HomeMy WebLinkAbout20223573.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #6 FOR PREVENTION OF INFERTILITY AND
MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS (STI) AND AUTHORIZE
CHAIR TO SIGN AND 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 Contract Amendment #6 for the
Prevention of Infertility and Management of Sexually Transmitted Infections (STI) between the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Public Health and Environment, and the Colorado
Department of Public Health and Environment, commencing upon the full execution of signatures,
and ending December 31, 2023, with further terms and conditions being as stated in said
amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that Contract Amendment #6 for the Prevention of Infertility and
Management of Sexually Transmitted Infections (STI) between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Department of Public Health and Environment, and the Colorado Department of
Public Health and Environment, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to electronically sign and submit said amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 28th day of December, A.D., 2022.
BOARD OF COUNTY COMMISSIONERS
WE D COUNTY, COLORADO
ATTEST: dAdthio G jdt0 ,,k,
Weld County Clerk to the Board
BY:
Nu
Deputy Clerk to the Board
APPOVED AS TO FOR
A +.County Attorney
Date of signature: 01(2.3 /0.3
S ott K. James, Chair
EXCUSED
Mike Freeman, Pro-Tem
EXCUSED
Perry L. Buck
teve Moreno
Lori Saine
O1/31/23
2022-3573
HL0054
cn1fo4- iGa0s9t
Memorandum
TO: Scott James, Chair
Board of County Commissioners
FROM: Gene O'Hara, Interim Executive Director
Department of Public Health &
Environment
DATE: December 19, 2022
SUBJECT: Contract Amendment #5 with
CDPHE for 2023 Sexually Transmitted
Infection Prevention & Treatment
Services
For the Board's approval is renewal Contract Amendment #5 between the Colorado
Department of Public Health and Environment (CDPHE) and the Board of County
Commissioners of Weld County for the use and benefit of the Weld County Department of
Public Health and Environment.
This project serves to support the prevention of Chlamydia, Gonorrhea, Syphilis and HIV
infection through the provision of screening, treatment, and management of individuals
exposed or testing positive for these infectious diseases. Project activities include testing in
the Family Planning and STI clinics and direct education and outreach activities to affected
populations Activities will be conducted by current staff; no additional FTE is being
requested to perform the contract deliverables.
The term of this contract is from January 1, 2023, through December 31, 2023. CDPHE will
reimburse the health department up to $71,760 during the project period.
The Board approved placement of this Amendment on the Board's agenda via pass -around
dated December 19, 2022
I recommend approval of this Contract Amendment #5 with CDPHE for the management of
STIs.
2022-3573
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
TITLE: Contract Amendment #5 with CDPHE for 2023 Sexually Transmitted Infection Prevention &
Treatment Services
DEPARTMENT: PUBLIC HEALTH & ENVIRONMENT DATE: December 19, 2022
PERSON REQUESTING: Gene O'Hara, Interim Executive Director
Brief description of the problem/issue:
For the Board's review and approval for placement on the agenda is renewal contract amendment #5
between the Colorado Department of Public Health and Environment (CDPHE) and the Board of County
Commissioners of Weld County for the use and benefit of the Weld County Department of Public Health
and Environment.
This project serves to support the prevention of Chlamydia, Gonorrhea, Syphilis and HIV infection
through the provision of screening, treatment, and management of individuals exposed or testing positive
for these infectious diseases. Project activities include testing in the Family Planning and STI clinics and
direct education and outreach activities to affected populations Activities will be conducted by current
staff; no additional FTE is being requested to perform the contract deliverables.
The term of this contract is from January 1, 2023, through December 31, 2023. CDPHE will reimburse
the health department up to $71,760 during the project period.
This contract amendment is currently under review with the Weld County Attorney's office, and we will
await their approval prior to placement of this item on the Board's agenda.
What options exist for the Board? (include consequences, impacts, costs, etc. of options):
Approving this contract amendment allows WCDPHE to continue our efforts in preventing STIs in Weld
County. Gonorrhea, Chlamydia, Syphilis and HIV rates continue to rise across Colorado and collaborating
with CDPHE and using this funding to help screen, treat and manage clients who are at risk or test
positive for STIs will allow us to better serve our communities.
Declining this contract amendment will prevent the receipt of funding from CDPHE to reduce the
county's costs associated with activities that we have historically performed. Without this external
funding from CDPHE, the clinic may need to increase the costs of services for Chlamydia, Gonorrhea,
Syphilis and HIV testing which may result in clients having fewer options for screening and treatment,
particularly those who are underinsured.
Recommendation: I recommend approval of this contract amendment #5 with CDPHE for the
management of STIs.
