resources).
Email any questions to pm@corxconsortium.org
5. CRC GrantCorps - is also a resource that provides guidance on how to apply for grants. Are you a
Colorado -based initiative or organization applying for a grant in workforce development? See if
you're eligible here (reference the link to this site in Section L — References and Resources).
D. How to Submit an Application
1. In General. Email the Grant Application Workbook, Signature Page, and any other required
documents in one zip file as an attachment to this email address:
RFP IBE.kucwx12i2cw5v1ck@u.box.com Please be aware of email server file size limitations.
The maximum file size the Department can accept is 15 GB.
2. Only Attachments. Only the zip file goes through. The Department cannot see any text or
messages sent to the email address identified above. Written questions may be emailed to
the Single Point of Contact.
Page 8 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
3. File Names. The zip file name should start with the solicitation type, solicitation number,
and vendor name (e.g., "RFA 2021000XXX Vendor Name..."). Vendors may include
additional information in the zip file name.
4. Timing. The zip file typically uploads within five minutes; however, vendors should submit
zip files at least thirty minutes prior to any deadline to ensure the file is received.
5. Confirmation. Vendors will receive an email confirmation from box.com that the zip file was
uploaded correctly. If not, please contact the Single Point of Contact.
6. No Encryption. Do not encrypt emails sent to the submission email as it may prevent full
submission.
7. Pre -application Conference. There was an optional pre -application conference held on
November 29, 2022, which described the grant purpose and application process. This Pre -
application Conference was recorded and is incorporated into this RFA by reference. Please
access this recording via the link referenced in Section L - References and Resources.
8. Questions. Applicants may submit questions using this form: RFA 22-1281 Children, Youth
and Family Applicant Questions (link to this form can be found in Section L — References and
Resources). Questions will be answered according to the schedule in Section C - Grant
Application Process. Questions will be answered within 10 business days after the question
deadline for each submission group, per the schedule in Section C - Grant Application
Process. The final Q&A document will be posted in the Vendor Self Service (VSS) page for
this RFA. Please review the Q&A document prior to submitting your question to see if it has
already been asked and answered. The final deadline for questions is January 8, 2024. The
Department may answer some, all, or none of the questions asked by posting them publicly.
• Please note that all Q&A's will be posted under one document on VSS.
9. This RFA will be closed when there are no more funds remaining to allocate or after
February 1, 2024, whichever comes first. Late Applications may not be accepted unless
specifically allowed by rule and at the Department's sole discretion.
E. Application Format
1. Applications should be submitted on the Exhibit B - Grant Application Workbook. All
questions requiring a response in this RFA have a corresponding space to answer on the
Grant Application Workbook. Instructions to fill out the Grant Application Workbook are
found on the "Instructions" tab on the Grant Application Workbook.
2. Please submit your budget on the "Budget" tabs on the Grant Application Workbook.
a. Note: Budgets must be submitted individually for FY23 (April 2023 - June 30, 2023),
FY24 (July 1, 2023 -June 30, 2024), and FY25 (July 1, 2024 - December 30, 2024).
Applicants do not have to apply for all fiscal years if their project will be shorter in
time.
Page 9 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
b. Applicants must submit EITHER Exhibit B-1- 1281 CYF Grant Application Workbook for
Capacity Type Budgets OR Exhibit B-2 - 1281 CYF Grant Application Workbook for
Deliverable Type Budgets templates, but not both. Applicants may request any grant
amount for their overall project period.
3. Note: For a capacity -type budget, a grant recipient may apply its agency's federally
negotiated indirect rate, if any, or a 10% de minimis indirect rate.
4. Applications that do not follow the sequence, outline, and response format of this Grant
Application Workbook may be deemed non -responsive and disqualified from further
consideration.
F. Application Content
Application Substance. Please answer the questions listed within the Grant Application Workbook
(Exhibit B1 or B2). Answers will be evaluated based on the quality, value, and fit of the objectives
established in HB 22-1281.
1. Mandatory Criteria (25 points)
Applicants MUST respond to the following questions in order to qualify for the grant. If any questions
in this Mandatory Criteria section are not appropriately addressed, the application will be
disqualified.
a. The BHA may only award grants to Applicants that offer a monetary contribution or in -kind
contributions ("match") that directly support the services provided with a grant award.
Applicants must provide at least the match amount identified in the table below.
Please identify your organization's size and confirm the match amount you will provide.
Additionally, please detail match funds in the Budget tabs of the Grant Application Workbook.
Answer this question in row 40 of the Grant Application Workbook. (S points)
ize of r aRization / '"
ward Arno
Annual O.rganizatikr1".
Budget size
Percer age Match
Requirement on grant` award
amount
Large Org. (as defined by org.
budget)
$20,000,000
5%
Small Org. (as defined by org.
budget)
Less than $20M
2.5%
*Award of $50,000 or less
Any Size
0%
Colorado Department of Human Services
Page 10 of 20
Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
• Match requirements reflect each year of funding requested. (i.e., total grant amounts
requested for each individual Fiscal Year of funding requested, this is not cumulative).
• If organizations are collaborating, each of the participating organizations budgets
must be combined to determine the annual organization budget size and the dollar
match requirements.
b. In order to receive a grant, an Applicant must use the BHA's community assessment toolkit
(reference Section C(3) - Community Assessment Toolkit) or an existing county, regional, or
community assessment that serves the purpose of identifying gaps in behavioral health
services in the geographic area served by the grant award. The BHA shall give preference to
applicants providing a service that addresses a gap in behavioral health or substance use
disorder services identified by the applicant with a community assessment tool:
i. Identify which community assessment tool you used (e.g., the BHA's community
assessment toolkit or an existing local assessment). Please provide a web link to the tool
you used. Answer this question in row 46 of the Grant Application Workbook. (6 points)
ii. Provide an explanation of the gaps in behavioral health services that the tool identified
in your area. Answer this question in row 48 of the Grant Application Workbook. (7
points)
iii. Demonstration of need: explain how the approach in this grant proposal addresses the
gap in services identified by the tool. Answer this question in row 50 of the Grant
Application Workbook. (7 points)
2. Preferred Criteria (75 points)
a. Work Plan (35 points)
i. Provide a detailed description of the work plan for your proposed plan/project/services.
Answer this question in cells B51-883 of the Grant Application Workbook. List the
counties where services will be provided and identify which ASO regions (reference the
link in Section L— References and Resources) are serviced by your grant project. Provide
an outline of proposed phases & activities to achieve the objectives of the grant project
outlined above. Answer this question in row 56 of the Grant Application Workbook. (35
points)
b. Collaboration and Alignment: (15 points)
i. Explain how you have collaborated or communicated with relevant local government
and community based organizations where the services will be provided, including but
not limited to the local Regional Accountability Entities (RAEs) Administrative Service
Organizations (ASOs), and Managed Service Organizations (MSOs) Answer this question
in row 93 of the Grant Application Workbook. (8 points)
Page 11 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
a. Please include letter(s) of support from the local Regional Accountability Entity
(RAE) and others where appropriate for any Medicaid covered service.
Additionally, letter(s) of support from Administration Service Organizations (ASOs)
and/or Managed Service Organizations (MSOs) for any services that are crisis
services or SUD services respectively, should be provided. Please include the
letter(s) as separate attachments in your application. Please feel free to leave
comments in row 95 of the Grant Application Workbook. (7 points)
ii. Regional Opioid Settlement Plan: Please explain whether and how this request aligns
with a regional opioid settlement plan (reference Section L— References and Resources)
Answer this question in row 99 of the Grant Application Workbook. (No score applied,
informational only)
c. Organizational Readiness (15 points)
i. Provide your organization's mission statement and a statement about how prior and/or
current work will complement this grant. Answer this question in row 103 of the Grant
Application Workbook. (5 points)
ii. Describe your experience managing previous projects or service grants similar in scope
or size to this request. Answer this question in row 105 of the Grant Application
Workbook. (5 points)
iii. Provide a description of the applicant's experience in providing culturally competent
and gender responsive services (including whether the organization adheres to the
Culturally and Linguistically Appropriate Services (�),.)standards (reference the link to
this information in Section L— References and Resources) and whether the applicant is
representative of the individuals the applicants seek to serve with the grant. Answer this
question in row 109 of the Grant Application Workbook. (5 points)
d. Sustainability Plan (10 points)
i. Provide your organization's plan to sustain the services provided with a grant award
beyond the duration of grant, including the organization's ability to bill other payors
such as Medicaid where appropriate. Answer this question in row 113 of the Grant
Application Workbook. (10 pts)
3. Cost and Budget Information (20 Points)
a. Please submit your budget on the "Budget" tabs on the Grant Application Workbook for the
applicable term. Answer this question in the budget tabs of the Grant Application Workbook.
Please use the following instructions to complete your budget:
i. Note: Submit budgets individually for FY23 (April 2023 - June 30, 2023), FY24 (July 1,
2023 - June 30, 2024), and FY25 (July 1, 2024 - December 30, 2024). Applicants do not
have to apply for all fiscal years if their project will be shorter in time.
ii. Applicants must submit EITHER Exhibit B-1- 1281 CYF Grant Application Workbook for
Capacity Type Budgets OR Exhibit B-2 - 1281 CYF Grant Application Workbook for
Deliverable Type Budgets templates, but not both.
Page 12 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
iii. Nate: Identify the source(s) of contributing funds or in -kind contributing resources.
b. Note: Applicants may request any grant amount for their overall project period.
c. Note: For a capacity -type budget, a grant recipient may apply its agency's federally negotiated
indirect rate, if any, or a 10% de minimis indirect rate.
d. For applicants other than tribal governments: If more than $1,000,000 is requested for a
capital expenditure (meaning development of buildings, vehicles, land, or machinery expected
to be used for more than one year), please provide a written justification for the expenditure
to the BHA. Written justifications for selected proposals will be submitted to the Governor's
Office for approval. Awards are contingent upon Governor's Office approval. The written
justification must include the following elements:
i. Describe the harm or need to be addressed.
ii. Explain why a capital expenditure is appropriate; and
iii. Compare the proposed capital expenditure to at least two alternative capital
expenditures and demonstrate why the proposed capital expenditure is superior.
For Capital Expenditures: Answer this question in row 124 of the Grant Application. (No points. This
is for informational purposes only and will assist in determining proper approvals routing).
4. Applicant Attestations
a. Eligibilky. Please provide an attestation that your organization falls under the eligible
organization categories listed in Section B(2) — Introduction and Background — Eligible
Organizations. Answer this question in row 24 of the Grant Application Workbook.
b. Allowable Uses of Funding. Please provide an attestation that your organization, if awarded,
will use funding for purposes listed in the categories outlined in Section B(2) — Introduction
and Background — Allowable Uses of Funding. Answer this question in row 31 of the Grant
Application Workbook.
c. Federal American Disabilities Act of 1990. Please provide an attestation that your
organization, if awarded, will comply with the American Disabilities Act of 1990, and serve
individuals with a disability, regardless of primary diagnosis, co-occurring conditions, if the
individual requires assistance with activities of daily living. Answer this question in row 28 of
the Grant Application Workbook.
G. Demographic Form
1. Please fill out the following form regarding your organization's demographic information:
https://app.sma rtsheet. com/b/form/219f6d b8803 b4994af b9 bf70e84fa421
2. The Department strives to be inclusive of all communities throughout the State. To support
diverse representation in procurement and in alignment with Executive Order D 2020 175
from Governor Polis, the Department is asking organizations to complete this form.
Completing this form is voluntary and does not affect an organization's application or
Page 13 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
contract. The information captured will be submitted directly to the Department's Equity,
Diversity, and Inclusion Office. If there are questions regarding how this data is used or
completion of this form, please email CDHS_EDI@state.co.us.
H. How Applications are Evaluated
1. In General. The Department will assess each application based on Evaluation Factors and
determine the best application(s). The assessment may vary based on the time and
resources available to make a determination. The Department may request more
information or clarifications from any vendor. The Single Point of Contact will notify all
vendors of the final decision.
2. Mandatory Criteria. The Department may identify mandatory criteria. However, the
Department reserves the right to waive mandatory requirements in its sole discretion.
3. Evaluation Factors. The Department may evaluate applications based on the information
requested or referenced in the application content section, or as noted throughout the
solicitation.
4. References. The Department may contact references, whether provided or not, and also
consider them as part of the evaluation.
I. Ethics and Commitment to Equity, Diversity, and Inclusion
1. Any person involved in the purchasing process for the State, any end users of such goods
and services, any vendor or contractor that does business with the state, and any other
interested third parties to the procurement process shall enhance the proficiency and
stature of the purchasing process by adhering to the highest standards of ethical behavior.
2. The State of Colorado believes that an equitable, diverse, and inclusive workplace is one
where all employees and community partners, whatever their gender, race, ethnicity,
religion, national origin, age, sexual orientation, gender identity, citizenship status,
education, disability, socio-economic status, or any other identity, feel valued and
respected. We are committed to nondiscriminatory practices and providing equitable
opportunities for employment and advancement in all our departments, programs, services,
and worksites. We respect and value diverse life experiences and work to ensure that all
voices are heard so that a person's future success is not determined by their identity.
J. Administrative Information
1. Communication. All communication regarding this solicitation must be done through the
Single Point of Contact identified above. Unauthorized contact with any Department
Page 14 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
personnel other than the Single Point of Contact regarding this solicitation is prohibited and
may result in disqualification.
2. Notices. The Department may modify this solicitation by posting changes via the Colorado
VSS website. All communications will be posted on the VSS, www.colorado.gov/vss, and/or
through a direct email from the Single Point of Contact.
3. Modifications of Applications. Applications may be modified or withdrawn by the vendor
prior to the established due date and time.
4. Presentations or Site Visits. At the Department's sole discretion, the Department may
request presentations or site visits. Vendors should not, however, prepare the application
with the assumption that an opportunity for oral presentations or revisions will be offered.
5. Acceptance of solicitation terms. An application submitted in response to this solicitation
shall constitute a binding offer and acknowledgment that all terms and conditions of this
solicitation are accepted. Vendors must identify any variations between its application and
the solicitation. Failure to do so shall be deemed a waiver of any rights to subsequently
modify the terms of performance.
6. Contract. Vendors must agree to the State's contract terms, found here:
httos://cdhs.colorado.gov/procurement or as an exhibit to this solicitation. Please note that
any referenced or attached model contract lists the State's standard required legal
provisions but may not include the specific scope of work and other specific terms or
requirements for this solicitation. Vendors must review any attached contract terms and
note any exceptions. If no exceptions are noted, Vendor is indicating an intent to accept the
terms as -is. Modifications to the State's contract terms constitute increased risk and costs to
the State. Therefore, Vendor's noted exceptions may be considered in any evaluation.
7. Award. The Department will notify all vendors who submitted an application when it issues
a Notice of Intent to Award or an actual award. The awarded vendor(s) must act in good
faith to execute an agreement on or before the Anticipated Contract Start Date identified
above. If this date is not met, through no fault of the State, the State, at its sole discretion,
may cancel the Notice of Intent to Award.
8. Reconsiderations.
Sponsoring Agency Reconsiderations. If a Sponsoring Agency provides for an
appeal process, then the Department will follow the appeal process provided by
the Sponsoring Agency.
b. Federal Program Reconsiderations. If a federal program under which funding is
provided for provides for an appeal process, then the Department will follow
the appeal process provided for by the federal program.
c. Department Reconsiderations. If there is no Sponsoring Agency or federal
appeal process available, then vendors who believe that they should have been
issued an award when they were not or who believe that they were otherwise
not properly awarded may submit an appeal to Chris Frenz (email to
Page 15 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
christopher.frenz@state.co.us), Procurement Director, Division of Contracts and
Procurement, Department of Human Services, who will review the appeal and
make a final determination, unless the authority for making this determination
is otherwise specified by law. The sole remedy for Applicants shall be potential
funding depending on availability of funding. The appeal shall be submitted in
writing within five business days after such aggrieved person knows, or should
have known, of the facts giving rise thereto.
9. CORE Registration. Unless otherwise noted, before the Department can award to any
vendor, that vendor must be registered in CORE, which can be completed through Vendor
Self Service at www.colorado.gov/vss.
10. EFT. Awarded vendors are encouraged to sign up for EFT transfers.
11. Secretary of State Registration. Before Contract execution, the awarded vendor must be
registered to do business in the State of Colorado. If a vendor is a foreign corporation
(formed under a statute or common law in a jurisdiction other than Colorado) or other
foreign entity transacting business in the State of Colorado, it shall warrant that it currently
has obtained and shall maintain any applicable certificate of authority to transact business
in the State of Colorado and has designated a registered agent in Colorado to accept service
of process (https://www.sos.state.co.us/biz/BusinessEntityCriteria.do).
12. System for Award Management. Before Contract execution, the awarded vendor(s) must be
registered with the System for Award Management (SAM.eov).
13. Confidentiality. Anything submitted by a vendor is likely to become public information.
Vendors may submit, as a part of its solicitation response, a written request for classification
of certain portions of the response as confidential information. Material for which
confidentiality has been requested shall be readily identifiable and separable from other
portions of the solicitation to facilitate public inspection of the non -confidential portion of
the solicitation response. In no event shall an entire solicitation response be classified as
confidential.
14. Background Checks. Pursuant to C.R.S. §27-90-111 and Department policy, any vendor, and
its agent(s), who has direct contact with vulnerable persons in a state -operated facility, or
who provides state -funded services that involve direct contact with vulnerable persons in
the vulnerable person's home or residence, shall:
a. submit to and successfully pass a criminal background check, and
b. report any arrests, charges, or summonses for any disqualifying offense as
specified by C.R.S. §27-90-111 to the Department.
15. Application Prices. Estimated prices are not acceptable. Best and final offers may be
considered in determining the apparent successful vendor. Applications shall be firm for a
period of not less than 180 calendar days from the date of award.
16. Cancellation. A solicitation may be canceled only when there are cogent and compelling
reasons to believe that the cancellation of the solicitation is in the state's best interest. An
Page 16 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
award of a contract under a solicitation may be canceled, in whole or in part, when the
procurement official determines in writing that such action is in the state's best interest.
17. Costs. The Department is not liable for any cost incurred by vendors prior to any formal
contract, purchase order, or other agreement. No property interest of any nature shall
occur until a contract is signed by all concerned parties.
18. Appliotion Rejection. The Department may reject an application, waive informalities, and
minor irregularities, or accept any portion.
19. Tax ID. Any tax identification number provided must be that of the vendor responding to
the solicitation. The vendor must be a legal entity with the legal right to contract.
20. News Releases. Vendors may not issue any news releases pertaining to this solicitation
without the Department's prior written approval.
21. Taxes. The Department is exempt from all federal excise taxes under Chapter 32 of the
Internal Revenue Code (Registration No. 84-730123K) and from all state and local
government use taxes C.R.S. §39-26-114(a). The Colorado State and Local Sales Tax
Exemption Number is 98-02565. When materials are purchased in certain political
subdivisions (for example - City of Denver), the vendor may be required to pay sales tax
even though the ultimate product or service is provided to the State of Colorado. This sales
tax will not be reimbursed by the State.
22. E -Verify. Vendors must participate in the federal E -Verify program, or the Colorado
Departrnent of Labor and Employment Program as required by C.R.S. §8-17.5-101.
23. Services Outside of Colorado or the United States. Vendors must disclose services
performed outside of Colorado or the United States as required by C.R.S. §24-102-206.
24. Notice to Nonresident Bidders. If a nonresident vendor is from a state that provides a
bidding preference to vendors from that state, then a comparable percentage disadvantage
will be applied to the bid of that nonresident vendor pursuant to C.R.S. §24-103-908. The
vendor may obtain additional information from the department of personnel's website.
[The rest of this page intentionally left blank]
Page 17 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
bivision of Contracts and Procurement (v. 6/22)
K. Exhibit List
• Exhibit A- Statement of Work (For Review Only)
• Exhibit B-1 - 1281 CYF Grant Application Workbook for Capacity Type Budgets (Complete and
Submit either B1 or B2)
• Exhibit B-2 - 1281 CYF Grant Application Workbook for Deliverable Type Budgets (Complete and
Submit either 61 or B2)
• Exhibit C- HIPAA Business Associate Addendum - Qualified Service Organization Addendum (For
Review Only)
Exhibit D1 - State and Local Fiscal Recovery Funds - Subrecipient Provisions (For Review Only)
Exhibit D2 - State and Local Fiscal Recovery Funds - Contractor Provisions (For Review Only)
Exhibit E - Miscellaneous Provisions (For Review Only)
Exhibit F - Supplemental Provisions for Federal Awards (For Review Only)
Exhibit G - CDHS Personal Services Contract Template (For Review Only)
L. References and Resources
RFA 22-1281 Children, Youth and Family Applicant Questions Form:
https://docs.google.com/forms/d/e/1FAIpQLSfc0xgiDBFZalec HiXppXDNf4b0vYS6ItrRQFi0Lyg3Lu
7KOA/viewform
Link to the Recording of the Pre -application conference held November 29, 2022:
o https://www.youtube.com/watch?v=CAYs1IQu1hQ
o PowerPoint presentation from pre -application conference:
https://docs.google.com/presentation/d/iXiBk3hQECsVrH EH Hz-
raulOMy5gTOfi6/edit#slide=id.p2
House Bill 22-1281: https://leg.colorado.gov/sites/default/files/2022a 1281 signed.pdf
Community Assessment Toolkit:
https://experience.a rcgis.com/experience/d278a3c436464b3f8a 141c66beff74f9/page/Home-
Page/#layout 1406 block 4
Grant Writing Assistance - Colorado Consortium for Prescription Drug Abuse:
https://corxconsortiu m.org/wp-content/uploads/Grant-W riting-Assistance-Gu ide-1.5.22. pdf
Technical Assistance Form:
https://docs.google.com/forms/d/e/1FAIpQL5eHTevBBJd4mxClfDMcNfInZ4VW MQcRkl UoghZJB
SX4PdaoLQ/viewform
Page 18 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
The Consortium — List of Rural and Frontier Counties in Colorado:
https://corxconsortium.org/wp-content/uploads/County-list.pdf
CRC GrantCorps: https://crcamerica.org/grantcorps/
Regional Ctpioid Settlement Plan:
https://coag.gov/opioids/#:^':text=In%20August%202021%2C%20after%20announcing,% C%20r
ecovery%2C%20and%20prevention%20programs.
ASO Regions:
https://tableau.state.co.us/t/CDOBH Ext/views/OBH CMHC MSO ASO UpdatedMap/Provider
Maps-ASO?%3Aembed=y&%3AisGuestRedirectFromVizportal=y
https://crcamerica.org/grantcorps/
Culturally and Linguistically Appropriate Services (..fit_51 standards:
https://thinkculturalhealth.hhs.gov/
"Creating a Culture of Equity," Advancing Health Equity. University of Chicago, 2022.
https://www.solvingdisparities.org/tools/roadmap/creating-a-culture-of-equity
o This resource is a white paper on best practices and principles in advancing equity in
health care design and delivery developed by the University of Chicago. This guide is
informational only and does not constitute any official policy of the Behavioral Health
Administration. The recommendations in this resource do not constitute program
requirements.
Page 19 of 20
Colorado Department of Human Services Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
M. Signature Page
Please complete and submit the Signature Page along with the application.
Vendor Name
Weld County Department of Human Services
Vendor Address
315 N. 11th Avenue, Building A; Greeley, CO 80631
Vendor Contact Name
Julie Witkowski, Family Resource Division Head
Vendor Contact Email
witkowjk@weldgov.com
Vendor Contact Phone
970-400-6777
Does the Vendor have any perceived,
potential, or apparent conflicts of interest? If
so, please disclose them.
No
Is the Vendor a Service Disabled Veteran
Owned Small Business pursuant to C.R.S. §24-
103-905?
No
Is the Vendor currently on any debarred list?
No
Name of person authorized to submit this
application
Julie Witkowski
Signature from an authorized individual.
Signatures may be physical or electronic as
defined by the Uniform Electronic
Transactions Act. Some examples of
acceptable signatures are DocuSign, Adobe,
or scanned physical copies.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
if\SC&Uz—s—,--
Mike Freeman, Chair JAN 1 1 2023
Colorado Department of Human Services
ATTEST:
Weld C
BY:
Deputy
ddrittA) .161.;ok
C
Clerk to the Board
Page 20 of 20
Solicitation Number: RFP IBEH 2023000171
Division of Contracts and Procurement (v. 6/22)
2923-d1!�
Exhibit A - Statement of Work
Children, Youth, and Family Behavioral Health Services Grants
Article 1
Purpose and Target Population
1.1 Purpose
In accordance with 27-60-502, C.R.S., the Behavioral Health Administration (BHA) awards grants
to local governments, community -based organizations, federally -recognized Indian tribes, local
collaborative management programs, local juvenile services planning committees, and
nonprofit organizations for programs and services along the behavioral health care continuum
in areas of highest need and to address gaps in services, including children -oriented, youth -
oriented, and family -oriented behavioral health care services. The purpose of the grant
program is to expand or implement services that have been identified as gaps in Child, Youth,
and Family (CYF)-oriented behavioral health care and to improve outcomes for individuals
served.
1.2 Target Population
The target population includes persons eighteen (18) years of age or younger and their families
and persons twenty-one (21) years of age or younger who are receiving special education
services and their families pursuant to Part 1 of Article 20 of Title 22 s who have behavioral
health problems, including parent -child dyads, with acute, complex, and/or severe conditions
and needs.
Article 2
Definitions and Acronyms
Administrative Services Organizations (ASO) are organizations contracted by the Behavioral
Health Administration to administer and manage regional behavioral health crisis services.
Behavioral Health Administration (BHA) means the Behavioral Health Administration
established in section 27-60-203.
Behavioral Health Administrative Services Region means a Behavioral Health Administrative
Services Region designated by the BHA Commissioner after consultation with the Department
of Health Care Policy and Financing and consideration of the regional structure that serves the
Medicaid population.
Behavioral Health -Care Services Assessment Tool means the assessment tool described in
section 27-60-502 (1)(c) developed by the BHA to identify regional gaps in behavioral health-
care services.
Page 1 of 6
Care Access Point means a location at which a person seeking behavioral health care can
receive care coordination.
Community -Based Organization means a nonprofit or for-profit organization that provides
behavioral health-care services.
Grant Program means the community behavioral health-care continuum gap grant program
established in C.R.S 27-60-502.
Local Education Provider means a school district, a charter school authorized pursuant to part 1
of article 30.5 of Title 22, and Institute charter school authorized pursuant to part 5 of article
30.5 of title 22, or a Board of Cooperative Services as defined in C.R.S. 22-5-103.
Local Government means a county, municipality, city and county, or local education provider.
Managed Services Organizations (MSO) are organizations designated and contracted by the
Behavioral Health Administration to administer and manage a full continuum of SUD
prevention, intervention, treatment, recovery, and harm reduction services on a regional basis.
Nonprofit Organization means an organization that is exempt from taxation under Section 501
(c)(3) of the federal "Internal Revenue Code of 1986, as amended.
Regional Accountability Entity (RAE) are organizations in Health First Colorado, Colorado's
Medicaid program. They are responsible for coordinating members' care, ensuring they are
connected with primary and behavioral health care, and developing regional strategies to serve
Colorado Medicaid members.
Statement of Work (SOW)
State Court Administrator's Office (SCAO)
Article 3
Objectives of Grant
3.1 The Contractor shall provide one or more of the following services related to the following
grant objectives outlined below.
a. To expand Child, Youth, and Family (CYF) oriented behavioral health care services;
b. To address identified local behavioral health needs; to establish care access points in
each behavioral health administrative services region;
c. To provide care navigation and coordination services;
d. To expand evidence -based or evidence -informed behavioral health treatment, including
substance use disorder treatment;
Page 2 of 6
e. To provide intensive outpatient services, including high-fidelity wraparound, youth
mobile response, and expanded caregiver interventions;
f. And to fund capital expenditures related to providing the above treatment services.
Article 4
Roles & Responsibilities
4.1 The Grant Application submitted in the RFA shall also serve as a work plan to be used with
this SOW and followed upon execution of the contract to monitor the grant project
performance The activities and services identified in the Grant Application/ work plan are
incorporated into this Contract by reference.
4.2 Contractor will be expected to have the capacity to operationalize the State's contract at
signing and implement delivery of services within sixty (60) days of contract execution and to
spend or obligate any grant money by December 31, 2024.
4.3 Contractor shall maintain clear communication with regards to progress on the submitted
Grant Application Template Work Plan.
4.4 Contractor shall work with providers to identify ongoing payer sources for these services, to
include Medicaid, Medicare, Third -party insurance, etc.
4.5 Contractor shall ensure that any program funded by the grant must comply with the federal
"Americans with Disabilities Act of 1990" and serve individuals with a disability, regardless of
primary diagnosis, co-occurring conditions, if the individual requires assistance with activities of
daily living.
4.6 Contractor shall use the CLAS Standards (https://thinkculturalhealth.hhs.gov/) to help the
organization and programs take into account cultural health beliefs, preferred languages,
health literacy levels, and communication needs.
4.7 Services shall be provided in English and Spanish.
4.8 Period of Performance
a. Overall, Grant deadline to expend all funds December 30, 2024. However, renewal of
contract is subject to approval by the Program Manager for each state fiscal year as
funding allows and compliance to contract performance.
b. State fiscal years end June 30. New fiscal years begin July 1 in which a new contract will
be issued (as funding and contract compliance allow) under guidance and direction of
the Program Manager.
Page 3 of 6
4.9 Grant recipients may use no more than 10% of grant funding for administrative costs, per
HB 22-1281 (27-60-502, C.R.S.).
Article 5
Reporting, Deliverables, & Due Dates
5.1 Contractor shall measure the metrics identified in the Coronavirus State and Local Fiscal
Recovery Funds (SLFRF) Subrecipient Quarterly Report Workbook, as may be amended, per the
terms of Exhibit D-1, SLFRF Subrecipient Provisions Exhibit.
5.2 Contractor shall provide any other narrative or reporting required by Exhibit D-1, SLFRF
Subrecipient Provisions Exhibit, as may be amended.
5.3 Criteria for Acceptance of Deliverables
a. The BHA will review the Contractor's deliverables in accordance with all specifications
stated in this SOW and the Grant Application work plan. Deliverables and overall
performance will be monitored, tracked, inspected and accepted or rejected by the
Program Manager and designated State personnel.
b. The acceptance of deliverables and satisfactory work performance required herein shall
be based on the timeliness, accuracy, and standards as specified in the requirements of
this statement of work and the Grant Application work plan.
5.4 When submitting reports please briefly describe the metrics you are using for the Reports
and Deliverables to demonstrate the impact of your grant on the populations you serve. This
may include the specific data points, tools, process, and frequency with which data will be
collected and reported.
5.5 If making capital purchases, the Contractor shall track and be able to identify grant -
purchased capital assets separate from their own non -grant related capital assets. The
Contractor is required to contact and confirm with the BHA in any circumstance where they
intend to dispose of the asset(s).
5.6 Deliverables Table
Deadline
Activity
Page 4 of 6
30 days after the end of
the grant term
Submit Final Grant Report to include the following:
(a) Information about the use of the grant award, including the
services provided with a grant award and where those services
were provided;
(b) The amount of contributing funds or in -kind contributing
resources that supported the services;
(c) Aggregated demographic information of the individuals who
receive services funded with a grant award;
(d) Whether the recipient is continuing to provide the services, and
any other information requested by the State Department.
60 days prior to contract
renewal or end date
Submit Annual Report to include the following:
(a) Description of Activities performed under grant to include
current practices, development and implementation of work
plan scope, accountability to work plan, certifications, or
commitments regarding follow-up support;
(b) Existing capacity to serve;
(c) Recommendations to increase access to, and coordination of
services;
(d) Services denied or refused and justification;
(e) Timely access to services.
60 days after the end of
Submit Accountability Plan to include the following:
each quarter
(a) Description of grant goals presented in Grant Application to
cover all major services provided, deliverables, procedures for
monitoring accountability;
(b) Description of how funds are being used and providing value to
community through State and Federal grant requirements;
(c) Description of methods used for identifying and preventing
issues with the quality of services provided through this grant;
(d) Corrective actions taken, or to be implemented when goals are
not being met;
(e) Describe records to be kept to document accountability plan
and actions taken.
Page 5 of 6
60 days after the end of
each quarter
Submit ARPA Output and Outcomes Report to include the following:
(a) Capacity increase supported by this funding will be measured
by the number of new CYF-oriented BH programs created
and/or the expansion of current CYF-oriented BH programs.
Contractors shall report the number of beds created or
expanded, and existing providers shall report baseline numbers
of existing beds;
(b) Improved access to care supported by this funding will be
measured by the number of unduplicated clients served and
the number of services delivered. Contractors shall report
quarterly the number of unduplicated clients served and the
number of services provided. Existing providers shall report
baseline numbers of unduplicated clients served and services
provided.
(c) For capital expenditures greater than $1 million ONLY - Provide
justification and provide progress of capital expenditure.
60 days after the end of
each quarter
Submit Program Report to include the following:
(a) Information about the use of a grant award and where those
services were provided;
(b) The amount of contributing funds or in -kind contributing
resources that support the services;
(c) Aggregated demographic information of the individuals who
received services funded with a grant award;
(d) Whether the recipient is continuing to provide the services.
Method of Report Delivery (emailed to cdhs BHAdeliverables@state.co.us)
*Deadlines occurring after June 30, 2023, are contingent upon contract renewal.
Page 6 of 6
EXHIBIT B
COLORADO
Behavioral Health
Administration
EXHIBIT B, FY23 ANNUAL BUDGET
Capacity Budget Template
BHA Program
Children. Youth, Family Services Grants,
I t1322-1281
Contact Information
Agency Name
Budget Period
07/01/2024
- 1
2/30/2024
Project Name
Program Contact Name, Title
Phone
Email
Final Contract Name. Title
Phone
Email
Date Completed
All budget numbers arc estimates. Contract billing hill be on a cost reimbursement basis for actual expenses incurred.
EXPENDITURE CATEGORIES
Personnel Services: Salary/Benefits
Annual Budget
Position Title
Description of Work
Gross or
Annual
Salary
Fringe
Percent of
Time on
Project
Total Amount
Requested from BHA
$
$
S
$
$ .
$
S
$
$
$
$
S -
S
S
S
S
Personnel Services -Hourly Employees
Annual Budget
Position Title
Description of Work
Hourly
Wage
Hourly
Fringe
Hours on
Project
Total Amount
Requested from BHA
S
S
S
$
$
S
S -
S
S
Total Personnel Services
(including fringe benefits)
$ -
Client Costs
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount
Requested from BHA
$
$
$
$
S
5
S
5
$
Total Client Costs
$ -
Contract/Consultants Services (Subawards & Subcontracts,
Annual Budget
Name
Description of Work
Rate
Quantity
Total Amount
Requested from BHA
$
$
$
S
$
S
S -
$
Total Contract Services
$ -
Occupancy
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount
Requested from BHA
S
S
S
$
Total Occupancy
$ -
Operating
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount
Requested from BHA
S
S
DO NOT enter your own formulas
2 CFT § 200.92-Subaward means an award
provided by a pass -through entity to subrecipient
for the subrecipient to carry out part of a Federal
award received by the pass -through entity . A
subaward may be provided through any form of
legal agreement, including an agreement that the
pass -through entity considers a contract.
Page 1 of
Last update 05_31_2022
EXHIBIT B
S
$
S
S
Total Operating
$ -
Depreciation/Amortization
Annual Budget
Item
Description of Item
Total Amount
Requested from BHA
50.00
50.00
$0.00
50.00
50.00
50.00
50.00
50.00
Total Depreciation/Amortization
$ -
Professional Fees
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount
Requested from BHA
S
S
S
S -
S
Total Professional Fees
$ -
Capital Costs
Annual Budget
Item
Description of Item
Rate
Quantity
Total Amount
Requested from BHA
S -
S -
S
S
Total Capital Costs
$ -
TOTAL DIRECT COSTS (TDC)
$
Exclusions from Indirect Cost Base expenses per OMB 2CFR § 200
Subaward in excess of $25.000
Rent
Equipment (over S5000)
Other Unallowable Expenses (not allowed a direct cost) such as land, real estate purchase etc
Total Expenses per OMB 2CFR § 200
$ -
MODIFIED TOTAL DIRECT COSTS (MTDC)
$ -
Indirect Costs
Annual Budget
Rem
Description of Item
Percentage
Total Amount
Requested from BHA
S
Total Indirect
S -
Grand Total Expenses
$ -
Match Requirement Chart: Size of Organization & Award amount
Match Requirement
Organization Annual Budget Size
Percentage Match
Requirement on grant
award
SELECT YOUR
MATCH AMOUNT
large org
$20,000,000 or more
5%
small
less than 520.000,000
2.5%
?.5`!;
Award of $50,000
or less
any size
0%
MATCH
AMOUNT
REQUIRED
$ -
Match Amount Required must be listed below in Revenue Offset and/ or Matching Funds
Revenue Offset
j Annual Budget
Client Services
Medicaid ree for Service Cash
S
Medicaid Capitation Encounters
valued at the Cost Per Unit of Service per unit Cost Report of Negotiated Rates received from Regional
S -
BHA Indigent Encounters"
S
3rd Party Insurance Cash Receipts
S -
Medicare Cash
S
Self-Pay/Client Fees
S
Cash from other Sources: (Specify below)
S
S
S
Total Client Services
$ -
"The rate that your entity is receiving must be used to offset costs in this area
"Encounters valued using the current year's fee for services schedule issued by BHA and not to exceed contract amount
Matching Funds
Contracts and Grants
Non -Governmental Contracts
S
Other State Revenue/Accrual
S
Federal Grant Funds/Accrual
Local =unds/Accrual
S -
Private Grant Funds/Accrual
S -
Public Support
S -
Private Support
S -
In -Kind Donations
S -
S
Other Funds (Specify below)
S
S
S
Total Contracts and Grants
S -
Grand Total Revenue Offset
S -
Net Cost
$ -
The Parties may mutually agree in writing, to modify the Budget administratively using an BHA Budget Reallocation form
This is the amount the BHA will award for the grant project
Page 2 of Last update 05_31-2022
Exhibit B
CetiIP
COLORADO
Behavioral Health
Administration
EXHIBIT 13, FY23 ANNUAL BUDGET
Deliverable Budget Template
BHA Program
Children. Youth, Family Services Grants,
HB22-1281
Contact Information
Agency Name
Budget Period
07/01/2024 - 12/30/2024
Project Name
Program Contact Name, Title
Phone
Email
Fiscal Contract Name, Title
Phone
Email
Date Completed
All contract deliscc:Mks must 1w received In contract term end of
Contract - Fixed Deliverables
Deliverable
Description of Work
Measurement
Rate or
Charge
Hours
or Units
Total Requested
from BHA
Total Fixed Deliverable based costs
-
Match Requirement Chart: Size of Organization & Award amount
Match
Requirement
Organization Annual Budget Size
Percentage Match
Requirement on grant
large org.
$20,000,000 or more
5%
small
less than $20,000,000
2.5%
Award of
$50,000 or less
any size
0%
MATCH AMOUNT
SELECT YOUR
MATCH
AMOUNT
5.00%
Match Amount Required must be listed below in Revenue Offset and/ or Matching Funds
Revenue Offset
Annual Budget
Client Services Offsets
Medicaid Fee for Service Cash
-
Medicaid Capitation Encounters
.a+ued a: :he Cost Per Unit of Service per unit Cost Report of Negotiated Rates received from Regional Accountable Entity (RAE)'
-
Indigent Encounters"
$0 00
3rd Party Insurance Cash Receipts
-
Medicare Cash
-
Self-Pay/Client Fees
Cash from other Sources: (Specify below)
_
Total Client Services
SO 00
`The rate that your entity is receiving must be used to offset costs in this area
"Encounters valued using the current year's fee for services schedule issued by and not to exceed contract amount
Matching Funds
Contracts and Grants Offsets
MSO Revenue
-
Non -Governmental Contracts
_
Other State Revenue/Accrual
_
Federal Grant Funds/Accrual
_
Local Funds/Accrual
50.00
Private Grant Funds/Accrual
_
Public Support
_
Private Support
_
In -Kind Donations
Required Match Funds
Other Funds (Specify below)
-
Total Contracts and Grants
$0.00
Grand Total Revenue Offset
$0.00
Total
Budget Amount
$0.00
Travel, Supplies, Operating and Indirect should be included in your deliverables
Do not alter equations
This is the amount the BHA will award for the grant project
of
Edited: 08_02_2022
Exhibit C - HIPAA BUSINESS ASSOCIATE AGREEMENT
This HIPAA Business Associate Agreement ("Agreement") between the State and Contractor is agreed to in
connection with, and as an exhibit to, the Contract. For purposes of this Agreement, the State is referred to as
"Covered Entity" and the Contractor is referred to as "Business Associate". Unless the context clearly requires a
distinction between the Contract and this Agreement, all references to "Contract" shall include this Agreement.
1. PURPOSE
Covered Entity wishes to disclose information to Business Associate, which may include Protected Health
Information ("PHI"). The Parties intend to protect the privacy and security of the disclosed PHI in compliance
with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Pub. L. No. 104-191 (1996) as
amended by the Health Information Technology for Economic and Clinical Health Act ("HITECH Act") enacted
under the American Recovery and Reinvestment Act of 2009 ("ARRA") Pub. L. No. 111-5
(2009), implementing regulations promulgated by the U.S. Department of Health and Human Services at 45
C.F.R. Parts 160, 162 and 164 (the "HIPAA Rules") and other applicable laws, as amended. Prior to the
disclosure of PHI, Covered Entity is required to enter into an agreement with Business Associate containing
specific requirements as set forth in, but not limited to, Title 45, Sections 160.103, 164.502(e) and 164.504(e) of
the Code of Federal Regulations ("C.F.R.") and all other applicable laws and regulations, all as may be amended.
2. DEFINITIONS
The following terms used in this Agreement shall have the same meanings as in the HIPAA Rules: Breach, Data
Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary,
Notice of Privacy Practices, Protected Health Information, Required by Law, Secretary, Security Incident,
Subcontractor, Unsecured Protected Health Information, and Use.