Approve Schedule
Recommendation Work Session Other/Comments:
Perry L. Buck
Mike Freeman, Pro-Tem
Scott K. James, Chair
Steve Moreno
Lori Saine
DocuSign Envelope ID: 0607620E-C2B4-42F6-BDD8-D20E1B2DE6BB
CONTRACT AMENDMENT #5
SIGNATURE AND COVER PAGE(S)
State Agency:
Colorado Department Of Public Health and Environment
4300 Cherry Creek Drive South
Denver, Colorado 80246
Original Contract Number:
17 FHHA 95844
Contractor:
Amendment Contract Number:
Board of County Commissioners of Weld County
2020*3023 Amendment #5
(a political subdivision of the state of Colorado)
1150 "O" Street
Greeley CO 80631
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley CO 80631
Contract Performance Beginning Date:
Current Contract Expiration Date:
The later of the Effective date or February 2, 2017
December 31, 2023
CONTRACT MAXIMUM AMOUNT TABLE
Document
Type
Contract
Number
Federal
Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
Original Contract
17FHHA 95844
$11,935.00
$0.00
$0.00
02/02/2017-
12/31/2017
$11,935.00
Contract
18 FHHA
$13,020.00
$0.00
$0.00
01/01/2018-
Amendment #1
105307
12/31/2018
$13,020.00
Contract
Amendment #2
19 FHHA
121540
$13,020.00
$0.00
$0.00
01/01/2019-
12/31/2019
$13,020.00
GFCL#1
2020*3023
GFCL #1
$13,020.00
$0.00
$0.00
01/01/2020-
12/31/2020
$13,020.00
Contract
2020*3023
$21,759.00
$0.00
$0.00
01/01/2021-
Amendment #3
Amendment #3
12/31/2021
$21,759.00
Option Letter #1
2020*3023
$10,000.00
$0.00
$0.00
09/20/2021 -
Option Letter #1
12/31/2021
$10,000.00
Contract
2020*3023
$116,077.00
$0.00
$0.00
01/01/2022 -
Amendment #4
Amendment #4
12/31/2022
$116,077.00
Contract
2020*3023
571,760.00
$0.00
$0.00
01/01/2023-
$71,760.00
Amendment#5
Amendment #5
12/31/2023
Current Contract Maximum
$270,591.00
Cumulative Amount
Page 1 of 4
Amendment Contract Number: 2020*3023 Amendment #5
Ver01.11.19
.9a--373
DocuSign Envelope ID: 0607B20E-C2B4-42F6-BDD8-D20E1B2DE6BB
SIGNATURE PAGE
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment
and to bind the Party authorizing his or her signature.
CONTRACTOR
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
for the use and benefit of the Weld County Department of
Public Health and Environment
Lartuuemuoe
...
By: Signature
Scott K. James
Name of Person Signing for Contractor
Chair, Commissioners
Title of Person Signing for Contractor
Date:
2022-12-28
STATE OF COLORADO
Jared S. Polls, Governor
Colorado Department of Public Health and Environment
Jill Hunsaker Ryan, MPH, Executive Director
LDocuSigned by:
nnrteotccnnarc...
By: Signature
Lisa McGovern
Name of Executive Director Delegate
Procurement & Contracts Section Director ft
Title of Executive Director Delegate
Date:
2022-12-28
In accordance with §24-30-202 C.R.S., this Contract is not valid until signed and dated below by the State Controller or
an authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
DocuSigned by:
jEshw UJ
,.....f:AAA540FRA7Qdn5
By: Signature
Justin Weigle
Name of State Controller Delegate
Health Divisions Controller
Title of State Controller Delegate
Amendment Effective Date:
2022-12-29
-- Signature and Cover Pages End --
Page 2 of 4
Amendment Contract Number: 2020*3023 Amendment #5
Ver. 06.05.20
G2D.1o1-0613
DocuSign Envelope ID: 0607B20E-C2B4-42F6-BDD8-D20E1 B2DE6BB
I. PARTIES
This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover
Page for this Amendment (the "Contract") is entered into by and between the Contractor, and the
State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract.
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date
shown under the State Controller Signature. The State shall not be bound by any provision of
this Amendment before that Amendment Effective Date, and shall have no obligation to pay
Contractor for any Work performed or expense incurred under this Amendment either before
or after of the Amendment term shown in §3.B of this Amendment.
B. Amendment Term
The Parties' respective performances under this Amendment and the changes to the Contract
contained herein shall commence on the Amendment Effective Date shown under the State
Controller Signature or January 1, 2023, whichever is later, and shall terminate on the
termination of the Contract or December 31, 2023, whichever is earlier.