The following terms used in this Agreement shall have the meanings set forth below:
a. Business Associate. "Business Associate" shall have the same meaning as the term "business
associate" at 45 C.F.R. 160.103, and shall refer to Contractor.
b. Covered Entity. "Covered Entity" shall have the same meaning as the term "covered entity" at 45
C.F.R. 160.103, and shall refer to the State.
c. Information Technology and Information Security. "Information Technology" and "Information
Security" shall have the same meanings as the terms "information technology" and "information
security", respectively, in §24-37.5-102, C.R.S.
Capitalized terms used herein and not otherwise defined herein or in the HIPAA Rules shall have the meanings
ascribed to them in the Contract.
3. OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE
a. Permitted Uses and Disclosures.
i. Business Associate shall use and disclose PHI only to accomplish Business Associate's
obligations under the Contract.
Page 1 of 9
HIPAA BAA
Revised August 2018
i. To the extent Business Associate carries out one or more of Covered Entity's obligations
under Subpart E of 45 C.F.R. Part 164, Business Associate shall comply with any and all
requirements of Subpart E that apply to Covered Entity in the performance of such obligation.
ii. Business Associate may disclose PHI to carry out the legal responsibilities of Business
Associate, provided, that the disclosure is Required by Law or Business Associate obtains
reasonable assurances from the person to whom the information is disclosed that:
A. the information will remain confidential and will be used or disclosed only as
Required by Law or for the purpose for which Business Associate originally
disclosed the information to that person, and;
B. the person notifies Business Associate of any Breach involving PHI of which it is
aware.
iii. Business Associate may provide Data Aggregation services relating to the Health Care
Operations of Covered Entity. Business Associate may de -identify any or all PHI created or
received by Business Associate under this Agreement, provided the de -identification
conforms to the requirements of the HIPAA Rules.
b. Minimum Necessary. Business Associate, its Subcontractors and agents, shall access, use, and
disclose only the minimum amount of PHI necessary to accomplish the objectives of the Contract, in
accordance with the Minimum Necessary Requirements of the HIPAA Rules including, but not
limited to, 45 C.F.R. 164.502(b) and 164.514(d).
c. Impermissible Uses and Disclosures.
i. Business Associate shall not disclose the PHI of Covered Entity to another covered entity
without the written authorization of Covered Entity.
ii. Business Associate shall not share, use, disclose or make available any Covered Entity PHI in
any form via any medium with or to any person or entity beyond the boundaries or
jurisdiction of the United States without express written authorization from Covered Entity.
d. Business Associate's Subcontractors.
Business Associate shall, in accordance with 45 C.F.R. 164.502(e)(1)(ii) and 164.308(b)(2),
ensure that any Subcontractors who create, receive, maintain, or transmit PHI on behalf of
Business Associate agree in writing to the same restrictions, conditions, and requirements that
apply to Business Associate with respect to safeguarding PHI.
ii. Business Associate shall provide to Covered Entity, on Covered Entity's request, a list of
Subcontractors who have entered into any such agreement with Business Associate.
iii. Business Associate shall provide to Covered Entity, on Covered Entity's request, copies of
any such agreements Business Associate has entered into with Subcontractors.
e. Access to System. If Business Associate needs access to a Covered Entity Information Technology
system to comply with its obligations under the Contract or this Agreement, Business Associate shall
request, review, and comply with any and all policies applicable to Covered Entity regarding such
Page 2 of 9
HIPAA BAA
Revised August 2018
system including, but not limited to, any policies promulgated by the Office of Information
Technology and available at http://oit.state.co.us/about/policies.
f. Access to PHI. Business Associate shall, within ten days of receiving a written request from Covered
Entity, make available PHI in a Designated Record Set to Covered Entity as necessary to satisfy
Covered Entity's obligations under 45 C.F.R. 164.524.
g.
Amendment of PHI.
Business Associate shall within ten days of receiving a written request from Covered Entity
make any amendment to PHI in a Designated Record Set as directed by or agreed to by
Covered Entity pursuant to 45 C.F.R. 164.526, or take other measures as necessary to satisfy
Covered Entity's obligations under 45 C.F.R. 164.526.
ii. Business Associate shall promptly forward to Covered Entity any request for amendment of
PHI that Business Associate receives directly from an Individual.
h. Accounting Rights. Business Associate shall, within ten days of receiving a written request from
Covered Entity, maintain and make available to Covered Entity the information necessary for
Covered Entity to satisfy its obligations to provide an accounting of Disclosure under 45 C.F.R.
164.528.
i. Restrictions and Confidential Communications.
J.
i. Business Associate shall restrict the Use or Disclosure of an Individual's PHI within ten days
of notice from Covered Entity of:
A. a restriction on Use or Disclosure of PHI pursuant to 45 C.F.R. 164.522; or
B. a request for confidential communication of PHI pursuant to 45 C.F.R. 164.522.
ii. Business Associate shall not respond directly to an Individual's requests to restrict the Use or
Disclosure of PHI or to send all communication of PHI to an alternate address.
iii. Business Associate shall refer such requests to Covered Entity so that Covered Entity can
coordinate and prepare a timely response to the requesting Individual and provide direction to
Business Associate.
Governmental Access to Records. Business Associate shall make its facilities, internal practices,
books, records, and other sources of information, including PHI, available to the Secretary for
purposes of determining compliance with the HIPAA Rules in accordance with 45 C.F.R. 160.310.
k. Audit, Inspection and Enforcement.
Business Associate shall obtain and update at least annually a written assessment performed
by an independent third party reasonably acceptable to Covered Entity, which evaluates the
Information Security of the applications, infrastructure, and processes that interact with the
Covered Entity data Business Associate receives, manipulates, stores and distributes. Upon
request by Covered Entity, Business Associate shall provide to Covered Entity the executive
summary of the assessment.
Page 3 of 9
HIPAA BAA
Revised August 2018
ii. Business Associate, upon the request of Covered Entity, shall fully cooperate with Covered
Entity's efforts to audit Business Associate's compliance with applicable HIPAA Rules. If,
through audit or inspection, Covered Entity determines that Business Associate's conduct
would result in violation of the HIPAA Rules or is in violation of the Contract or this
Agreement, Business Associate shall promptly remedy any such violation and shall certify
completion of its remedy in writing to Covered Entity.
I. Appropriate Safeguards.
i. Business Associate shall use appropriate safeguards and comply with Subpart C of 45 C.F.R.
Part 164 with respect to electronic PHI to prevent use or disclosure of PHI other than as
provided in this Agreement.
ii. Business Associate shall safeguard the PHI from tampering and unauthorized disclosures.
iii. Business Associate shall maintain the confidentiality of passwords and other data required for
accessing this information.
iv. Business Associate shall extend protection beyond the initial information obtained from
Covered Entity to any databases or collections of PHI containing information derived from
the PHI. The provisions of this section shall be in force unless PHI is de -identified in
conformance to the requirements of the HIPAA Rules.
m. Safeguard During Transmission.
Business Associate shall use reasonable and appropriate safeguards including, without
limitation, Information Security measures to ensure that all transmissions of PHI are
authorized and to prevent use or disclosure of PHI other than as provided for by this
Agreement.
ii. Business Associate shall not transmit PHI over the internet or any other insecure or open
communication channel unless the PHI is encrypted or otherwise safeguarded with a FIPS-
compliant encryption algorithm.
Reporting of Improper Use or Disclosure and Notification of Breach.
Business Associate shall, as soon as reasonably possible, but immediately after discovery of a
Breach, notify Covered Entity of any use or disclosure of PHI not provided for by this
Agreement, including a Breach of Unsecured Protected Health Information as such notice is
required by 45 C.F.R. 164.410 or a breach for which notice is required under §24-73-103,
C.R.S.
ii. Such notice shall include the identification of each Individual whose Unsecured Protected
Health Information has been, or is reasonably believed by Business Associate to have been,
accessed, acquired, or disclosed during such Breach.
iii. Business Associate shall, as soon as reasonably possible, but immediately after discovery of
any Security Incident that does not constitute a Breach, notify Covered Entity of such
incident.
Page 4 of 9
HIPAA BAA
Revised August 2018
iv. Business Associate shall have the burden of demonstrating that all notifications were made as
required, including evidence demonstrating the necessity of any delay.
o. Business Associate's Insurance and Notification Costs.
i. Business Associate shall bear all costs of a Breach response including, without limitation,
notifications, and shall maintain insurance to cover:
A. loss of PHI data;
B. Breach notification requirements specified in HIPAA Rules and in §24-73-103,
C.R.S.; and
C. claims based upon alleged violations of privacy rights through improper use or
disclosure of PHI.
ii. All such policies shall meet or exceed the minimum insurance requirements of the Contract
or otherwise as may be approved by Covered Entity (e.g., occurrence basis, combined single
dollar limits, annual aggregate dollar limits, additional insured status, and notice of
cancellation).
iii. Business Associate shall provide Covered Entity a point of contact who possesses relevant
Information Security knowledge and is accessible 24 hours per day, 7 days per week to assist
with incident handling.
iv. Business Associate, to the extent practicable, shall mitigate any harmful effect known to
Business Associate of a Use or Disclosure of PHI by Business Associate in violation of this
Agreement.
P.
q.
Subcontractors and Breaches.
Business Associate shall enter into a written agreement with each of its Subcontractors and
agents, who create, receive, maintain, or transmit PHI on behalf of Business Associate. The
agreements shall require such Subcontractors and agents to report to Business Associate any
use or disclosure of PHI not provided for by this Agreement, including Security Incidents and
Breaches of Unsecured Protected Health Information, on the first day such Subcontractor or
agent knows or should have known of the Breach as required by 45 C.F.R. 164.410.
ii. Business Associate shall notify Covered Entity of any such report and shall provide copies of
any such agreements to Covered Entity on request.
Data Ownership.
i. Business Associate acknowledges that Business Associate has no ownership rights with
respect to the PHI.
ii. Upon request by Covered Entity, Business Associate immediately shall provide Covered
Entity with any keys to decrypt information that the Business Association has encrypted and
maintains in encrypted form, or shall provide such information in unencrypted usable form.
Page 5 of 9
HIPAA BAA
Revised August 2018
r. Retention of PHI. Except upon termination of this Agreement as provided in Section 5, below,
Business Associate and its Subcontractors or agents shall retain all PHI throughout the term of this
Agreement, and shall continue to maintain the accounting of disclosures required under Section 3.h,
above, for a period of six years.
4. OBLIGATIONS OF COVERED ENTITY
a. Safeguards During Transmission. Covered Entity shall be responsible for using appropriate
safeguards including encryption of PHI, to maintain and ensure the confidentiality, integrity, and
security of PHI transmitted pursuant to this Agreement, in accordance with the standards and
requirements of the HIPAA Rules.
b. Notice of Changes.
Covered Entity maintains a copy of its Notice of Privacy Practices on its website. Covered
Entity shall provide Business Associate with any changes in, or revocation of, permission to use
or disclose PHI, to the extent that it may affect Business Associate's permitted or required uses
or disclosures.
ii. Covered Entity shall notify Business Associate of any restriction on the use or disclosure of
PHI to which Covered Entity has agreed in accordance with 45 C.F.R. 164.522, to the extent
that it may affect Business Associate's permitted use or disclosure of PHI.
5. TERMINATION
a. Breach.
i. In addition to any Contract provision regarding remedies for breach, Covered Entity shall
have the right, in the event of a breach by Business Associate of any provision of this
Agreement, to terminate immediately the Contract, or this Agreement, or both.
ii. Subject to any directions from Covered Entity, upon termination of the Contract, this
Agreement, or both, Business Associate shall take timely, reasonable, and necessary action to
protect and preserve property in the possession of Business Associate in which Covered
Entity has an interest.
b. Effect of Termination.
i. Upon termination of this Agreement for any reason, Business Associate, at the option of
Covered Entity, shall return or destroy all PHI that Business Associate, its agents, or its
Subcontractors maintain in any form, and shall not retain any copies of such PHI.
ii. If Covered Entity directs Business Associate to destroy the PHI, Business Associate shall
certify in writing to Covered Entity that such PHI has been destroyed.
iii. If Business Associate believes that returning or destroying the PHI is not feasible, Business
Associate shall promptly provide Covered Entity with notice of the conditions making return
or destruction infeasible. Business Associate shall continue to extend the protections of
Page 6 of 9
HIPAA BAA
Revised August 2018
Section 3 of this Agreement to such PHI, and shall limit further use of such PHI to those
purposes that make the return or destruction of such PHI infeasible.
6. INJUNCTIVE RELIEF
Covered Entity and Business Associate agree that irreparable damage would occur in the event Business
Associate or any of its Subcontractors or agents use or disclosure of PHI in violation of this Agreement, the
HIPAA Rules or any applicable law. Covered Entity and Business Associate further agree that money damages
would not provide an adequate remedy for such Breach. Accordingly, Covered Entity and Business Associate
agree that Covered Entity shall be entitled to injunctive relief, specific performance, and other equitable relief to
prevent or restrain any Breach or threatened Breach of and to enforce specifically the terms and provisions of this
Agreement.
7. LIMITATION OF LIABILITY
Any provision in the Contract limiting Contractor's liability shall not apply to Business Associate's liability under
this Agreement, which shall not be limited.
8. DISCLAIMER
Covered Entity makes no warranty or representation that compliance by Business Associate with this Agreement
or the HIPAA Rules will be adequate or satisfactory for Business Associate's own purposes. Business Associate
is solely responsible for all decisions made and actions taken by Business Associate regarding the safeguarding of
PHI.
9. CERTIFICATION
Covered Entity has a legal obligation under HIPAA Rules to certify as to Business Associate's Information
Security practices. Covered Entity or its authorized agent or contractor shall have the right to examine Business
Associate's facilities, systems, procedures, and records, at Covered Entity's expense, if Covered Entity
determines that examination is necessary to certify that Business Associate's Information Security safeguards
comply with the HIPAA Rules or this Agreement.
10. AMENDMENT
a. Amendment to Comply with Law. The Parties acknowledge that state and federal laws and
regulations relating to data security and privacy are rapidly evolving and that amendment of this
Agreement may be required to provide procedures to ensure compliance with such developments.
i. In the event of any change to state or federal laws and regulations relating to data security
and privacy affecting this Agreement, the Parties shall take such action as is necessary to
implement the changes to the standards and requirements of HIPAA, the HIPAA Rules
and other applicable rules relating to the confidentiality, integrity, availability and
security of PHI with respect to this Agreement.
ii. Business Associate shall provide to Covered Entity written assurance satisfactory to
Covered Entity that Business Associate shall adequately safeguard all PHI, and obtain
Page 7 of 9
HIPAA BAA
Revised August 2018
written assurance satisfactory to Covered Entity from Business Associate's
Subcontractors and agents that they shall adequately safeguard all PHI.
iii. Upon the request of either Party, the other Party promptly shall negotiate in good faith the
terms of an amendment to the Contract embodying written assurances consistent with the
standards and requirements of HIPAA, the HIPAA Rules, or other applicable rules.
iv. Covered Entity may terminate this Agreement upon 30 days' prior written notice in the event
that:
A. Business Associate does not promptly enter into negotiations to amend the Contract
and this Agreement when requested by Covered Entity pursuant to this Section; or
B. Business Associate does not enter into an amendment to the Contract and this
Agreement, which provides assurances regarding the safeguarding of PHI sufficient,
in Covered Entity's sole discretion, to satisfy the standards and requirements of the
HIPAA, the HIPAA Rules and applicable law.
b. Amendment of Appendix. The Appendix to this Agreement may be modified or amended by the
mutual written agreement of the Parties, without amendment of this Agreement. Any modified or
amended Appendix agreed to in writing by the Parties shall supersede and replace any prior version
of the Appendix.
11. ASSISTANCE IN LITIGATION OR ADMINISTRATIVE PROCEEDINGS
Covered Entity shall provide written notice to Business Associate if litigation or administrative proceeding is
commenced against Covered Entity, its directors, officers, or employees, based on a claimed violation by
Business Associate of HIPAA, the HIPAA Rules or other laws relating to security and privacy or PHI. Upon
receipt of such notice and to the extent requested by Covered Entity, Business Associate shall, and shall cause its
employees, Subcontractors, or agents assisting Business Associate in the performance of its obligations under the
Contract to, assist Covered Entity in the defense of such litigation or proceedings. Business Associate shall, and
shall cause its employees, Subcontractor's and agents to, provide assistance, to Covered Entity, which may
include testifying as a witness at such proceedings. Business Associate or any of its employees, Subcontractors or
agents shall not be required to provide such assistance if Business Associate is a named adverse party.
12. INTERPRETATION AND ORDER OF PRECEDENCE
Any ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is consistent with the
HIPAA Rules. In the event of an inconsistency between the Contract and this Agreement, this Agreement shall
control. This Agreement supersedes and replaces any previous, separately executed HIPAA business associate
agreement between the Parties.
13. SURVIVAL
Provisions of this Agreement requiring continued performance, compliance, or effect after termination shall
survive termination of this contract or this agreement and shall be enforceable by Covered Entity.
Page 8 of 9
HIPAA BAA
Revised August 2018
APPENDIX TO HIPAA BUSINESS ASSOCIATE AGREEMENT
This Appendix ("Appendix") to the HIPAA Business Associate Agreement ("Agreement") is s an appendix to the
Contract and the Agreement. For the purposes of this Appendix, defined terms shall have the meanings ascribed
to them in the Agreement and the Contract.
Unless the context clearly requires a distinction between the Contract, the Agreement, and this Appendix, all
references to "Contract" or "Agreement" shall include this Appendix.
1. PURPOSE
This Appendix sets forth additional terms to the Agreement. Any sub -section of this Appendix marked as
"Reserved" shall be construed as setting forth no additional terms.
2. ADDITIONAL TERMS
a. Additional Permitted Uses. In addition to those purposes set forth in the Agreement, Business
Associate may use PHI for the following additional purposes:
i. Reserved.
b. Additional Permitted Disclosures. In addition to those purposes set forth in the Agreement, Business
Associate may disclose PHI for the following additional purposes:
i. Reserved.
c. Approved Subcontractors. Covered Entity agrees that the following Subcontractors or agents of
Business Associate may receive PHI under the Agreement:
Reserved.
d. Definition of Receipt of PHI. Business Associate's receipt of PHI under this Contract shall be
deemed to occur, and Business Associate's obligations under the Agreement shall commence, as
follows:
i. Reserved.
e. Additional Restrictions on Business Associate. Business Associate agrees to comply with the
following additional restrictions on Business Associate's use and disclosure of PHI under the
Contract:
i. Reserved.
f. Additional Terms. Business Associate agrees to comply with the following additional terms under the
Agreement:
i. Reserved.
Page 9 of 9
HIPAA BAA
Revised August 2018
V.4
a
COLORADO
Financial Services
De,Oneni d Pitman Semen
...ton of Contracts and Procurement.
EXHIBIT D-1 - SLFRF SUBRECIPIENT PROVISIONS (CDHS)
This Exhibit and the Appendices hereto apply regarding the use of State and Local Fiscal Recovery
Funds (SLFRF) to comply with requirements established by the U.S. Department of Treasury and
the Colorado Department of Personnel & Administration, Office of the State Controller re the
Colorado Department of Human Services (CDHS).
This SLFRF Provisions Exhibit may supplement other Exhibit(s) to the instant Agreement. In the
event that terms on prior Exhibit(s) to the instant Agreement conflict with this SLFRF Provisions
Exhibit, this Exhibit shall control and take precedence.
The Contractor/Vendor/Other Agency entity with which the Colorado Department of Human
Services (CDHS) is contracting per this Agreement may be referred to as "Subrecipient" herein,
the designation per controlling law and mandates. This "Subrecipient" designation shall apply in
this context notwithstanding prior definition(s) of any entity to this agreement as "Contractor" or
any other title.
Subrecipient must agree to and comply with the terms of these SLFRF Provisions in order to
receive and use these funds. Subrecipient shall execute not only the instant Agreement, but also
specifically the Certification Agreement appendix to the instant Exhibit. A failure to also
separately execute the Certification Agreement appendix hereto shall not relieve Subrecipient of
the rules/obligations set forth herein; such a clerical error must be promptly remedied upon
discovery by notifying the CDHS office/program contact, who can then assist with the logistics of
mandatory signing, which shall retroactively apply.
In the event that Subrecipient is/was in receipt of SLFRF funding from CDHS prior to execution
of the instant Exhibit, Subrecipient understands that its obligations set forth herein with regards to
that funding shall retroactively apply.
The regulations and requirements surrounding receipt and use of SLFRF funding is an evolving
subject matter as established by the U.S. Department of Treasury and put into established policy
by the Colorado Department of Personnel & Administration, Office of the State Controller for use
with CDHS Agreements. As such, Subrecipient agrees to execute any additional
Agreements/Amendments as required by CDHS to establish and/or update these procedures.
Subrecipient agrees to accept written notice from CDHS of updates to these requirements and to
comply with same forthwith, even if prior to or without a formal Amendment to the Agreement to
update this Exhibit or the rules/requirements established herein. Regardless, if CDHS requests that
1
V.4
Subrecipient execute an Amendment to formalize implementation of and/or acknowledgment of
updates to this Exhibit, Subrecipient shall promptly comply.
Subrecipient agrees to stay abreast of and comply with the most current iterations of the
requirements re SLFRF funding set forth on https://osc.colorado.gov/american-rescue-plan-act
(see SLFRF Grant Agreement Templates Tab).
APPENDIX 1 TO SLFRF EXHIBIT- BUDGET SUPPLEMENT
1. BUDGET BY US TREASURY EXPENDITURE CATEGORY
1.1 Expenditure Categories identified in this Appendix will determine what is reported on as
outlined in the all following Appendices to this Exhibit.
Project
Number
Project Title
US Treasury Expenditure Category
Number and Name
Budget
Total
2. BUDGET BY FUNCTION
3. EXPENDITURE CATEGORY MODIFICATIONS
1.1 Increases or decreases in any Expenditure Category must be requested and approved by the
State Agency by using the SLFRF Expenditure Modification Form. This form can be found
at: https://osc.colorado.gov/american-rescue-plan-act (see SLFRF Grant Agreement
Templates Tab). In no event may this be used to modify the overall total of this Agreement
or otherwise any non SLFRF expenditures.
APPENDIX 2 TO SLFRF EXHIBIT- FEDERAL PROVISIONS
SUPPLEMENT
1. APPLICABILITY OF PROVISIONS.
1.1. The Grant to which these Federal Provisions are attached has been funded, in whole or in
part, with an Award of Federal funds. In the event of a conflict between the provisions of
these Federal Provisions, the Special Provisions, the body of the Grant, or any attachments
or exhibits incorporated into and made a part of the Grant, the provisions of these Federal
Provisions shall control.
2
V.4
1.2. The State of Colorado is accountable to Treasury for oversight of their subrecipients,
including ensuring their subrecipients comply with the SLFRF statute, SLFRF Award
Terms and Conditions, Treasury's Final Rule, and reporting requirements, as applicable.
1.3. Additionally, any subrecipient that issues a subaward to another entity (2' d tier
subrecipient), must hold the 2❑d tier subrecipient accountable to these provisions and
adhere to reporting requirements.
1.4. These Federal Provisions are subject to the Award as defined in §2 of these Federal
Provisions, as may be revised pursuant to ongoing guidance from the relevant Federal or
State of Colorado agency or institutions of higher education.
2. DEFINITIONS.
2.1. For the purposes of these Federal Provisions, the following terms shall have the
meanings ascribed to them below.
2.1.1. "Award" means an award of Federal financial assistance, and the Grant
setting forth the terms and conditions of that financial assistance, that a non -Federal
Entity receives or administers.
2.1.2. "Entity" means:
2.1.2.1. a Non -Federal Entity;
2.1.2.2. a foreign public entity;
2.1.2.3. a foreign organization;
2.1.2.4. a non-profit organization;
2.1.2.5. a domestic for-profit organization (for 2 CFR parts 25 and 170 only);
2.1.2.6. a foreign non-profit organization (only for 2 CFR part 170) only);
2.1.2.7. a Federal agency, but only as a Subrecipient under an Award or Subaward
to a non -Federal entity (or 2 CFR 200.1); or
2.1.2.8. a foreign for-profit organization (for 2 CFR part 170 only).
2.1.3. "Executive" means an officer, managing partner or any other employee in
a management position.
2.1.4. "Expenditure Category (EC)" means the category of eligible uses as defined
by the US Department of Treasury in "Appendix 1 of the Compliance and
Reporting Guidance, State and Local Fiscal Recovery Funds" report available at
www.treasury.gov.
2.1.5. "Federal Awarding Agency" means a Federal agency providing a Federal
Award to a Recipient as described in 2 CFR 200.1
2.1.6. "Grant" means the Grant to which these Federal Provisions are attached.
2.1.7. "Grantee" means the party or parties identified as such in the Grant to which
these Federal Provisions are attached.
3
V.4
2.1.8. "Non -Federal Entity means a State, local government, Indian tribe,
institution of higher education, or nonprofit organization that carries out a Federal
Award as a Recipient or a Subrecipient.
2.1.9. "Nonprofit Organization" means any corporation, trust, association,
cooperative, or other organization, not including IHEs, that:
2.1.9.1. Is operated primarily for scientific, educational, service, charitable, or
similar purposes in the public interest;
2.1.9.2. Is not organized primarily for profit; and
2.1.9.3. Uses net proceeds to maintain, improve, or expand the operations of the
organization.
2.1.10. "OMB" means the Executive Office of the President, Office of
Management and Budget.
2.1.11. "Pass -through Entity" means a non -Federal Entity that provides a Subaward
to a Subrecipient to carry out part of a Federal program.
2.1.12. "Prime Recipient" means the Colorado State agency or institution of higher
education identified as the Grantor in the Grant to which these Federal Provisions
are attached.
2.1.13. "Subaward" means an award by a Prime Recipient to a Subrecipient funded
in whole or in part by a Federal Award. The terms and conditions of the Federal
Award flow down to the Subaward unless the terms and conditions of the Federal
Award specifically indicate otherwise in accordance with 2 CFR 200.101. The term
does not include payments to a Contractor or payments to an individual that is a
beneficiary of a Federal program.
2.1.14. "Subrecipient" or "Subgrantee" means a non -Federal Entity (or a Federal
agency under an Award or Subaward to a non -Federal Entity) receiving Federal
funds through a Prime Recipient to support the performance of the Federal project
or program for which the Federal funds were awarded. A Subrecipient is subject to
the terms and conditions of the Federal Award to the Prime Recipient, including
program compliance requirements. The term does not include an individual who is
a beneficiary of a federal program.
2.1.15. "System for Award Management (SAM)" means the Federal repository into
which an Entity must enter the information required under the Transparency Act,
which maybe found at http://www.sam.gov. "Total Compensation" means the cash
and noncash dollar value earned by an Executive during the Prime Recipient's or
Subrecipient's preceding fiscal year (see 48 CFR 52.204-10, as prescribed in 48
CFR 4.1403(a)) and includes the following:
2.1.15.1. Salary and bonus;
2.1.15.2. Awards of stock, stock options, and stock appreciation rights, using the
dollar amount recognized for financial statement reporting purposes with
respect to the fiscal year in accordance with the Statement of Financial
4
V.4
Accounting Standards No. 123 (Revised 2005) (FAS 123R), Shared Based
Payments;
2.1.15.3. Earnings for services under non -equity incentive plans, not including group
life, health, hospitalization or medical reimbursement plans that do not
discriminate in favor of Executives and are available generally to all salaried
employees;
2.1.15.4. Change in present value of defined benefit and actuarial pension plans;
2.1.15.5. Above -market earnings on deferred compensation which is not tax -
qualified;
2.1.15.6. Other compensation, if the aggregate value of all such other compensation
(e.g., severance, termination payments, value of life insurance paid on
behalf of the employee, perquisites or property) for the Executive exceeds
$10,000.
2.1.16. "Transparency Act" means the Federal Funding Accountability and
Transparency Act of 2006 (Public Law 109-282), as amended by §6202 of Public
Law 110-252.
2.1.17. "Uniform Guidance" means the Office of Management and Budget
Uniform Administrative Requirements, Cost Principles, and Audit Requirements
for Federal Awards. The terms and conditions of the Uniform Guidance flow down
to Awards to Subrecipients unless the Uniform Guidance or the terms and
conditions of the Federal Award specifically indicate otherwise.
2.1.18. "Unique Entity ID" means the Unique Entity ID established by the federal
government for a Grantee at https://sam.gov/content/home..
3. COMPLIANCE.
3.1. Grantee shall comply with all applicable provisions of the Transparency Act and the
regulations issued pursuant thereto, all applicable provisions of the Uniform Guidance,
and all applicable Federal Laws and regulations required by this Federal Award. Any
revisions to such provisions or regulations shall automatically become a part of these
Federal Provisions, without the necessity of either party executing any further
instrument. The State of Colorado, at its discretion, may provide written notification to
Grantee of such revisions, but such notice shall not be a condition precedent to the
effectiveness of such revisions.
3.2. Per US Treasury Final Award requirements, grantee programs or services must not
include terms or conditions that undermine efforts to stop COVID-19 or discourage
compliance with recommendations and CDC guidelines.
5
V.4
4. SYSTEM FOR AWARD MANAGEMENT (SAM) AND UNIQUE ENTITY ID SYSTEM (UEI)
REQUIREMENTS.
4.1. SAM. Grantee shall maintain the currency of its information in SAM until the Grantee
submits the final financial report required under the Award or receives final payment,
whichever is later. Grantee shall review and update SAM information at least annually
after the initial registration, and more frequently if required by changes in its
information.
4.2. UEI. Grantee shall provide its Unique Entity ID to its Prime Recipient, and shall update
Grantee's information in SAM.gov at least annually after the initial registration, and
more frequently if required by changes in Grantee's information.
5. TOTAL COMPENSATION.
5.1. Grantee shall include Total Compensation in SAM for each of its five most highly
compensated Executives for the preceding fiscal year if:
5.1.1. The total Federal funding authorized to date under the Award is $30,000 or
more; and
5.1.2. In the preceding fiscal year, Grantee received:
5.1.2.1. 80% or more of its annual gross revenues from Federal procurement
Agreements and Subcontractors and/or Federal financial assistance Awards
or Subawards subject to the Transparency Act; and
5.1.2.2. $30,000,000 or more in annual gross revenues from Federal procurement
Agreements and Subcontractors and/or Federal financial assistance Awards
or Subawards subject to the Transparency Act; and
5.1.2.3. 5.1.2.3 The public does not have access to information about the
compensation of such Executives through periodic reports filed under
section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C.
78m(a), 78o(d) or § 6104 of the Internal Revenue Code of 1986.
6. REPORTING.
6.1. If Grantee is a Subrecipient of the Award pursuant to the Transparency Act, Grantee
shall report data elements to SAM and to the Prime Recipient as required in this Exhibit.
No direct payment shall be made to Grantee for providing any reports required under
these Federal Provisions and the cost of producing such reports shall be included in the
Grant price. The reporting requirements in this Exhibit are based on guidance from the
OMB, and as such are subject to change at any time by OMB. Any such changes shall
be automatically incorporated into this Grant and shall become part of Grantee's
obligations under this Grant.
6
V.4
7. EFFECTIVE DATE AND DOLLAR THRESHOLD FOR FEDERAL REPORTING.
7.1. Reporting requirements in §8 below apply to new Awards as of October 1, 2010, if the
initial award is $30,000 or more. If the initial Award is below $30,000 but subsequent
Award modifications result in a total Award of $30,000 or more, the Award is subject
to the reporting requirements as of the date the Award exceeds $30,000. If the initial
Award is $30,000 or more, but funding is subsequently de -obligated such that the total
award amount falls below $30,000, the Award shall continue to be subject to the
reporting requirements. If the total award is below $30,000 no reporting required; if
more than $30,000 and less than $50,000 then FFATA reporting is required; and,
$50,000 and above SLFRF reporting is required.
7.2. The procurement standards in §9 below are applicable to new Awards made by Prime
Recipient as of December 26, 2015. The standards set forth in §11 below are applicable
to audits of fiscal years beginning on or after December 26, 2014.
8. SUBRECIPIENT REPORTING REQUIREMENTS.
8.1. Grantee shall report as set forth below.
8.1.1. Grantee shall use the SLFRF Subrecipient Quarterly Report Workbook as referenced
in Appendix 4 to report to the State Agency within ten (10) days following each quarter
ended September, December, March and June. Additional information on specific
requirements are detailed in the SLFRF Subrecipient Quarterly Report Workbooks and
"Compliance and Reporting Guidance, State and Local Fiscal Recovery Funds" report
available at www.treasury.gov.
EC 1— Public Health
All Public Health Projects
a) Description of structure and objectives
b) Description of relation to COVID-19
c) Identification of impacted and/or disproportionately impacted communities
d) Capital Expenditures
i. Presence of capital expenditure in project
ii. Total projected capital expenditure
iii. Type of capital expenditure
iv. Written justification
v. Labor reporting
COVID-19 Interventions and Mental Health (1.4, 1.11, 1.12, 1.13)
a) Amount of total project used for evidence -based programs
b) Evaluation plan description
COVID-19 Small Business Economic Assistance (1.8)
a) Number of small businesses served
COVID-19 Assistance to Non -Profits (1.9)
a) Number of non -profits served
COVID-19 Aid to Travel, Tourism, and Hospitality or Other Impacted Industries (1.10)
a) Sector of employer
b) Purpose of funds
7
V.4
EC 2 — Negative Economic Impacts
All Negative Economic Impacts Projects
a) Description of project structure and objectives
b) Description of project's response to COVID-19
c) Identification of impacted and/or disproportionately impacted communities
d) Amount of total project used for evidence -based programs and description of
evaluation plan (not required for 2.5, 2.8, 2.21-2.24, 2.27-2.29, 2.31, 2.34-2.36)
e) Number of workers enrolled in sectoral job training programs
f) Number of workers completing sectoral job training programs
g) Number of people participating in summer youth employment programs
h) Capital Expenditures
i. Presence of capital expenditure in project
ii. Total projected capital expenditure
iii. Type of capital expenditure
iv. Written justification
v. Labor reporting
Household Assistance (2.1-2.8)
a) Number of households served
b) Number of people or households receiving eviction prevention services (2.2 & 2.5
only) (Federal guidance may change this requirement in July 2022)
c) Number of affordable housing units preserved or developed (2.2 & 2.5 only)
(Federal guidance may change this requirement in July 2022)
Healthy Childhood Environments (2.11-2.13)
a) Number of children served by childcare and early learning (Federal guidance may
change this requirement in July 2022)
b) Number of families served by home visiting (Federal guidance may change this
requirement in July 2022)
Education Assistance (2.14, 2.24-2.27)
a) National Center for Education Statistics ("NCES") School ID or NCES District ID
b) Number of students participating in evidence -based programs (Federal guidance may
change this requirement in July 2022)
Housing Support (2.15, 2.16, 2.18)
a) Number of people or households receiving eviction prevention services (Federal
guidance may change this requirement in July 2022)
b) Number of affordable housing units preserved or developed (Federal guidance may
change this requirement in July 2022)
Small Business Economic Assistance (2.29-2.33)
a) Number of small businesses served
Assistance to Non -Profits (2.34)
a) Number of non -profits served
Aid to Travel, Tourism, and Hospitality or Other Impacted Industries (2.35-236)
a) Sector of employer
b) Purpose of funds
c) If other than travel, tourism and hospitality (2.36) — description of hardship
8
V.4
EC 3 — Public Health — Negative Economic Impact: Public Sector Capacity
Payroll for Public Health and Safety Employees (EC 3.1)
a) Number of government FTEs responding to COVID-19
Rehiring Public Sector Staff (EC 3.2)
a) Number of FTEs rehired by governments
EC 4 — Premium Pay
All Premium Pay Projects
a) List of sectors designated as critical by the chief executive of the jurisdiction, if
beyond those listed in the final rule
b) Numbers of workers served
c) Employer sector for all subawards to third -party employers
d) Written narrative justification of how premium pay is responsive to essential work
during the public health emergency for non-exempt workers or those making over
150 percent of the state/county's average annual wage
e) Number of workers to be served with premium pay in K-12 schools
EC 5 — Infrastructure Projects
All Infrastructure Projects
a) Projected/actual construction start date (month/year)
b) Projected/actual initiation of operations date (month/year)
c) Location (for broadband, geospatial data of locations to be served)
d) Projects over $10 million
i. Prevailing wage certification or detailed project employment and local
impact report
ii. Project labor agreement certification or project workforce continuity
plan
iii. Prioritization of local hires
iv. Community benefit agreement description, if applicable
Water and sewer projects (EC 5.1-5.18)
a) National Pollutant Discharge Elimination System (NPDES) Permit Number (if
applicable; for projects aligned with the Clean Water State Revolving Fund)
b) Public Water System (PWS) ID number (if applicable; for projects aligned with
the Drinking Water State Revolving Fund)
c) Median Household Income of service area
d) Lowest Quintile Income of the service area
Broadband projects (EC 5.19-5.21)
a) Confirm that the project is designed to, upon completion, reliably meet or exceed
symmetrical 100 Mbps download and upload speeds.
i. If the project is not designed to reliably meet or exceed symmetrical 100
Mbps download and upload speeds, explain why not, and
ii. Confirm that the project is designed to, upon completion, meet or exceed
100 Mbps download speed and between at least 20 Mbps and 100 Mbps
upload speed, and be scalable to a minimum of 100 Mbps download
speed and 100 Mbps upload speed.
9
V.4
b) Additional programmatic data will be required for broadband projects and will be
defined in a subsequent version of the US Treasury Reporting Guidance,
including, but not limited to (Federal guidance may change this requirement in July 2022):
i. Number of households (broken out by households on Tribal lands and
those not on Tribal lands) that have gained increased access to
broadband meeting the minimum speed standards in areas that
previously lacked access to service of at least 25 Mbps download and 3
Mbps upload, with the number of households with access to minimum
speed standard of reliable 100 Mbps symmetrical upload and download
and number of households with access to minimum speed standard of
reliable 100 Mbps download and 20 Mbps upload
ii. Number of institutions and businesses (broken out by institutions on
Tribal lands and those not on Tribal lands) that have projected increased
access to broadband meeting the minimum speed standards in areas that
previously lacked access to service of at least 25 Mbps download and 3
Mbps upload, in each of the following categories: business, small
business, elementary school, secondary school, higher education
institution, library, healthcare facility, and public safety organization,
with the number of each type of institution with access to the minimum
speed standard of reliable 100 Mbps symmetrical upload and download;
and number of each type of institution with access to the minimum
speed standard of reliable 100 Mbps download and 20 Mbps upload.
iii. Narrative identifying speeds/pricing tiers to be offered, including the
speed/pricing of its affordability offering, technology to be deployed,
miles of fiber, cost per mile, cost per passing, number of households
(broken out by households on Tribal lands and those not on Tribal lands)
projected to have increased access to broadband meeting the minimum
speed standards in areas that previously lacked access to service of at
least 25 Mbps download and 3 Mbps upload, number of households with
access to minimum speed standard of reliable 100 Mbps symmetrical
upload and download, number of households with access to minimum
speed standard of reliable 100 Mbps download and 20 Mbps upload, and
number of institutions and businesses (broken out by institutions on
Tribal lands and those not on Tribal lands) projected to have increased
access to broadband meeting the minimum speed standards in areas that
previously lacked access to service of at least 25 Mbps download and 3
Mbps upload, in each of the following categories: business, small
business, elementary school, secondary school, higher education
institution, library, healthcare facility, and public safety organization.
Specify the number of each type of institution with access to the
minimum speed standard of reliable 100 Mbps symmetrical upload and
download; and the number of each type of institution with access to the
minimum speed standard of reliable 100 Mbps download and 20 Mbps
upload.
All Expenditure Categories
a) Program income earned and expended to cover eligible project costs
10
V.4
8.1.2. A Subrecipient shall report the following data elements to Prime Recipient no later
than five days after the end of the month following the month in which the Subaward
was made.
8.1.2.1. Subrecipient Unique Entity ID;
8.1.2.2. Subrecipient Unique Entity ID if more than one electronic funds transfer
(EFT) account;
8.1.2.3. Subrecipient parent's organization Unique Entity ID;
8.1.2.4. Subrecipient's address, including: Street Address, City, State, Country, Zip
+ 4, and Congressional District;
8.1.2.5. Subrecipient's top 5 most highly compensated Executives if the criteria in
§4 above are met; and
8.1.2.6. Subrecipient's Total Compensation of top 5 most highly compensated
Executives if the criteria in §4 above met.
8.1.3. To Prime Recipient. A Subrecipient shall report to its Prime Recipient, the
following data elements:
8.1.3.1. Subrecipient's Unique Entity ID as registered in SAM.
8.1.3.2. Primary Place of Performance Information, including: Street Address, City,
State, Country, Zip code + 4, and Congressional District.
8.1.3.3. Narrative identifying methodology for serving disadvantaged communities.
See the "Project Demographic Distribution" section in the "Compliance and
Reporting Guidance, State and Local Fiscal Recovery Funds" report
available at www.treasury.gov. This requirement is applicable to all
projects in Expenditure Categories 1 and 2.
8.1.3.4. Narrative identifying funds allocated towards evidenced -based
interventions and the evidence base. See the "Use of Evidence" section in
the "Compliance and Reporting Guidance, State and Local Fiscal Recovery
Funds" report available at www.treasury.gov. See section 8.1.1 for relevant
Expenditure Categories.
8.1.3.5. Narrative describing the structure and objectives of the assistance program
and in what manner the aid responds to the public health and negative
economic impacts of COVID-19. This requirement is applicable to
Expenditure Categories 1 and 2. For aid to travel, tourism, and hospitality
or other impacted industries (EC 2.11-2.12), also provide the sector of
employer, purpose of funds, and if not travel, tourism and hospitality a
description of the pandemic impact on the industry.
8.1.3.6. Narrative identifying the sector served and designated as critical to the
health and well-being of residents by the chief executive of the jurisdiction
and the number of workers expected to be served. For groups of workers
(e.g., an operating unit, a classification of worker, etc.) or, to the extent
applicable, individual workers, other than those where the eligible worker
11
V.4
receiving premium pay is earning (with the premium pay included) below
150 percent of their residing state or county's average annual wage for all
occupations, as defined by the Bureau of Labor Statistics Occupational
Employement and Wage Statistics, whichever is higher, OR the eligible
worker reciving premium pay is not exempt from the Fair Labor Standards
Act overtime provisions, include justification of how the premium pay or
grant is responsive to workers performing essential work during the public
health emergency. This could include a description of the essential workers'
duties, health or financial risks faced due to COVID-19 but should not
include personally identifiable information. This requirement applies to EC
4.1, and 4.2.