4. PURPOSE
The Parties entered into the agreement to support the prevention of Chlamydia Trachomatis (CT) and
Neisseria Gonorrhea (GC) infection through the provision of screening, treatment, and partner
management for these infectious diseases.
The Parties now desire to renew for an additional term and change current Contract Maximum
Total for the following reason: to provide services as set forth in the contract.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Maximum Amount table is deleted and replaced with the Current Contract
Maximum Amount table shown on the Signature and Cover Page for this Amendment.
B. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page
is hereby deleted and replaced with the Current Contract Expiration Date shown on the
Signature and Cover Page for this Amendment.
C. The Parties now agree to modify Exhibit B, Statement of Work, of the agreement. Exhibit
B, Statement of Work, is deleted and replaced in its entirety with Exhibit B, Statement of
Page 3 of 4
Amendment Contract Number: 2020*3023 Amendment #5 Ver 27.01.20
DocuSign Envelope ID: 0607B20E-C2B4-42F6-BDD8-D20E1 B2DE6BB
Work, attached to this Amendment for the following reason: to update required activities
for the contract.
D. The Parties now agree to modify Exhibit I, Budget, of the agreement. Exhibit I, Budget, is
deleted and replaced in its entirety with Exhibit I, Budget, attached to this Amendment for
the following reason: to update needed budget lines for the renewal.
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments or other modifications to the Contract, if any, remain in full force and effect except
as specifically modified in this Amendment. Except for the Special Provisions contained in the
Contract, in the event of any conflict, inconsistency, variance, or contradiction between the
provisions of this Amendment and any of the provisions of the Contract or any prior modification
to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and
control. The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment specifically
modifies those Special Provisions.
Page 4 of 4
Amendment Contract Number: 2020*3004 Amendment 114 Ver 27.01.20
DocuSign Envelope ID: 0607B20E-C2B4-42F6-BDD8-D20E1 B2DE6BB
EXHIBIT B
STATEMENT OF WORK
To Amendment Contract Number 2020*3023 Amendment #5
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
I. Entity Name: Weld County Health Department
II. Project Description:
This public health project serves to reduce new cases of Sexually Transmitted Infections (STI) throughout
Colorado with a focus on serving priority populations at risk for acquiring STIs within Weld County through
STI screening and treatment.
Colorado has seen substantial increases in sexually transmitted infections (STI) morbidity in 2021.
Appropriate and prompt testing of persons with STIs and exposure is critically important in preventing health
complications and interrupting disease transmissions in communities.
This project benefits individuals who are uninsured or underinsured and need access to free STI screening
and treatment in the federally funded Title X, STI, and community health clinics as well as non -clinical
outreach sites. This project promotes STI testing and treatment, as identified by the Centers of Disease
Control and Prevention's Strengthening Sexually Transmitted Infections' Prevention and Control for Health
Departments (STI PCHD) grant funding, to implement and strengthen STI prevention and control programs.
III. Definitions:
1. 340B Pricing - program allows qualifying hospitals and clinics that treat low-income and uninsured
patients to buy outpatient prescription drugs at a discounted price from the manufacturer.
2. CDC — Centers for Disease Control and Prevention
3. CDPHE- Colorado Department of Public Health and Environment
4. Clinical Setting - hospital, department, outpatient facility or clinic whose primary purpose is
diagnosing.
5. Client - An individual receiving contracted services by the Contractor.
6. CT — Chlamydia Trachomatis - a sexually transmitted disease that when left untreated, may result
in infertility in women
7. EPT — Expedited Partner Therapy
8. HIV- Human Immunodeficiency Virus
9. GC — Neisseria gonorrhea - a sexually transmitted disease that when left untreated, may result in
infertility in women
10. Increased Risk — Those who have a new sex partner, more than one sex partner, a sex partner with
concurrent partners, or a sex partner who has an STI. Additional risk factors include inconsistent
condom use among persons who are not in mutually monogamous relationships; previous or
coexisting sexually transmitted infections; and exchanging sex for money or drugs. Clinicians
should consider the communities they serve and may opt to consult state and local public health
authorities for guidance on identifying groups that are at increased risk.
11. Non -Clinical Setting - community -based, outreach sites, a person's home
12. Priority Populations: adolescents and young adults, men who have sex with men, and pregnant
women
13. Service Area: Weld County
14. STI— Sexually transmitted infections(s), including GC, CT and Syphilis.
15. STI Testing Services - includes screening for chlamydia, gonorrhea and syphilis
16. Syphilis — a sexually transmitted disease that when left untreated, may result in serious
complications or cause congenital syphilis among pregnant women.
17. Title X — Title X of the Public Health Service Act (Public Law 91-572 Population Research and
Voluntary Family Planning Programs). The federal grant program is dedicated solely to providing
individuals with comprehensive family planning and related preventive health services.