8.1.3.7. For infrastructure projects (EC 5) or capital expenditures in any expenditure
category, narrative identifying the projected construction start date
(month/year), projected initiation of operations date (month/year), and
location (for broadband, geospatial location data).
8.1.3.7.1. For projects over $10 million:
8.1.3.7.1.1.
8.1.3.7.1.2.
Certification that all laborers and mechanics employed by
Contractors and Subcontractors in the performance of such
project are paid wages at rates not less than those prevailing,
as determined by the U.S. Secretary of Labor in accordance
with subchapter IV of chapter 31 of title 40, United States
Code (commonly known as the "Davis -Bacon Act"), for the
corresponding classes of laborers and mechanics employed on
projects of a character similar to the Agreement work in the
civil subdivision of the State (or the District of Columbia) in
which the work is to be performed, or by the appropriate State
entity pursuant to a corollary State prevailing -wage -in -
construction law (commonly known as "baby Davis -Bacon
Acts"). If such certification is not provided, a recipient must
provide a project employment and local impact report
detailing (1) the number of employees of Contractors and sub-
contractors working on the project; (2) the number of
employees on the project hired directly and hired through a
third party; (3) the wages and benefits of workers on the
project by classification; and (4) whether those wages are at
rates less than those prevailing. Recipients must maintain
sufficient records to substantiate this information upon
request.
A Subrecipient may provide a certification that a project
includes a project labor agreement, meaning a pre -hire
collective bargaining agreement consistent with section 8(f)
of the National Labor Relations Act (29 U.S.C. 158(f)). If the
recipient does not provide such certification, the recipient
must provide a project workforce continuity plan, detailing:
(1) how the Subrecipient will ensure the project has ready
12
V.4
8.1.3.7.1.3.
8.1.3.7.1.4.
access to a sufficient supply of appropriately skilled and
unskilled labor to ensure high -quality construction throughout
the life of the project; (2) how the Subrecipient will minimize
risks of labor disputes and disruptions that would jeopardize
timeliness and cost-effectiveness of the project; and (3) how
the Subrecipient will provide a safe and healthy workplace
that avoids delays and costs associated with workplace
illnesses, injuries, and fatalities; (4) whether workers on the
project will receive wages and benefits that will secure an
appropriately skilled workforce in the context of the local or
regional labor market; and (5) whether the project has
completed a project labor agreement.
Whether the project prioritizes local hires.
Whether the project has a Community Benefit Agreement,
with a description of any such agreement.
8.1.4. Subrecipient also agrees to comply with any reporting requirements established by the
US Treasury, Governor's Office and Office of the State Controller. The State of
Colorado may need additional reporting requirements after this agreement is executed.
If there are additional reporting requirements, the State will provide notice of such
additional reporting requirements via Appendix 5— SLFRF Reporting Modification
Form.
9. PROCUREMENT STANDARDS.
9.1. Procurement Procedures. A Subrecipient shall use its own documented procurement
procedures which reflect applicable State, local, and Tribal laws and applicable
regulations, provided that the procurements conform to applicable Federal law and the
standards identified in the Uniform Guidance, including without limitation, 2 CFR
200.318 through 200.327 thereof.
9.2. Domestic preference for procurements (2 CFR 200.322). As appropriate and to the
extent consistent with law, the non -Federal entity should, to the greatest extent
practicable under a Federal award, provide a preference for the purchase, acquisition,
or use of goods, products, or materials produced in the United States (including but not
limited to iron, aluminum, steel, cement, and other manufactured products). The
requirements of this section must be included in all subawards including all
Agreements and purchase orders for work or products under this award.
13
V.4
9.3. Procurement of Recovered Materials. If a Subrecipient is a State Agency or an agency
of a political subdivision of the State, its Contractors must comply with section 6002
of the Solid Waste Disposal Act, as amended by the Resource Conservation and
Recovery Act. The requirements of Section 6002 include procuring only items
designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part
247, that contain the highest percentage of recovered materials practicable, consistent
with maintaining a satisfactory level of competition, where the purchase price of the
item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal
year exceeded $10,000; procuring solid waste management services in a manner that
maximizes energy and resource recovery; and establishing an affirmative procurement
program for procurement of recovered materials identified in the EPA guidelines.
10. ACCESS TO RECORDS.
10.1. A Subrecipient shall permit Prime Recipient and its auditors to have access to
Subrecipient's records and financial statements as necessary for Recipient to meet the
requirements of 2 CFR 200.332 (Requirements for pass -through entities), 2 CFR
200.300 (Statutory and national policy requirements) through 2 CFR 200.309 (Period
of performance), and Subpart F -Audit Requirements of the Uniform Guidance.
11. SINGLE AUDIT REQUIREMENTS.
11.1. If a Subrecipient expends $750,000 or more in Federal Awards during the
Subrecipient's fiscal year, the Subrecipient shall procure or arrange for a single or
program -specific audit conducted for that year in accordance with the provisions of
Subpart F -Audit Requirements of the Uniform Guidance, issued pursuant to the Single
Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR 200.501.
11.1.1. Election. A Subrecipient shall have a single audit conducted in accordance
with Uniform Guidance 2 CFR 200.514 (Scope of audit), except when it elects to
have a program -specific audit conducted in accordance with 2 CFR 200.507
(Program -specific audits). The Subrecipient may elect to have a program -specific
audit if Subrecipient expends Federal Awards under only one Federal program
(excluding research and development) and the Federal program's statutes,
regulations, or the terms and conditions of the Federal award do not require a
financial statement audit of Prime Recipient. A program -specific audit may not be
elected for research and development unless all of the Federal Awards expended
were received from Recipient and Recipient approves in advance a program -
specific audit.
11.1.2. Exemption. If a Subrecipient expends less than $750,000 in Federal Awards
during its fiscal year, the Subrecipient shall be exempt from Federal audit
requirements for that year, except as noted in 2 CFR 200.503 (Relation to other
audit requirements), but records shall be available for review or audit by appropriate
officials of the Federal agency, the State, and the Government Accountability
Office.
14
V.4
11.1.3. Subrecipient Compliance Responsibility. A Subrecipient shall procure or
otherwise arrange for the audit required by Subpart F of the Uniform Guidance and
ensure it is properly performed and submitted when due in accordance with the
Uniform Guidance. Subrecipient shall prepare appropriate financial statements,
including the schedule of expenditures of Federal awards in accordance with 2 CFR
200.510 (Financial statements) and provide the auditor with access to personnel,
accounts, books, records, supporting documentation, and other information as
needed for the auditor to perform the audit required by Uniform Guidance Subpart
F -Audit Requirements.
12. GRANT PROVISIONS FOR SUBRECIPIENT AGREEMENTS.
12.1. In addition to other provisions required by the Federal Awarding Agency or the Prime
Recipient, Grantees that are Subrecipients shall comply with the following provisions.
Subrecipients shall include all of the following applicable provisions in all
Subcontractors entered into by it pursuant to this Grant.
12.1.1. [Applicable to federally assisted construction Agreements.] Equal
Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all
Agreements that meet the definition of"federally assisted construction Agreement"
in 41 CFR Part 60-1.3 shall include the equal opportunity clause provided under 41
CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal Employment
Opportunity" (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as
amended by Executive Order 11375, "Amending Executive Order 11246 Relating
to Equal Employment Opportunity," and implementing regulations at 41 CFR part
60, Office of Federal Agreement Compliance Programs, Equal Employment
Opportunity, Department of Labor.
12.1.2. [Applicable to on -site employees working on government -funded
construction, alteration and repair projects.] Davis -Bacon Act. Davis -Bacon Act,
as amended (40 U.S.C. 3141-3148).
12.1.3. Rights to Inventions Made Under a grant or agreement. If the Federal
Award meets the definition of "funding agreement" under 37 CFR 401.2 (a) and
the Prime Recipient or Subrecipient wishes to enter into an Agreement with a small
business firm or nonprofit organization regarding the substitution of parties,
assignment or performance of experimental, developmental, or research work
under that "funding agreement," the Prime Recipient or Subrecipient must comply
with the requirements of 37 CFR Part 401, "Rights to Inventions Made by
Nonprofit Organizations and Small Business Firms Under Government Grants,
Agreements and Cooperative Agreements," and any implementing regulations
issued by the Federal Awarding Agency.
15
V.4
12.1.4. Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution
Control Act (33 U.S.C. 1251-1387), as amended. Agreements and subgrants of
amounts in excess of $150,000 must contain a provision that requires the non -
Federal awardees to agree to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the
Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387).
Violations must be reported to the Federal Awarding Agency and the Regional
Office of the Environmental Protection Agency (EPA).
12.1.5. Debarment and Suspension (Executive Orders 12549 and 12689). A
Agreement award (see 2 CFR 180.220) must not be made to parties listed on the
government wide exclusions in SAM, in accordance with the OMB guidelines at 2
CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189)
and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM
Exclusions contains the names of parties debarred, suspended, or otherwise
excluded by agencies, as well as parties declared ineligible under statutory or
regulatory authority other than Executive Order 12549.
12.1.6. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). Contractors that apply
or bid for an award exceeding $100,000 must file the required certification. Each
tier certifies to the tier above that it will not and has not used Federal appropriated
funds to pay any person or organization for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, officer or employee
of Congress, or an employee of a member of Congress in connection with obtaining
any Federal Agreement, grant or any other award covered by 31 U.S.C. 1352. Each
tier must also disclose any lobbying with non -Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from
tier to tier up to the non -Federal award.
12.1.7. Never Agreement with the enemy (2 CFR 200.215). Federal awarding
agencies and recipients are subject to the regulations implementing "Never
Agreement with the enemy" in 2 CFR part 183. The regulations in 2 CFR part 183
affect covered Agreements, grants and cooperative agreements that are expected to
exceed $50,000 within the period of performance, are performed outside the United
States and its territories, and are in support of a contingency operation in which
members of the Armed Forces are actively engaged in hostilities.
12.1.8. Prohibition on certain telecommunications and video surveillance services
or equipment (2 CFR 200.216). Grantee is prohibited from obligating or expending
loan or grant funds on certain telecommunications and video surveillance services
or equipment pursuant to 2 CFR 200.216.
16
V.4
12.1.9. Title VI of the Civil Rights Act. The Subgrantee, Contractor, Subcontractor,
transferee, and assignee shall comply with Title VI of the Civil Rights Act of 1964,
which prohibits recipients of federal financial assistance from excluding from a
program or activity, denying benefits of, or otherwise discriminating against a
person on the basis of race, color, or national origin (42 U.S.C. § 2000d et seq.), as
implemented by the Department of Treasury's Title VI regulations, 31 CFR Part
22, which are herein incorporated by reference and made a part of this Agreement
(or agreement). Title VI also includes protection to persons with "Limited English
Proficiency" in any program or activity receiving federal financial assistance, 42
U.S. C. § 2000d et seq., as implemented by the Department of the Treasury's Title
VI regulations, 31 CRF Part 22, and herein incorporated by reference and made part
of this Agreement or agreement.
13. CERTIFICATIONS.
13.1. Subrecipient Certification. Subrecipient shall sign a "State of Colorado Agreement
with Recipient of Federal Recovery Funds" Certification Form in separate Appendix
hereto and submit to State Agency with signed grant agreement.
13.2. Unless prohibited by Federal statutes or regulations, Prime Recipient may require
Subrecipient to submit certifications and representations required by Federal statutes
or regulations on an annual basis. 2 CFR 200.208. Submission may be required more
frequently if Subrecipient fails to meet a requirement of the Federal award.
Subrecipient shall certify in writing to the State at the end of the Award that the project
or activity was completed or the level of effort was expended. 2 CFR 200.201(3). If
the required level of activity or effort was not carried out, the amount of the Award
must be adjusted.
14. EXEMPTIONS.
14.1. These Federal Provisions do not apply to an individual who receives an Award as a
natural person, unrelated to any business or non-profit organization he or she may own
or operate in his or her name.
14.2. A Grantee with gross income from all sources of less than $300,000 in the previous tax
year is exempt from the requirements to report Subawards and the Total Compensation
of its most highly compensated Executives.
15. EVENT OF DEFAULT AND TERMINATION.
15.1. Failure to comply with these Federal Provisions shall constitute an event of default
under the Grant and the State of Colorado may terminate the Grant upon 30 days prior
written notice if the default remains uncured five calendar days following the
termination of the 30 -day notice period. This remedy will be in addition to any other
remedy available to the State of Colorado under the Grant, at law or in equity.
15.2. Termination (2 CFR 200.340). The Federal Award may be terminated in whole or in
part as follows:
15.2.1. By the Federal Awarding Agency or Pass -through Entity, if a Non -Federal
Entity fails to comply with the terms and conditions of a Federal Award;
17
V.4
15.2.2. By the Federal awarding agency or Pass -through Entity, to the greatest
extent authorized by law, if an award no longer effectuates the program goals or
agency priorities;
15.2.3. By the Federal awarding agency or Pass -through Entity with the consent of
the Non -Federal Entity, in which case the two parties must agree upon the
termination conditions, including the effective date and, in the case of partial
termination, the portion to be terminated;
15.2.4. By the Non -Federal Entity upon sending to the Federal Awarding Agency
or Pass -through Entity written notification setting forth the reasons for such
termination, the effective date, and, in the case of partial termination, the portion to
be terminated. However, if the Federal Awarding Agency or Pass -through Entity
determines in the case of partial termination that the reduced or modified portion
of the Federal Award or Subaward will not accomplish the purposes for which the
Federal Award was made, the Federal Awarding Agency or Pass -through Entity
may terminate the Federal Award in its entirety; or
15.2.5. By the Federal Awarding Agency or Pass -through Entity pursuant to
termination provisions included in the Federal Award.
[THE REST OF THIS PAGE IS INTENTIONALLY LEFT BLANK]
18
V.4
APPENDIX 3 TO SLFRF EXHIBIT- SUBRECIPIENT CERTIFICATION
AGREEMENT
AGREEMENT WITH SUBRECIPIENT OF FEDERAL RECOVERY FUNDS
Section 602(b) of the Social Security Act (the Act), as added by section 9901 of the
American Rescue Plan Act (ARPA), Pub. L. No. 117-2 (March 11, 2021), authorizes the
Department of the Treasury (Treasury) to make payments to certain Subrecipients from
the Coronavirus State Fiscal Recovery Fund. The State of Colorado has signed and
certified a separate agreement with Treasury as a condition of receiving such payments
from the Treasury. This agreement is between your organization and the State and your
organization is signing and certifying the same terms and conditions included in the
State's separate agreement with Treasury. Your organization is referred to as a
Subrecipient.
As a condition of your organization receiving federal recovery funds from the State, the
authorized representative below hereby (i) certifies that your organization will carry out
the activities listed in section 602(c) of the Act and (ii) agrees to the terms attached hereto.
Your organization also agrees to use the federal recovery funds as specified in bills passed
by the General Assembly and signed by the Governor.
Under penalty of perjury, the undersigned official certifies that the authorized
representative has read and understood the organization's obligations in the Assurances
of Compliance and Civil Rights Requirements, that any information submitted in
conjunction with this assurances document is accurate and complete, and that the
organization is in compliance with the nondiscrimination requirements.
Subrecipient Name:
Authorized Representative:
Title:
Signature:
19
V.4
AGREEMENT WITH SUBRECIPIENT OF FEDERAL RECOVERY FUNDS
TERMS AND CONDITIONS
1. Use of Funds.
a. Subrecipient understands and agrees that the funds disbursed under this award
may only be used in compliance with section 602(c) of the Social Security Act
(the Act) and Treasury's regulations implementing that section and guidance.
b. Subrecipient will determine prior to engaging in any project using this assistance
that it has the institutional, managerial, and financial capability to ensure proper
planning, management, and completion of such project.
2. Period of Performance. The period of performance for this subaward is shown on
page one of this Agreement. Subrecipient may use funds to cover eligible costs
incurred, as set forth in Treasury's implementing regulations, during this period of
performance.
3. Reporting. Subrecipient agrees to comply with any reporting obligations established by
Treasury as they relate to this award. Subrecipient also agrees to comply with any reporting
requirements established by the Governor's Office and Office of the State Controller. The
State will provide notice of such additional reporting requirements via separate Appendix
hereto — Reporting Modification Form.
4. Maintenance of and Access to Records
a. Subrecipient shall maintain records and financial documents sufficient to
evidence compliance with section 602(c), Treasury's regulations implementing
that section, and guidance issued by Treasury regarding the foregoing.
b. The Treasury Office of Inspector General and the Government Accountability
Office, or their authorized representatives, shall have the right of access to records
(electronic and otherwise) of Subrecipient in order to conduct audits or other
investigations.
c. Records shall be maintained by Subrecipient for a period of five (5) years after
all funds have been expended or returned to Treasury, whichever is later.
5. Pre -award Costs. Pre -award costs, as defined in 2 C.F.R. § 200.458, may not be paid
with funding from this award.
6. Administrative Costs. Subrecipient may use funds provided under this award to cover
both direct and indirect costs. Subrecipient shall follow guidance on administrative
costs issued by the Governor's Office and Office of the State Controller.
Cost Sharing. Cost sharing or matching funds are not required to be provided by
20
V.4
7. Subrecipient.
8. Conflicts of Interest. The State of Colorado understands and agrees it must maintain a
conflict of interest policy consistent with 2 C.F.R. § 200.318(c) and that such conflict of
interest policy is applicable to each activity funded under this award. Subrecipient and
Contractors must disclose in writing to the Office of the State Controller or the pass -
through entity, as appropriate, any potential conflict of interest affecting the awarded
funds in accordance with 2 C.F.R. § 200.112. The Office of the State Controller shall
disclose such conflict to Treasury.
9. Compliance with Applicable Law and Regulations.
a. Subrecipient agrees to comply with the requirements of section 602 of the Act,
regulations adopted by Treasury pursuant to section 602(f) of the Act, and
guidance issued by Treasury regarding the foregoing. Subrecipient also agrees to
comply with all other applicable federal statutes, regulations, and executive
orders, and Subrecipient shall provide for such compliance by other parties in any
agreements it enters into with other parties relating to this award.
b. Federal regulations applicable to this award include, without limitation, the following:
i. Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, 2 C.F.R. Part 200, other than such
provisions as Treasury may determine are inapplicable to this Award and
subject to such exceptions as may be otherwise provided by Treasury.
Subpart F — Audit Requirements of the Uniform Guidance, implementing
the Single Audit Act, shall apply to this award.
ii. Universal Identifier and System for Award Management (SAM), 2 C.F.R.
Part 25, pursuant to which the award term set forth in Appendix A to 2
C.F.R. Part 25 is hereby incorporated by reference.
iii. Reporting Subaward and Executive Compensation Information, 2 C.F.R.
Part 170, pursuant to which the award term set forth in Appendix A to 2
C.F.R. Part 170 is hereby incorporated by reference.
iv. OMB Guidelines to Agencies on Government wide Debarment and
Suspension (Nonprocurement), 2 C.F.R. Part 180, including the
requirement to include a term or condition in all lower tier covered
transactions (Agreements and Subcontractors described in 2 C.F.R. Part
180, subpart B) that the award is subject to 2 C.F.R. Part 180 and
Treasury's implementing regulation at 31 C.F.R. Part 19.
v. Subrecipient Integrity and Performance Matters, pursuant to which the
award term set forth in 2 C.F.R. Part 200, Appendix XII to Part 200 is
hereby incorporated by reference.
21
V.4
vi. Government wide Requirements for Drug -Free Workplace, 31 C.F.R. Part
20.
vii. New Restrictions on Lobbying, 31 C.F.R. Part 21.
viii. Uniform Relocation Assistance and Real Property Acquisitions Act of
1970 (42 U.S.C. §§ 4601-4655) and implementing regulations.
ix. Generally applicable federal environmental laws and regulations.
c. Statutes and regulations prohibiting discrimination applicable to this award
include, without limitation, the following:
Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d et seq.) and
Treasury's implementing regulations at 31 C.F.R. Part 22, which prohibit
discrimination on the basis of race, color, or national origin under
programs or activities receiving federal financial assistance;
ii. The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42
U.S.C. §§ 3601 et seq.), which prohibits discrimination in housing on
the basis of race, color, religion, national origin, sex, familial status, or
disability;
iii. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §
794), which prohibits discrimination on the basis of disability under any
program or activity receiving federal financial assistance;
iv. The Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101 et
seq.), and Treasury's implementing regulations at 31 C.F.R. Part 23,
which prohibit discrimination on the basis of age in programs or activities
receiving federal financial assistance; and
v. Title II of the Americans with Disabilities Act of 1990, as amended (42
U.S.C. §§ 12101 et seq.), which prohibits discrimination on the basis of
disability under programs, activities, and services provided or made
available by state and local governments or instrumentalities or agencies
thereto.
Remedial Actions. In the event of Subrecipient's noncompliance with section 602 of
the Act, other applicable laws, Treasury's implementing regulations, guidance, or
any reporting or other program requirements, Treasury may impose additional
conditions on the receipt of a subsequent tranche of future award funds, if any, or
take other available remedies as set forth in 2 C.F.R. § 200.339. In the case of a
violation of section 602(c) of the Act regarding the use of funds, previous payments
shall be subject to recoupment as provided in section 602(e) of the Act and any
22
V.4
10. additional payments may be subject to withholding as provided in sections
602(b)(6)(A)(ii)(III) of the Act, as applicable.
11. Hatch Act. Subrecipient agrees to comply, as applicable, with requirements of the Hatch
Act (5 U.S.C.§§ 1501-1508 and 7324-7328), which limit certain political activities of
State or focal government employees whose principal employment is in connection with
an activity financed in whole or in part by this federal assistance.
12. False Statements. Subrecipient understands that making false statements or claims in
connection with this award is a violation of federal law and may result in criminal,
civil, or administrative sanctions, including fines, imprisonment, civil damages and
penalties, debarment from participating in federal awards or Agreements, and/or any
other remedy available by law.
13. Publications. Any publications produced with funds from this award must
display the following language: "This project [is being] [was] supported, in
whole or in part, by federal award number SLFRF0126 awarded to the State of
Colorado by the U.S. Department of the Treasury."
14. Debts Owed the Federal Government.
a. Any funds paid to the Subrecipient (1) in excess of the amount to which the
Subrecipient is finally determined to be authorized to retain under the terms
of this award; (2) that are determined by the Treasury Office of Inspector
General to have been misused; or (3) that are determined by Treasury to be
subject to a repayment obligation pursuant to sections 602(e) and
603(b)(2)(D) of the Act and have not been repaid by the Subrecipient shall
constitute a debt to the federal government.
b. Any debts determined to be owed to the federal government must be paid
promptly by Subrecipient. A debt is delinquent if it has not been paid by the
date specified in Treasury's initial written demand for payment, unless other
satisfactory arrangements have been made or if the Subrecipient knowingly
or improperly retains funds that are a debt as defined in paragraph 14(a).
Treasury will take any actions available to it to collect such a debt.
15. Disclaimer.
a. The United States expressly disclaims any and all responsibility or liability to
Subrecipient or third persons for the actions of Subrecipient or third persons
resulting in death, bodily injury, property damages, or any other losses
resulting in any way from the performance of this award or any other losses
resulting in any way from the performance of this award or any Agreement,
or Subcontractor under this award.
b. The acceptance of this award by Subrecipient does not in any way establish
23
V.4
an agency relationship between the United States and Subrecipient.
16. Protections for Whistleblowers.
a. In accordance with 41 U.S.C. § 4712, Subrecipient may not discharge, demote,
or otherwise discriminate against an employee in reprisal for disclosing to any of
the list of persons or entities provided below, information that the employee
reasonably believes is evidence of gross mismanagement of a federal Agreement
or grant, a gross waste of federal funds, an abuse of authority relating to a federal
Agreement or grant, a substantial and specific danger to public health or safety,
or a violation of law, rule, or regulation related to a federal Agreement (including
the competition for or negotiation of an Agreement) or grant.
b. The list of persons and entities referenced in the paragraph above includes the
following:
i. A member of Congress or a representative of a committee of Congress;
ii. An Inspector General;
iii. The Government Accountability Office;
iv. A Treasury employee responsible for Agreement or grant oversight or
management;
v. An authorized official of the Department of Justice or other law
enforcement agency;
vi. A court or grand jury; or
vii. A management official or other employee of Subrecipient,
Contractor, or Subcontractor who has the responsibility to
investigate, discover, or address misconduct.
c. Subrecipient shall inform its employees in writing of the rights and remedies
provided under this section, in the predominant native language of the workforce.
17. Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043,
62 FR 19217 (Apr. 18, 1997), Subrecipient should encourage its Contractors to
adopt and enforce on-the-job seat belt policies and programs for their employees
when operating company -owned, rented or personally owned vehicles.
1. Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR
51225 (Oct. 6, 2009), Subrecipient should encourage its employees, Subrecipients, and
Contractors to adopt and enforce policies that ban text messaging while driving, and
24
V.4
Subrecipient should establish workplace safety policies to decrease accidents caused by
distracted drivers.
ASSURANCES OF COMPLIANCE WITH CIVIL RIGHTS REQUIREMENTS
ASSURANCES OF COMPLIANCE WITH
TITLE VI OF THE CIVIL RIGHTS ACT OF
1964
As a condition of receipt of federal financial assistance from the Department of the
Treasury, the Subrecipient provides the assurances stated herein. The federal financial
assistance may iiclude federal grants, loans and Agreements to provide assistance to the
Subrecipient's beneficiaries, the use or rent of Federal land or property at below market value,
Federal training, a loan of Federal personnel, subsidies, and other arrangements with the
intention of providing assistance. Federal financial assistance does not encompass
Agreements of guarantee or insurance, regulated programs, licenses, procurement
Agreements by the Federal government at market value, or programs that provide direct
benefits.
The assurances apply to all federal financial assistance from or funds made available
through the Department of the Treasury, including any assistance that the Subrecipient may
request in the future.
The Civi Rights Restoration Act of 1987 provides that the provisions of the
assurances applyto all of the operations of the Subrecipient's program(s) and activity(ies), so
long as any portion of the Subrecipient's program(s) or activity(ies) is federally assisted in
the manner prescribed above.
1. Subrecipient ensures its current and future compliance with Title VI of the Civil Rights Act
of 1964, as amended, which prohibits exclusion from participation, denial of the benefits of,
or subjection to discrimination under programs and activities receiving federal financial
assistance, of any person in the United States on the ground of race, color, or national origin
(42 U.S.C. § 2000d et seq.), as implemented by the Department of the Treasury Title VI
regulations at 31 CFR Part 22 and other pertinent executive orders such as Executive Order
13166, directives, circulars, policies, memoranda, and/or guidance documents.
2. Subrecipient acknowledges that Executive Order 13166, "Improving Access to Services
for Persons with Limited English Proficiency," seeks to improve access to federally
assisted programs and activities for individuals who, because of national origin, have
Limited English proficiency (LEP). Subrecipient understands that denying a person access
to its programs, services, and activities because of LEP is a form of national origin
discrimination prohibited under Title VI of the Civil Rights Act of 1964 and the
Department of the Treasury's implementing regulations. Accordingly, Subrecipient shall
25
V.4
initiate reasonable steps, or comply with the Department of the Treasury's directives, to
ensure that LEP persons have meaningful access to its programs, services, and activities.
Subrecipient understands and agrees that meaningful access may entail providing
language assistance services, including oral interpretation and written translation where
necessary, to ensure effective communication in the Subrecipient's programs, services,
and activities.
3. Subrecipient agrees to consider the need for language services for LEP persons when
Subrecipient develops applicable budgets and conducts programs, services, and activities.
As a resource, the Department of the Treasury has published its LEP guidance at 70 FR
6067. For more information on taking reasonable steps to provide meaningful access for
LEP persons, please visit http://www.lep.gov.
4. Subrecipient acknowledges and agrees that compliance with the assurances constitutes a
condition of continued receipt of federal financial assistance and is binding upon
Subrecipient and Subrecipient's successors, transferees, and assignees for the period in
which such assistance is provided.
5. Subrecipient acknowledges and agrees that it must require any sub -grantees, contractors,
subcontractors, successors, transferees, and assignees to comply with assurances 1-4
above, and agrees to incorporate the following language in every Agreement or
agreement subject to Title VI and its regulations between the Subrecipient and the
Subrecipient's sub -grantees, Contractors, Subcontractors, successors, transferees, and
assignees:
The sub -grantee, Contractor, Subcontractor, successor, transferee, and assignee shall
comply with Title VI of the Civil Rights Act of 1964, which prohibits Subrecipients of
federal financial assistance from excluding from a program or activity, denying benefits
of or otherwise discriminating against a person on the basis of race, color, or national
origin (42 U.S.C. § 2000d et seq), as implemented by the Department of the Treasury's
Title VI regulations, 31 CFR Part 22, which are herein incorporated by reference and
made a part of this Agreement (or agreement). Title VI also includes protection to
persons with "Limited English Proficiency" in any program or activity receiving federal
financial assistance, 42
U.S.C. § 2000d et seq., as implemented by the Department of the Treasury's Title VI
regulations, 31 CFR Part 22, and herein incorporated by reference and made a part
of this Agreement or agreement.
6. Subrecipient understands and agrees that if any real property or structure is provided or
improved with the aid of federal financial assistance by the Department of the Treasury, this
assurance obligates the Subrecipient, or in the case of a subsequent transfer, the transferee,
for the period during which the real property or structure is used for a purpose for which the
federal financial assistance is extended or for another purpose involving the provision of
similar services or benefits. If any personal property is provided, this assurance obligates the
Subrecipient for the period during which it retains ownership or possession of the property.
7. Subrecipient shall cooperate in any enforcement or compliance review activities by the
Department of the Treasury of the aforementioned obligations. Enforcement may include
26
V.4
investigation, arbitration, mediation, litigation, and monitoring of any settlement
agreements that may result from these actions. The Subrecipient shall comply with
information requests, on -site compliance reviews and reporting requirements.
8. Subrecipient shall maintain a complaint log and inform the Department of the Treasury of
any complaints of discrimination on the grounds of race, color, or national origin, and limited
English proficiency covered by Title VI of the Civil Rights Act of 1964 and implementing
regulations and provide, upon request, a list of all such reviews or proceedings based on the
complaint, pending or completed, including outcome. Subrecipient also must inform the
Department of the Treasury if Subrecipient has received no complaints under Title VI.
9. Subrecipient must provide documentation of an administrative agency's or court's
findings of non-compliance of Title VI and efforts to address the non-compliance,
including any voluntary compliance or other agreements between the Subrecipient and
the administrative agency that made the finding. If the Subrecipient settles a case or
matter alleging such discrimination, the Subrecipient must provide documentation of
the settlement. If Subrecipient has not been the subject of any court or administrative
agency finding of discrimination, please so state.
10. If the Subrecipient makes sub -awards to other agencies or other entities, the Subrecipient
is responsible for ensuring that sub-Subrecipients also comply with Title VI and other
applicable authorities covered in this document State agencies that make sub -awards
must have in place standard grant assurances and review procedures to demonstrate that
that they are effectively monitoring the civil rights compliance of sub- Subrecipients.
The United States of America has the right to seek judicial enforcement of the terms of this
assurances document and nothing in this document alters or limits the federal enforcement
measures that the United States may take in order to address violations of this document or
applicable federal law.
APPENDIX 4 TO SLFRF EXHIBIT- SLFRF SUBRECIPIENT QUARTERLY
REPORT REQUIREMENTS
1. SLFRF SUBRECIPIENT QUARTERLY REPORT WORKBOOK
1.1 The SLFRF Subrecipient Quarterly Report Workbook must be submitted to the State
Agency within ten (10) days following each quarter ended September, December,
March and June. The SLFRF Subrecipient Quarterly Report Workbook can be found
at: hops://osc.colorado.gov/american-rescue-plan-act (see SLFRF Grant Agreement
Templates Tab).
1.2 The requirements set forth in this Appendix 4 do not apply if the instant Agreement is
between two Colorado State Agencies.
27
V.4
APPENDIX 5 TO SLFRF EXHIBIT- SAMPLE SLFRF REPORTING
MODIFICATIONS FORM
Grantee:
Project Title:
Project Duration: I To:
State Agency:
Grant Agreement No:
Project No:
From:
This form serves as notification that there has been a change to the reporting requirements set forth in the original
SLFRF Grant Agreement.
The following reporting requirements have been (add/ remove additional rows as necessary):
Updated Reporting
Requirement
(Add/Delete/Modify)
Project Number
Reporting Requirement
By signing this form, the Grantee agrees to and acknowledges the changes to the reporting requirements set
forth in the original SLFRF Grant Agreement. All other terms and conditions of the original SLFRF Grant
Agreement, with any approved modifications, remain in full force and effect. Grantee shall submit this form
to the State Agency within 10 business days of the date sent by that Agency.
Grantee
Date
State Agency Grant Manager Date
28
V.3
COLORADO
Financial Services
Depatme t of Hunan Senn -es
Divtston of Contracts and Procurement
EXHIBIT D2 - SLFRF CONTRACTOR PROVISIONS (CDHS)
This Exhibit applies regarding the use of State and Local Fiscal Recovery Funds (SLFRF) to
comply with requirements established by the U.S. Department of Treasury and the Colorado
Department of Personnel & Administration, Office of the State Controller re the Colorado
Department of Himan Services (CDHS).
This SLFRF Provisions Exhibit may supplement other Exhibit(s) to the instant Agreement. In the
event that terms on prior Exhibit(s) to the instant Agreement conflict with this SLFRF Provisions
Exhibit, this Exhibit shall control and take precedence.
Contractor must agree to and comply with the terms of these SLFRF Provisions in order to receive
and use these funds.
In the event that Contractor is/was in receipt of SLFRF funding from CDHS prior to execution of
the contract item including the instant Exhibit, Contractor understands that its obligations set forth
herein with regards to that funding shall retroactively apply.
The regulations and requirements surrounding receipt and use of SLFRF funding is an evolving
subject matter as established by the U.S. Department of Treasury and put into established policy
by the Colorado Department of Personnel & Administration, Office of the State Controller for use
with CDHS Agreements. As such, Contractor agrees to execute any additional
Agreements/Amendments as required by CDHS to establish and/or update these procedures.
Contractor agrees to accept written notice from CDHS of updates to these requirements and to
comply with same forthwith, even if prior to or without a formal Amendment to the Agreement to
update this Exhibit or the rules/requirements established herein. Regardless, if CDHS requests that
Contractor execute an Amendment to formalize implementation of and/or acknowledgment of
updates to this Exhibit, Contractor shall promptly comply.
Contractor agrees to stay abreast of and comply with the most current iterations of the requirements
re SLFRF funding set forth on https://osc.colorado.gov/american-rescue-plan-act (see SLFRF
Grant Agreement Templates tab).
1
V.3
1. DEFINITIONS.
1.1. For the purposes of these Federal Provisions, the following terms shall have the
meanings ascribed to them below.
1.1.1. "Award" means an award of Federal financial assistance, and the Grant
setting forth the terms and conditions of that financial assistance, that a non -Federal
Entity receives or administers.
1.1.2. "Entity" means:
1.1.2.1. a Non -Federal Entity;
1.1.2.2. a foreign public entity;
1.1.2.3. a foreign organization;
1.1.2.4. a non-profit organization;
1.1.2.5. a domestic for-profit organization (for 2 CFR parts 25 and 170 only);
1.1.2.6. a foreign non-profit organization (only for 2 CFR part 170) only);
1.1.2.7. a Federal agency, but only as a Subrecipient under an Award or Subaward
to a non -Federal entity (or 2 CFR 200.1); or
1.1.2.8. a foreign for-profit organization (for 2 CFR part 170 only).
1.1.3. "Executive" means an officer, managing partner or any other employee in
a management position.
1.1.4. "Expenditure Category (EC)" means the category of eligible uses as defined
by the US Department of Treasury in "Appendix 1 of the Compliance and
Reporting Guidance, State and Local Fiscal Recovery Funds" report available at
www.treasury.gov.
1.1.5. "Federal Awarding Agency" means a Federal agency providing a Federal
Award to a Recipient as described in 2 CFR 200.1
1.1.6. "Grant" means the Grant Agreement/Contract to which these Federal
Provisions are attached.
1.1.7. "Grantee" means the party or parties identified as such in the Grant
Agreement/Contract to which these Federal Provisions are attached. This party may
alternatively be referred to as "Contractor".
1.1.8. "Non -Federal Entity" means a State, local government, Indian tribe,
institution of higher education, or nonprofit organization that carries out a Federal
Award as a Recipient or a Subrecipient.
1.1.9. "Nonprofit Organization" means any corporation, trust, association,
cooperative, or other organization, not including IHEs, that:
1.1.9.1. Is operated primarily for scientific, educational, service, charitable, or
similar purposes in the public interest;
1.1.9.2. Is not organized primarily for profit; and
2
V.3
1.1.9.3. Uses net proceeds to maintain, improve, or expand the operations of the
organization.
1.1.10. "OMB" means the Executive Office of the President, Office of
Management and Budget.
1.1.11. "System for Award Management (SAM)" means the Federal repository into
which an Entity must enter the information required under the Transparency Act,
which may be found at http://www.sam.gov. "Total Compensation" means the cash
and noncash dollar value earned by an Executive during the Prime Recipient's or
Subrecipient's preceding fiscal year (see 48 CFR 52.204-10, as prescribed in 48
CFR 4.1403(a)) and includes the following:
1.1.11.1. Salary and bonus;
1.1.11.2. Awards of stock, stock options, and stock appreciation rights, using the
dollar amount recognized for financial statement reporting purposes with
respect to the fiscal year in accordance with the Statement of Financial
Accounting Standards No. 123 (Revised 2005) (FAS 123R), Shared Based
Payments;
1.1.11.3. Earnings for services under non -equity incentive plans, not including group
life, health, hospitalization or medical reimbursement plans that do not
discriminate in favor of Executives and are available generally to all salaried
employees;
1.1.11.4. Change in present value of defined benefit and actuarial pension plans;
1.1.11.5. Above -market earnings on deferred compensation which is not tax -
qualified;
1.1.11.6. Other compensation, if the aggregate value of all such other compensation
(e.g., severance, termination payments, value of life insurance paid on
behalf of the employee, perquisites or property) for the Executive exceeds
$10,000.
1.1.12. "Transparency Act" means the Federal Funding Accountability and
Transparency Act of 2006 (Public Law 109-282), as amended by §6202 of Public
Law 110-252.
1.1.13. "Uniform Guidance" means the Office of Management and Budget
Uniform Administrative Requirements, Cost Principles, and Audit Requirements
for Federal Awards. The terms and conditions of the Uniform Guidance flow down
to Awards to Subrecipients unless the Uniform Guidance or the terms and
conditions of the Federal Award specifically indicate otherwise.
1.1.14. "Unique Entity ID" means the Unique Entity ID established by the federal
government for a Grantee at https://sam.gov/content/home.
3
V.3
2. REPORTING.
2.1. Pursuant to the Transparency Act, Grantee shall report data elements to SAM and to
the Prime Recipient as required in this Exhibit. No direct payment shall be made to
Grantee for providing any reports required under these Federal Provisions and the cost
of producing such reports shall be included in the Grant price. The reporting
requirements in this Exhibit are based on guidance from the OMB, and as such are
subject to change at any time by OMB. Any such changes shall be automatically
incorporated into this Grant and shall become part of Grantee's obligations under this
Grant.
2.1.1. Grantee also agrees to comply with any reporting requirements established by the
Governor's Office and Office of the State Controller. The State of Colorado may need
additional reporting requirements after this agreement is executed. If there are
additional reporting requirements, the State will provide notice of such additional
reporting requirements via the SLFRF Reporting Modification Form, a sample of
which is included in this Exhibit.
3. OTHER FEDERAL PROVISIONS.
3.1. Debarment and Suspension (Executive Orders 12549 and 12689): An Agreement
award (see 2 CFR 180.220) must not be made to parties listed on the government wide
exclusions in SAM, in accordance with the OMB guidelines at 2 CFR 180 that
implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR
part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as
parties declared ineligible under statutory or regulatory authority other than Executive
Order 12549.
3.1.1. Never Agreement with the enemy (2 CFR 200.215): Federal awarding agencies
and recipients are subject to the regulations implementing "Never Agreement with the
enemy" in 2 CFR part 183. The regulations in 2 CFR part 183 affect covered
Agreements, grants and cooperative agreements that are expected to exceed $50,000
within the period of performance, are performed outside the United States and its
territories, and are in support of a contingency operation in which members of the
Armed Forces are actively engaged in hostilities.
3.1.2. Title VI of the Civil Rights Act. The Subgrantee, Contractor, Subcontractor,
transferee, and assignee shall comply with Title VI of the Civil Rights Act of 1964,
which prohibits recipients of federal financial assistance from excluding from a
program or activity, denying benefits of, or otherwise discriminating against a
person on the basis of race, color, or national origin (42 U.S.C. § 2000d et seq.), as
implemented by the Department of Treasury's Title VI regulations, 31 CFR Part
22, which are herein incorporated by reference and made a part of this Agreement
(or agreement). Title VI also includes protection to persons with "Limited English
Proficiency" in any program or activity receiving federal financial assistance, 42
U.S. C. § 2000d et seq., as implemented by the Department of the Treasury's Title
VI regulations, 31 CRF Part 22, and herein incorporated by reference and made part
of this Agreement or agreement.
4
V.3
3.2. Maintenance of and Access to Records
3.2.1. Contractor shall maintain records and financial documents sufficient to evidence
compliance with section 602(c), Treasury's regulations implementing that section, and
guidance issued by Treasury regarding the foregoing.
3.2.2. The Treasury Office of Inspector General and the Government Accountability
Office, or their authorized representatives, shall have the right of access to records
(electronic and otherwise) of Contractor in order to conduct audits or other
investigations.
3.2.3. Records shall be maintained by Contractor for a period of five (5) years after all
funds have been expended or returned to Treasury, whichever is later.
3.3. False Statements. Contractor understands that making false statements or claims in
connection with this award is a violation of federal law and may result in criminal, civil,
or administrative sanctions, including fines, imprisonment, civil damages and penalties,
debarment from participating in federal awards or Agreements, and/or any other remedy
available by law.
3.4. Publications. Any publications produced with funds from this award must display the
following language: "This project [is being] [was] supported, in whole or in part, by
federal award number SLFRF0126 awarded to the State of Colorado by the U.S.
Department of the Treasury."
3.5. Protections for Whistleblowers:
3.5.1. In accordance with 41 U.S.C. § 4712, Contractor may not discharge, demote, or
otherwise discriminate against an employee in reprisal for disclosing to any of the list
of persons or entities provided below, information that the employee reasonably
believes is evidence of gross mismanagement of a federal Agreement or grant, a gross
waste of federal funds, an abuse of authority relating to a federal Agreement or grant,
a substantial and specific danger to public health or safety, or a violation of law, rule,
or regulation related to a federal Agreement (including the competition for or
negotiation of an Agreement) or grant.
3.5.2. The list of persons and entities referenced in the paragraph above includes the
following:
3.5.2.1. A member of Congress or a representative of a committee of Congress;
3.5.2.2. An Inspector General;
3.5.2.3. The Government Accountability Office;
3.5.2.4. A Treasury employee responsible for Agreement or grant oversight or
management;
3.5.2.5. An authorized official of the Department of Justice or other law
enforcement agency;
3.5.2.6. A court or grand jury; or
5
V.3
3.5.2.7. A management official or other employee of Contractor, or Subcontractor
who has the responsibility to investigate, discover, or address misconduct.
3.5.3. Contractor shall inform its employees in writing of the rights and remedies provided
under this section, in the predominant native language of the workforce.
3.6. Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043, 62
FR 19217 (Apr. 18, 1997), Contractor should encourage its employees and
Subcontractors to adopt and enforce on-the-job seat belt policies and programs for their
employees when operating company -owned, rented or personally owned vehicles.
3.7. Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR
51225 (Oct. 6, 2009), Contractors should encourage its employees and SubContractors
to adopt and enforce policies that ban text messaging while driving, and Contractor
should establish workplace safety policies to decrease accidents caused by distracted
drivers.
[THE REST OF THIS PAGE INTENTIONALLY LEFT BLANK]
6
V.3
SAMPLE SLFRF REPORTING MODIFICATIONS FORM
Grantee:
Project Title:
Project Duration: I To:
State Agency:
Grant Agreement No:
Project No:
From: I
This form serves as notification that there hasbeen a change to the SLFRF reporting requirements set forth in the
Agreement.
The following reporting requirements have been (add/ remove additional rows as necessary):
By signing this form, the Grantee/Contractor agrees to and acknowledges the changes to the SLFRF
reporting requirements set forth in the existing Agreement. All other terms and conditions of the Agreement,
with any approved modifications, remain in full force and effect. Grantee/Contractor shall submit this form
to the State Agency within 10 business days of the date sent by that Agency.
Grantee
Date
State Agency Grant Manager Date
7
Exhibit E
Exhibit E
Miscellaneous Provisions
I. General Provisions and Requirements
A. Finance and Data Protocols
The Contractor shall comply with the Behavioral Health Administration's (BHA) most current
Finance and Data Protocols and the Behavioral Health Accounting and Auditing Guidelines,
made a part of this Contract by reference.
B. Marketing and Communications
The Contractor shall comply with the following marketing and communications requirements:
1. Reports or Evaluations. All reports or evaluations funded by BHA must be reviewed
by BHA staff, including program, data, and communications, over a period of no
fewer than 15 business days. The Contractor may be asked to place a report or
evaluation on a BHA template and the report or evaluation is required to display the
BHA logo. The Contractor shall submit the finished document to BHA in its final
format and as an editable Word or Google document.
2. Press Releases. All press releases about work funded by BHA must note that the
work is funded by the Colorado Department of Human Services, Behavioral Health
Administration. Press releases about work funded by BHA must be reviewed by
BHA program and communications staff over a period of no fewer than five
business days.
3. Marketing Materials. Contractor shall include the current Colorado Department of
Human Services, Behavioral Health Administration logo on any marketing
materials, such as brochures or fact sheets, that advertise programs funded by this
Contract. Marketing materials must be approved by the Contract's assigned BHA
program contract over a period of no fewer than 5 business days.
4. All Other Documents. All other documents published by the Contractor about its
BHA -funded work, including presentations or website content, should mention the
Colorado Department of Human Services, Behavioral Health Administration as a
funder.
5. Opinion of BHA. BHA may require the Contractor to add language to documents
that mention BHA reading: "The views, opinions and content expressed do not
necessarily reflect the views, opinions or policies of the Colorado Department of
Human Services, Behavioral Health Administration."
C. Start-up Costs
If the State reimburses the Contractor for any start-up costs and the Contractor closes the
program or facility within three years of receipt of the start-up costs, the Contractor shall
reimburse the State for said start-up costs within sixty (60) days of the closure. The Contractor
is not required to reimburse the State for start-up costs if the facility or program closure is due
to BHA eliminating funding to that specific program and/or budget line item.
Page 1 of 5
Exhibit E
D. Immediate Notification of Closures / Reductions in Force
If the Contractor intends to close a facility or program, it shall notify the BHA Contracts Unit
at least five business days prior to the closure. Similarly, if the Contractor, or any sub-
contractor provider, intends to conduct a reduction in force which affects a program funded
through this contract, the Contractor shall notify the BHA Contracts Unit at least five business
days prior to the layoffs.
E. Licensing and Designation Database Electronic Record System (LADDERS)
The Contractor shall use LADDERS (http://www.colorado.gov/ladders) as needed and/or as
required by rule to submit applications for BHA licensing and designation, keep current all
provider directory details, and submit policies and procedures.
F. Contract Contact Procedure
The Contractor shall submit all requests for BHA interpretation of this Contract or for
amendments to this Contract to the BHA Contract Manager.
G. The Contractor shall comply with all the provisions and requirements of RFA #: RFP
IBEH 2023000171.
H. Continuity of Operations Plan
1. In the event of an emergency resulting in a disruption of normal
activities, BHA may request that Contractor provide a plan describing
how Contractor will ensure the execution of essential functions of the
Contract, to the extent possible under the circumstances of the inciting
emergency ("Continuity of Operations Plan" or "Plan").
2. The Continuity of Operations Plan must be specific and responsive to the
circumstances of the identified emergency.
3. BHA will provide formal notification of receipt of the Continuity of
Operations Plan to the Contractor.
4. The Continuity of Operations Plan will not impact or change the budget
or any other provisions of the contract, and Contractor's performance will
be held to the same standards and requirements as the original Contract
terms, unless otherwise specified in the Continuity of Operations Plan.
5. Any submitted Continuity of Operations Plan will be ratified as an
amendment to the contract as soon as possible.
6. Contractor shall communicate, in a format mutually agreed upon by BHA
and Contractor staff, on a frequency that supports the monitoring of
services under the Continuity of Operations Plan. If adjustments are
needed to the Plan, such adjustments will be made in writing and
accompanied by written notice of receipt from BHA.
a. As part of the BHA/Contractor communication during the
Page 2 of 5
Exhibit E
emergency, Contractor and BHA will evaluate whether the
emergency has resolved such that normal operations may be
resumed.
b. Contractor and BHA will agree in writing when the emergency
situation is sufficiently resolved and agree to a closeout period
that is four weeks or less.
c. BHA will submit notice accepting the termination of the Continuity of
Operations Plan to the Contractor as the final action for any qualifying
emergency response.
I. Cultural Responsiveness in Service Delivery
1. The Behavioral Health Administration expects funding dollars to support equity in
access, services provided, and behavioral health outcomes among individuals of
all cultures, gender identities, sexual orientations, races, and ethnicities.
Accordingly, Contractors should collect and use data to: (1) identify priority
populations vulnerable to health disparities encompassing the contractor's entire
geographic service area (e.g., racial, ethnic, limited English speaking, indigenous,
sexual orientation, gender identity groups, etc.) and (2) implement strategies to
decrease the disparities in access, service use, and outcomes —both within those
subpopulations and in comparison to the general population.
2. One strategy for addressing health disparities is the use of the recently revised
National Standards for Culturally and Linguistically Appropriate Services in
Health and Health Care (CLAS). The U.S. Department of Health and Human
Services (HHS) Think Cultural Health website
(https://thinkculturalhealth.hhs.gov/) also features information, continuing
education opportunities, resources, and more for health and health care
professionals to learn about culturally and linguistically appropriate services, or
CLAS.
3. Contractors providing direct behavioral health prevention, treatment, or recovery
services shall submit one of the following two documents to
cdhs BHAdeliverablesastate.co.us by August 31 annually:
a. If a provider has completed an equity plan that identifies how they will
address health equity, they can submit the plan or;
b. Submit a completed CLAS checklist that follows this HHS format:
https://thinkculturalhealth.hhs.gov/assets/pdfs/AnImplementationChecklist
fortheNationalCLASStandards.pdf
J. Prohibition on Marijuana. Funds may not be used, directly or indirectly, to purchase,
prescribe, or provide marijuana or treatment using marijuana. Treatment in this context
includes the treatment of opioid use disorder. Funds also cannot be provided to any
individual who or organization that provides or permits marijuana use for the purposes of
treating substance use or mental disorders. This prohibition does not apply to those
Page 3 of 5
Exhibit E
providing such treatment in the context of clinical research permitted by the DEA and
under an FDA -approved investigational new drug application where the article being
evaluated is marijuana or a constituent thereof that is otherwise a banned controlled
substance under federal law.
II. Use of Subcontracts.
A. Services described in this Contract may be performed by Contractor or by a subcontractor,
except where this Contract states explicitly that a service must not be subcontracted.
1. Contractor shall ensure that its subcontractors perform to the terms of this Contract as set
forth in the Contract provisions.
B. Any subcontract for services must include, at a minimum, the following:
1. A description of each partner's participation
2. Responsibilities to the program (policy and/or operational)
3. Resources the subcontractor will contribute, reimbursement rates, services to be included
and processes in collecting and sharing data and the most recent CDHS version of the
HIPAA Business Associates Addendum, if this Contract contains the HIPAA Business
Associates Addendum/Qualified Service Organization Addendum as an exhibit.
4. A copy of this Contract and all its terms and conditions.
C. The Contractor shall provide to BHA a copy of any proposed subcontract between the
Contractor and any potential provider of services to fulfill any requirements of this Contract, to
cdhs BHAdeliverables@state.co.us within 30 days of subcontract execution.
D. BHA reserves the right to require Contractor to renegotiate subcontracts where necessary to
adhere to the terms of this Contract.
E. Subcontractor/Partnership Termination. In the event where partnerships with a subcontractor
such as a treatment provider is terminated, the Contractor shall transition to a new partnership
no later than 30 days from termination to ensure continuity of care for all participants of the
program.
Audit Requirements
A. Independent Audit Requirements
1. "Independent financial audit" shall be defined as follows— a financial audit conducted by a
certified public accounting firm or certified public accountant (CPA) in accordance with
generally accepted accounting principles and applicable federal regulations. The CPA or
firm must be independent of the Contractor. "Independent" means not a regular full-time
or part-time employee of the Contractor and not receiving any form of compensation from
the Contractor other than compensation that the CPA receives for the conduct of the
financial audit.
2. If the Contractor or sub -contractor expends federal awards from all sources (direct or from
pass -through entities) in an amount of $300,000 or more during its fiscal year shall have an
independent financial audit performed annually. The audit shall identify, examine, and
Page 4 of 5
Exhibit E
report the income and expenditures specific to operation of the services described in this
contract. The audit will be presented in the format specified in the "Accounting and
Auditing Guidelines" for Colorado Department of Human Services, Behavioral Health
Administration (BHA), found on the BHA website.
3. The Contractor agrees to comply with the qualified or disclaimer opinion rendered by the
independent auditor on financial statements or the negative opinion on peer review reports.
Non-compliance with these standards shall result in enforcement of remedies against the
Contractor as provided in this Contract.
B. Annual Single Audit
1. If the Contractor or sub -contractor expends federal awards from all sources (direct or from
pass -through entities) in an amount of $750,000 or more during its fiscal year, then the
Contractor or sub -contractor shall have an audit of that fiscal year in accordance with the
Single Audit Act Amendments of 1996, (31 U.S.C. 7501-7507), the provisions for which
are outlined in Exhibit E, "Supplemental Provisions for Federal Awards."
III. Financial Requirements
A. Funding Sources
1. The Contractor shall identify all funds delivered to subcontractors as state general fund,
state cash funds, or federal grant dollars in Exhibit B, "Budget."
2. If a Single Audit is performed in accordance with Section IV.B. above, the Contractor shall
report the amount of the federal grant identified in the budget under the CFDA number
identified on the first page of this Contract.
3. The Contractor shall communicate the CFDA number to all sub -contractors in their sub-
contracts.
B. Budget Reallocations
1. The Contractor may reallocate funds between the budget categories of this contract, up to
10% of the total contract amount, upon written approval by BHA, without a contract
amendment. Any allowable reallocation is still subject to the limitations of the
Not to Exceed and the Maximum Amount Available per Fiscal Year.
C. Payment Terms
1. The Contractor shall invoice monthly for services, no later than the 20th of the month
following when services are provided.
2. The Contractor shall utilize the invoice template(s) provided by BHA.
3. All payment requests shall be submitted electronically to
CDHS BHApayment@state.co.us
4. Any requests for payment received after September 10th for the prior state fiscal year cannot
be processed by BHA.
5. The State will make payment on invoices within 45 days of receipt of a correct and complete
invoice to CDHS_BHApayment@state.co.us. Consequently, the Contractor must have
adequate solvency to pay its expenses up to 45 days after invoice submission to the State.
Page 5 of 5
a
COLORADO
Financial services
Department of
Cnvlrion of Contracts and Procurement
EXHIBIT F - Supplemental Provisions for Federal Awards
For the purposes of this Exhibit only, Contractor is also identified as "Subrecipient." This Contract has been funded, in
whole or in part, with an award of Federal funds. In the event of a conflict between the provisions of these Supplemental
Provisions for Federal Awards, the Special Provisions, the Contract or any attachments or exhibits incorporated into and
made a part of the Contract, the Supplemental Provisions for Federal Awards shall control. In the event of a conflict
between the Supplemental Provisions for Federal Awards and the FFATA Supplemental Provisions (if any), and/or
exhibit regarding SLFRF Federal Provisions, the terms re FFATA and/or SLFRF shall control. If the source of the funding
of the Contract is a grant, these Federal Provisions are subject to the Award as defined in §2 of these Federal Provisions,
as may be revised pursuant to ongoing guidance from the relevant Federal or State of Colorado agency or institutions of
higher education.
1) Federal Award Identification
i. Subrecipient: Subrecipient name (must match registered name in www.sam.gov)
ii. Subrecipient Unique Entity ID number: UEI #;
iii. The Federal Award Identification Number (FAIN) is FAIN;
iv. The Federal award date is Award Date (this is the date when the Federal award is signed by the
authorized official of the Federal awarding agency);
v. The subaward period of performance start date is start date and end date is end date;
vi. Federal Funds:
Contract or
Amount of Federal funds
Total amount of Federal
Total amount of the
Fiscal Year
obligated by this Contract
funds obligated to the
Subrecipient
Federal Award committed
to Subrecipient by CDHS
Insert
Amount of Federal
Total amount of Federal
Total Amount of the
Contract
Funds obligated by this
Funds awarded to
Federal Award
term or
Contract by CDHS to
Subrecipient per this
committed to
fiscal year
Subrecipient
program across all active
contracts
Subrecipient by CDHS
vii. Federal award project description: Federal award project description (as required to be responsive to the
Federal Funding Accountability and Transparency Act (FFATA);
viii. The name of the Federal awarding agency is Federal awarding agency; the name of the pass -through entity
is the State of Colorado, Department of Human Services (CDHS); and the contact information for the
awarding official is contact information for awarding official of CDHS;
ix. The Catalog of Federal Domestic Assistance (CFDA) number is if applicable, insert CFDA number,
otherwise put N/A, name is if applicable, insert program title, otherwise put N/A, and dollar amount is if
applicable, insert dollar amount, otherwise put N/A;
x. This award [is or is not] for research & development;
Supplemental Provisions for Federal Awards
Revised December 2021
Page 1 of 10
xi. 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 CDHS cost allocation plan.
2) All requirements imposed by CDHS on Subrecipient so that the Federal award is used in accordance with Federal
statutes, regulations, and the terms and conditions of the Federal award, are stated in insert reference to exhibit that
contains this information.
3) Any additional requirements that CDHS imposes on Subrecipient in order for CDHS to meet its own responsibility to
the Federal awarding agency, including identification of any required financial and performance reports, are stated in
insert reference to exhibit that contains this information (put N/A if not applicable).
4) Subrecipient's approved indirect cost rate is Choose art item. Insert percentage (this must match your budget). If
zero, choose CDHS negotiated rate and put 0 %.
5) Subrecipient must permit CDHS and auditors to have access to Subrecipient's records and financial statements as
necessary for CDHS to meet the requirements of 2 CFR §200.331 Requirements for pass -through entities, §§ 200.300
Statutory and National Policy Requirements through §200309 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 Exhibit and
insert reference to exhibit that contains closeout procedures, or put N/A.
7) Performance and Final Status. Subrecipient shall submit all financial, performance, and other reports to CDHS no
later than Insert number of days 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
If a box below is checked, the accompanying provision applies.
i. II Subrecipient is not required to provide matching funds.
ii. ❑ Subrecipient shall provide matching funds as stated in insert reference to exhibit that contains match
information. Subrecipient shall have raised the full amount of matching funds prior to the Effective Date and
shall report to CDHS regarding the status of such funds upon request. Subrecipient's obligation to pay all or
any part of any matching funds, whether direct or contingent, only extends to funds duly and lawfully
appropriated for the purposes of this Contract by the authorized representatives of the Subrecipient and paid
into the Subrecipient's treasury or bank account. Subrecipient represents to CDHS that the amount designated
as matching funds has been legally appropriated for the purposes of this Contract by its authorized
representatives and paid into its treasury or bank account. Subrecipient does not by this Contract irrevocably
pledge present cash reserves for payments in future fiscal years, and this Contract is not intended to create a
multiple -fiscal year debt of the Subrecipient. Subrecipient shall not pay or be liable for any claimed interest,
late charges, fees, taxes or penalties of any nature, except as required by Subrecipient's laws or policies.
1. DEFINITIONS.
1.1. For the purposes of these Federal Provisions, the following terms shall have the meanings ascribed to them
below.
1.1.1. "Award" means an award of Federal financial assistance, and the Contract setting forth the terms and
conditions of that financial assistance, that a non -Federal Entity receives or administers.
1.1.1.1.1. Awards may be in the form of:
1.1.1.1.2. Grants;
1.1.1.1.3. Contracts;
Supplemental Provisions for Federal Awards Page 2 of 10
Revised December 2021
1.1.1.1.4. Cooperative Contracts, which do not include cooperative research and development
Contracts (CRDA) pursuant to the Federal Technology Transfer Act of 1986, as amended (15 U.S.C.
3710);
1.1.1.1.5. Loans;
1.1.1.1.6. Loan Guarantees;
1.1.1.1.7. Subsidies;
1.1.1.1.8. Insurance;
1.1.1.1.9. Food commodities;
1.1.1.1.10. Direct appropriations;
1.1.1.1.11. Assessed and voluntary contributions; and
1.1.1.1.12. Other financial assistance transactions that authorize the expenditure of Federal funds by
non -Federal Entities.
1.1.1.1.13. Any other items specified by OMB in policy memoranda available at the OMB website or
other source posted by the OMB.
1.1.1.2.
1.1.1.2.1.
Award does not include:
Technical assistance, which provides services in lieu of money;
1.1.1.2.2. A transfer of title to Federally -owned property provided in lieu of money; even if the award
is called a grant;
1.1.1.2.3. Any award classified for security purposes; or
1.1.1.2.4. Any award funded in whole or in part with Recovery funds, as defined in section 1512 of
the American Recovery and Reinvestment Act (ARRA) of 2009 (Public Law 111-5).
1.1.2. "Contract" means the Contract to which these Federal Provisions are attached and includes all Award types
in § of this Exhibit.
1.1.3. "Contractor" means the party or parties to a Contract funded, in whole or in part, with Federal financial
assistance, other than the Prime Recipient, and includes grantees, subgrantees, Subrecipients, and
borrowers. For purposes of Transparency Act reporting, Contractor does not include Vendors.
1.1.4. "Unique Entity ID number" or "UEI" is the Unique Entity ID number established by the federal
government in the Unique Entity ID System to uniquely identify a business entity. For more, see:
www.sam.gov.
1.1.5. "Entity" means:
1.1.5.1. If the source of funding is a Grant:
1.1.5.1.1. a Non -Federal Entity;
1.1.5.1.2. a foreign public entity;
1.1.5.1.3. a foreign organization;
1.1.5.1.4. a non-profit organization;
1.1.5.1.5. a domestic for-profit organization (for 2 CFR parts 25 and 170 only);
1.1.5.1.6. a foreign non-profit organization (only for 2 CFR part 170) only);
1.1.5.1.7. a Federal agency, but only as a Subrecipient under an Award or Subaward to a
non -Federal entity (or 2 CFR 200.1); or
1.1.5.1.8. a foreign for-profit organization (for 2 CFR part 170 only).
Supplemental Provisions for Federal Awards Page 3 of 10
Revised December 2021
1.1.5.2. If the source of funding is not a Grant:
1.1.5.2.1. all of the following as defined at 2 CFR part 25, subpart C;
1.1.5.2.2. A governmental organization, which is a State, local government, or Indian Tribe;
1.1.5.3. a foreign public entity;
1.1.5.4. a domestic or foreign non-profit organization;
1.1.5.5. a domestic or foreign for-profit organization; and
1.1.5.6. a Federal agency, but only a Subrecipient under an Award or Subaward to a non -
Federal entity.
1.1.6. "Executive" means an officer, managing partner or any other employee in a management position.
1.1.7. If the source of funding is a Grant, "Federal Awarding Agency" means a Federal agency providing a
Federal Award to a Recipient as described in 2 CFR 200.1. If the source of funding is not a Grant, "Federal
Award Identification Number (FAIN)" means an Award number assigned by a Federal agency to a Prime
Recipient.
1.1.8. "FFATA" means the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282),
as amended by §6202 of Public Law 110-252. FFATA, as amended, also is referred to as the "Transparency
Act.
9,
1.1.9. "Federal Provisions" means these Federal Provisions subject to the Transparency Act and Uniform
Guidance, as may be revised pursuant to ongoing guidance from the relevant Federal or State of Colorado
agency or institutions of higher education.
1.1.10. If the source of funding is a Grant, "Grant" as used herein is the Contract to which these Federal Provisions
are attached.
1.1.11. "Grantee" means the party or parties identified as such in the Grant to which these Federal Provisions are
attached if the source of funding is a Grant.
1.1.12. "Non -Federal Entity means a State, local government, Indian tribe, institution of higher education, or
nonprofit organization that carries out a Federal Award as a Recipient or a Subrecipient.
1.1.13. "Nonprofit Organization" means any corporation, trust, association, cooperative, or other organization, not
including IHEs, that:
1.1.13.1. Is operated primarily for scientific, educational, service, charitable, or similar purposes in the
public interest;
1.1.13.2. Is not organized primarily for profit; and
1.1.13.3. Uses net proceeds to maintain, improve, or expand the operations of the organization.
1.1.14. "OMB" means the Executive Office of the President, Office of Management and Budget.
1.1.15. "Pass -through Entity" means a non -Federal Entity that provides a Subaward to a Subrecipient to carry out
part of a Federal program.
1.1.16. "Prime Recipient" means a Colorado State agency or institution of higher education that receives an Award,
or, of the source of funding is a Grant it is that agency or institution identified as the Grantor in the Grant
to which these Federal Provisions are attached.
1.1.17. "Subaward" means an award by a Prime Recipient to a Subrecipient funded in whole or in part by a Federal
Award. The terms and conditions of the Federal Award flow down to the Subaward unless the terms and
conditions of the Federal Award specifically indicate otherwise in accordance with 2 CFR 200.101 or 2
CFR 200.38, as applicable. The term does not include payments to a contractor or payments to an individual
that is a beneficiary of a Federal program.
Supplemental Provisions for Federal Awards Page 4 of 10
Revised December 2021
1.1.18. "Subrecipient" or, if the source of funding is a Grant, "Subgrantee" means a non -Federal Entity (or a Federal
agency under an Award or Subaward to a non -Federal Entity) receiving Federal funds through a Prime
Recipient to support the performance of the Federal project or program for which the Federal funds were
awarded. A Subrecipient is subject to the terms and conditions of the Federal Award to the Prime Recipient,
including program compliance requirements. The term "Subrecipient" includes and may be referred to as
Subgrantee. The term does not include an individual who is a beneficiary of a federal program.
1.1.19. "Subrecipient Parent UEI Number" means the Subrecipient parent organization's 12 -digit Unique Entity
ID System (UEI) number that appears in the subrecipient's System for Award Management (SAM) profile,
if applicable.
1.1.20. "System for Award Management (SAM)" means the Federal repository into which an Entity must enter
the information required under the Transparency Act, which may be found at http://www.sam.gov.
1.1.21. "Total Compensation" means the cash and noncash dollar value earned by an Executive during the Prime
Recipient's or Subrecipient's preceding fiscal year (see 48 CFR 52.204-10, as prescribed in 48 CFR
4.1403(a), as applicable) and includes the following:
1.1.21.1. Salary and bonus;
1.1.21.2. Awards of stock, stock options, and stock appreciation rights, using the dollar amount
recognized for financial statement reporting purposes with respect to the fiscal year in
accordance with the Statement of Financial Accounting Standards No. 123 (Revised 2005)
(FAS 123R), Shared Based Payments;
1.1.21.3. Earnings for services under non -equity incentive plans, not including group life, health,
hospitalization or medical reimbursement plans that do not discriminate in favor of Executives
and are available generally to all salaried employees;
1.1.21.4. Change in present value of defined benefit and actuarial pension plans;
1.1.21.5. Above -market earnings on deferred compensation which is not tax -qualified;
1.1.21.6. Other compensation, if the aggregate value of all such other compensation (e.g., severance,
termination payments, value of life insurance paid on behalf of the employee, perquisites or
property) for the Executive exceeds $10,000.
1.1.22. "Transparency Act" means the Federal Funding Accountability and Transparency Act of 2006 (Public Law
109-282), as amended by §6202 of Public Law 110-252. The Transparency Act may also be referred to as
FFATA.
1 1.23. "Uniform Guidance" means the Office of Management and Budget Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards, which, unless the source of funding is a Grant,
supersedes requirements from OMB Circulars A-21, A-87, A-110, and A-122, OMB Circulars A-89, A-
102, and A-133, and the guidance in Circular A-50 on Single Audit Act follow-up. The terms and
conditions of the Uniform Guidance flow down to Awards to Subrecipients unless the Uniform Guidance
or the terms and conditions of the Federal Award specifically indicate otherwise.
1 1.24. "Vendor" means a dealer, distributor, merchant or other seller providing property or services required for a
project or program funded by an Award. A Vendor is not a Prime Recipient or a Subrecipient and is not
subject to the terms and conditions of the Federal award. Program compliance requirements do not pass
through to a Vendor.
2. COMPLIANCE.
Supplemental Provisions for Federal Awards Page 5 of 10
Revised December 2021
2.1. Contractor/Grantee shall comply with all applicable provisions of the Transparency Act and the regulations
issued pursuant thereto, all applicable provisions of the Uniform Guidance, including, but not limited to, all
applicable Federal Laws and regulations required by this Federal Award. Any revisions to such provisions or
regulations shall automatically become a part of these Federal Provisions, without the necessity of either party
executing any further instrument. The State of Colorado, at its discretion, may provide written notification to
Contractor/Grantee of such revisions, but such notice shall not be a condition precedent to the effectiveness of
such revisions.
3. SYSTEM FOR AWARD MANAGEMENT (SAM) AND UNIQUE ENTITY ID SYSTEM (UEI)
REQUIREMENTS.
3.1. SAM. Contractor/Grantee shall maintain the currency of its information in SAM until the Contractor/Grantee
submits the final financial report required under the Award or receives final payment, whichever is later.
Contractor/Grantee shall review and update SAM information at least annually after the initial registration, and
more frequently if required by changes in its information.
3.2. UEI. Contractor/Grantee shall provide its UEI number to its Prime Recipient, and shall update
Contractor's/Grantee's information in www.sam.gov at least annually after the initial registration, and more
frequently if required by changes in Contractor's/Grantee's information.
4. TOTAL COMPENSATION.
4.1. Contractor/Grantee shall include Total Compensation in SAM for each of its five most highly compensated
Executives for the preceding fiscal year if:
4.1.1. The total Federal funding authorized to date under the Award is $30,000 or more if the source of funding
is a Grant, or otherwise $25,000 or more if the source of funding is not a Grant; and
4.1.2. In the preceding fiscal year, Contractor/Grantee received:
4.1.2.1. 80% or more of its annual gross revenues from Federal procurement contracts and subcontracts
and/or Federal financial assistance Awards or Subawards subject to the Transparency Act; and
4.1.2.2. $30,000,000 or more in annual gross revenues from Federal procurement contracts and
subcontracts and/or Federal financial assistance Awards or Subawards subject to the Transparency
Act if the source of funding is a Grant or otherwise $25,000,000 or more in annual gross revenues
from Federal procurement contracts and subcontracts and/or Federal financial assistance Awards
or Subawards subject to the Transparency Act if the source of funding is not a Grant; and
4.1.2.3. The public does not have access to information about the compensation of such Executives through
periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15
U.S.C. 78m(a), 78o(d) or § 6104 of the Internal Revenue Code of 1986.
5. REPORTING.
5.1. If Contractor/Grantee is a Subrecipient of the Award pursuant to the Transparency Act, Grantee shall report
data elements to SAM and to the Prime Recipient as required in this Exhibit. No direct payment shall be made
to Grantee for providing any reports required under these Federal Provisions and the cost of producing such
reports shall be included in the Contract/Grant price. The reporting requirements in this Exhibit are based on
guidance from the US Office of Management and Budget (OMB), and as such are subject to change at any time
by OMB. Any such changes shall be automatically incorporated into this Contract/Grant and shall become part
of Contractor's/Grantee's obligations under this Contract/Grant.
6. EFFECTIVE DATE AND DOLLAR THRESHOLD FOR REPORTING.
6.1. If the source of funding is a Grant, Reporting requirements in §8 below apply to new Awards as of October 1,
2010, if the initial award is $30,000 or more. If the initial Award is below $30,000 but subsequent Award
modifications result in a total Award of $30,000 or more, the Award is subject to the reporting requirements as
of the date the Award exceeds $30,000. If the initial Award is $30,000 or more, but funding is subsequently
de -obligated such that the total award amount falls below $30,000, the Award shall continue to be subject to
the reporting requirements.
Supplemental Provisions for Federal Awards Page 6 of 10
Revised December 2021
6.2. If the source of funding is not a Grant, Reporting requirements in §8 below apply to new Awards as of October
1, 2010, if the initial award is $25,000 or more. If the initial Award is below $25,000 but subsequent Award
modifications result in a total Award of $25,000 or more, the Award is subject to the reporting requirements as
of the date the Award exceeds $25,000. If the initial Award is $25,000 or more, but funding is subsequently
de -obligated such that the total award amount falls below $25,000, the Award shall continue to be subject to
the reporting requirements.
6.3. The procurement standards in §9 below are applicable to new Awards made by Prime Recipient as of December
26, 2015. The standards set forth in §11 below are applicable to audits of fiscal years beginning on or after
December 26, 2014.
7. SUBRECIPIENT REPORTING REQUIREMENTS.
7.1. If Contractor/Grantee is a Subrecipient, Contractor/Grantee shall report as set forth below.
7.1.1. To SAM. A Subrecipient shall register in SAM and report the following data elements in SAM for each
Federal Award Identification Number (FAIN) assigned by a Federal agency to a Prime Recipient no later
than the end of the month following the month in which the Subaward was made:
7.1.1.1. Subrecipient UEI Number;
7.1.1.2. Subrecipient UEI Number if more than one electronic funds transfer (EFT) account;
7.1.1.3. Subrecipient parent's organization UEI Number;
7.1.1.4. Subrecipient's address, including: Street Address, City, State, Country, Zip (+ 4 if source of
funding is a Grant or as otherwise directed per SAM directives for proper reporting), and
Congressional District;
7.1.1.5. Subrecipient's top 5 most highly compensated Executives if the criteria in §4 above are met;
and
7.1.1.6. Subrecipient's Total Compensation of top 5 most highly compensated Executives if the criteria
in §4 above met.
7.1.2. To Prime Recipient. A Subrecipient shall report to its Prime Recipient, upon the effective date of the
Contract/Grant, the following data elements:
7.1.2.1. Subrecipient's UEI Number as registered in SAM.
7.1.2.2. Primary Place of Performance Information, including: Street Address, City, State, Country, Zip
code + 4, and Congressional District.
8. PROCUREMENT STANDARDS.
8.1. Procurement Procedures. A Subrecipient shall use its own documented procurement procedures which reflect
applicable State, local, and Tribal laws and applicable regulations, provided that the procurements conform to
applicable Federal law and the standards identified in the Uniform Guidance, including without limitation, 2
CFR 200.318 through 200.327 thereof
8.2. If the source of funding is a Grant: Domestic preference for procurements (2 CFR 200.322). As appropriate
and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicable under a
Federal award, provide a preference for the purchase, acquisition, or use of goods, products, or materials
produced in the United States (including but not limited to iron, aluminum, steel, cement, and other
manufactured products). The requirements of this section must be included in all subawards including all
contracts and purchase orders for work or products under this award.
Supplemental Provisions for Federal Awards Page 7 of 10
Revised December 2021
83. Procurement of Recovered Materials. If a Subrecipient is a State Agency or an agency of a political subdivision
of the State, its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the
Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items
designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247, that contain the
highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of
competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during
the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that
maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement
of recovered materials identified in the EPA guidelines.
9. ACCESS TO RECORDS.
9.1. A Subrecipient shall permit Recipient/Prime Recipient and its auditors to have access to Subrecipient's records
and financial statements as necessary for Recipient to meet the requirements of 2 CFR 200.311-200.332
(Requirements for pass -through entities), 2 CFR 200300 (Statutory and national policy requirements) through
2 CFR 200.309 (Period of performance), and Subpart F -Audit Requirements of the Uniform Guidance.
10. SINGLE AUDIT REQUIREMENTS.
10.1. If a Subrecipient expends $750,000 or more in Federal Awards during the Subrecipient's fiscal year, the
Subrecipient shall procure or arrange for a single or program -specific audit conducted for that year in
accordance with the provisions of Subpart F -Audit Requirements of the Uniform Guidance, issued pursuant to
the Single Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR 200.501.
10.1.1. Election. A Subrecipient shall have a single audit conducted in accordance with Uniform Guidance 2 CFR
200.514 (Scope of audit), except when it elects to have a program -specific audit conducted in accordance
with 2 CFR 200.507 (Program -specific audits). The Subrecipient may elect to have a program -specific
audit if Subrecipient expends Federal Awards under only one Federal program (excluding research and
development) and the Federal program's statutes, regulations, or the terms and conditions of the Federal
award do not require a financial statement audit of Prime Recipient. A program -specific audit may not be
elected for research and development unless all of the Federal Awards expended were received from
Recipient and Recipient approves in advance a program -specific audit.
10.1.2. Exemption. If a Subrecipient expends less than $750,000 in Federal Awards during its fiscal year, the
Subrecipient shall be exempt from Federal audit requirements for that year, except as noted in 2 CFR
200.503 (Relation to other audit requirements), but records shall be available for review or audit by
appropriate officials of the Federal agency, the State, and the Government Accountability Office.
10.1.3. Subrecipient Compliance Responsibility. A Subrecipient shall procure or otherwise arrange for the audit
required by Subpart F of the Uniform Guidance and ensure it is properly performed and submitted when
due in accordance with the Uniform Guidance. Subrecipient shall prepare appropriate financial statements,
including the schedule of expenditures of Federal awards in accordance with 2 CFR 200.510 (Financial
statements) and provide the auditor with access to personnel, accounts, books, records, supporting
documentation, and other information as needed for the auditor to perform the audit required by Uniform
Guidance Subpart F -Audit Requirements.
11. CONTRACT/GRANT PROVISIONS FOR SUBRECEPIENT CONTRACTS.
11.1. In addition to other provisions required by the Federal Awarding Agency or the Prime Recipient,
Contractors/Grantees that are Subrecipients shall comply with the following provisions. Subrecipients shall
include all of the following applicable provisions in all subcontracts entered into by it pursuant to this
Contract/Grant.
Supplemental Provisions for Federal Awards Page 8 of 10
Revised December 2021
11.1.1. [Applicable to federally assisted construction contracts.] Equal Employment Opportunity. Except as
otherwise provided under 41 CFR Part 60, all contracts that meet the definition of "federally assisted
construction contract" in 41 CFR Part 60-1.3 shall include the equal opportunity clause provided under 41
CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal Employment Opportunity" (30 FR
12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending
Executive Order 11246 Relating to Equal Employment Opportunity," and implementing regulations at 41
CFR pail 60, Office of Federal Contract Compliance Programs, Equal Employment Opportunity,
Department of Labor.
11.1.2. [Applicable to on -site employees working on government -funded construction, alteration and repair
projects.] Davis -Bacon Act. Davis -Bacon Act, as amended (40 U.S.C. 3141-3148).
11.1.3. Rights to Inventions Made Under a contract/grant or agreement. If the Federal Award meets the definition
of "funding agreement"/ "funding Contract" under 37 CFR 401.2 (a) and the Prime Recipient or
Subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding
the substitution of parties, assignment or performance of experimental, developmental, or research work
under that "funding agreement,"/"funding Contract", the Prime Recipient or Subrecipient must comply with
the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small
Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing
regulations issued by the Federal Awarding Agency.
11.1.4. Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-
1387), as amended. Contracts and subgrants of amounts in excess of $150,000 must contain a provision
that requires the non -Federal awardee(s) to agree to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution
Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal Awarding
Agency and the Regional Office of the Environmental Protection Agency (EPA).
11.1.5. Debarment and Suspension (Executive Orders 12549 and 12689). A contract award (see 2 CFR 180.220) must
not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in
accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986
Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions
contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared
ineligible under statutory or regulatory authority other than Executive Order 12549.
11.1.6. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352). Contractors that apply or bid for an award exceeding
$100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not
used Federal appropriated funds to pay any person or organization for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an
employee of a member of Congress in connection with obtaining any Federal contract, grant or any other
award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non -Federal funds that
takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to
tier up to the non -Federal award.
11.1.7. Never contract with the enemy (2 CFR 200.215). Federal awarding agencies and recipients are subject to
the regulations implementing "Never contract with the enemy" in 2 CFR part 183. The regulations in 2
CFR part 183 affect covered contracts, grants and cooperative agreements that are expected to exceed
$50,000 within the period of performance, are performed outside the United States and its territories, and
are in support of a contingency operation in which members of the Armed Forces are actively engaged in
hostilities.
11.1.8. Prohibition on certain telecommunications and video surveillance services or equipment (2 CFR 200.216).
Grantee is prohibited from obligating or expending loan or grant funds on certain telecommunications and
video surveillance services or equipment pursuant to 2 CFR 200.216.
12. CERTIFICATIONS.
Supplemental Provisions for Federal Awards Page 9 of 10
Revised December 2021
12.1. Unless prohibited by Federal statutes or regulations, Recipient/Prime Recipient may require Subrecipient to
submit certifications and representations required by Federal statutes or regulations on an annual basis. 2 CFR
200.208. Submission may be required more frequently if Subrecipient fails to meet a requirement of the Federal
award. Subrecipient shall certify in writing to the State at the end of the Award that the project or activity was
completed or the level of effort was expended. 2 CFR 200.201(3). If the required level of activity or effort was
not carried out, the amount of the Award must be adjusted.
13. EXEMPTIONS.
13.1. These Federal Provisions do not apply to an individual who receives an Award as a natural person, unrelated to
any business or non-profit organization he or she may own or operate in his or her name.
13.2. A Contractor/Grantee with gross income from all sources of less than $300,000 in the previous tax year is
exempt from the requirements to report Subawards and the Total Compensation of its most highly compensated
Executives.
14. EVENT OF DEFAULT AND TERMINATION.
14.1. Failure to comply with these Federal Provisions shall constitute an event of default under the Contract/Grant
and the State of Colorado may terminate the Contract/Grant upon 30 days prior written notice if the default
remains uncured five calendar days following the termination of the 30 -day notice period. This remedy will be
in addition to any other remedy available to the State of Colorado under the Contract/Grant, at law or in equity.
14.2. Termination (2 CFR 200.340). The Federal Award may be terminated in whole or in part as follows:
14.2.1. By the Federal Awarding Agency or Pass -through Entity, if a Non -Federal Entity fails to comply with the
terms and conditions of a Federal Award;
14.2.2. By the Federal awarding agency or Pass -through Entity, to the greatest extent authorized by law, if an award
no longer effectuates the program goals or agency priorities;
14.2.3. By the Federal awarding agency or Pass -through Entity with the consent of the Non -Federal Entity, in
which case the two parties must agree upon the termination conditions, including the effective date and, in
the case of partial termination, the portion to be terminated;
14.2.4. By the Non -Federal Entity upon sending to the Federal Awarding Agency or Pass -through Entity written
notification setting forth the reasons for such termination, the effective date, and, in the case of partial
termination, the portion to be terminated. However, if the Federal Awarding Agency or Pass -through Entity
determines in the case of partial termination that the reduced or modified portion of the Federal Award or
Subaward will not accomplish the purposes for which the Federal Award was made, the Federal Awarding
Agency or Pass -through Entity may terminate the Federal Award in its entirety; or
14.2.5. By the Federal Awarding Agency or Pass -through Entity pursuant to termination provisions included in the
Federal Award.
EXHIBIT END
Supplemental Provisions for Federal Awards Page 10 of 10
Revised December 2021
GRANT APPLICATION AND SUBRECIPIENT CERTIFICATION AGREEMENT FOR STATE
AND LOCAL FISCAL RECOVERY FUNDS (SLFRF) FOR CHILDREN, YOUTH, AND FAMILY
SERVICES
APPROVED AS TO SUBSTANCE:
epa ent Head, or Deputy Department Head
APPROVED AS TO FUNDING:
4.4t,th.
Chief Financial Officer, or Controller
APPROVED AS TO FORM:
County Attorney
Hello