18. VH - Viral Hepatitis
Page 1 of 4
Amendment Contract Number 2020*3023 Amendment #4 Ver. 01.1 1.19
DocuSign Envelope ID: 0607620E-C2B4-42F6-BDD8-D20E1 B2DE6BB
EXHIBIT B
IV. WORK PLAN:
Goal #1: Provide high -quality HIV, STI, and VH prevention services to increase the priority population's access
to testing, education, and treatment, and reduce the acquisition of HIV/STI/VH throughout Colorado in order to
disrupt health inequities.
Objective #1: No later than the expiration date of the contract, reduce STI acquisition by providing STI testing
and treatment services for the priority population in the service area.
Primary Activity #1
The Contractor shall complete STI testing services in clinical settings for the priority
population in the service area.
Sub -Activities #1
1. The Contractor shall screen individuals within the priority population for STI testing
services.
2. The Contractor shall provide STI testing services to clients within the service area.
3. The Contractor shall maintain necessary clinical staff and supervision.
4. The Contractor shall notify clients of positive test results.
5. The Contractor shall refer clients with a positive result for STI treatment.
Primary Activity #2
The Contractor shall complete STI testing services in non -clinical settings for the priority
population in the service area.
Sub -Activities #2
1. The Contractor shall screen individuals within the priority population for STI testing
services.
2. The Contractor shall provide STI testing services to a minimum of 500 clients within
the service area.
3. The Contractor shall verify all staff providing STI testing in non -clinical settings have
completed CDPHE STI testing course requirements.
4. The Contractor shall notify clients of positive test results.
5. The Contractor shall refer clients with a positive result for STI treatment.
6. The Contractor shall maintain a referral list of partnering clinical agencies.
Primary Activity #3
The Contractor shall provide STI treatment for the priority population in the service area.
Sub -Activities #3
1. The Contractor shall determine the client's eligibility to receive medications through
the 340B pricing program.
2. The Contractor shall provide STI treatment for clients with a positive STI result.
3. The Contractor shall provide partner treatment via EPT, when indicated.
Primary Activity #4
The Contractor shall virtually attend scheduled CDPHE monitoring calls.
Primary Activity #5
The Contractor shall complete monthly narrative reports.
Standards and
Requirements
1. The content of electronic documents located on CDPHE and non-CDPHE websites
and information contained on CDPHE and non-CDPHE websites may be updated
periodically during the contract term. The Contractor shall monitor documents and
website content for updates and comply with the most recent revisions.
2. The Contractor shall perform STI screening in accordance with current CDC
screening guidelines available on the following website
https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf and are
incorporated and made part of this Contract by reference.
3. 1. The Contractor shall verify proof of qualification of staff providing the
contracted services that consist of a Certificate of Course Completion from CDPHE's
Office of HIV/STINH Training Unit. Mandatory training for contracted service is in
the General Training Requirements in the CDPHE Standards for STI Prevention
Page 2 of 4
Amendment Contract Number 2020*3023 Amendment 144
Ver. 01.11.19
DocuSign Envelope ID: 0607820E-C2B4-42F6-BDD8-D20E1B2DE6BB
EXHIBIT B
Services. This information is incorporated and made part of this Contract by
reference. https://cdphe.colorado.gov/hiv-training.
4. The Contract shall maintain one (1) of the following for STI testing throughout the
life of the project:
a. Valid, non -expired CLIA waiver certificate
b. Valid, non -expired WA certificate
5. The Contractor shall provide open hours for clinical testing at a minimum of 30 hours
per week.
6. Non -clinical settings consist of the following:
a. At home testing
b. Community Event testing
c. Testing provided at organizations that do not employ medical staff
7. The Contractor shall use STI treatment drugs from this project to treat STIs for low-
income clients who would be unable to afford the medications otherwise as outlined
in guidelines for 340B Pricing Program found here:
https://www.hrsa.gov/opa/index.html. This information is incorporated and made part
of this contract by reference.
8. The Contractor shall adhere to the current Sexually Transmitted Diseases Summary of
CDC Treatment Guidelines, available on the following website
https://www.cdc.gov/std/treatment-euidelines/toc.htm and are incorporated and made
part of this Contract by reference.
9. The Contractor shall comply with the data collection and reporting requirements
stated in the Guidelines Regarding Data Collection and Reporting. This document
can be accessed at https://www.colorado.gov/pacific/cdphe/sti-hiv-funded-partner-
oln icier and is incorporated and made part of this Contract by reference.
10. The Contractor shall comply with the guidelines concerning data security and
confidentiality stated in the Centers for Disease Control's Data Security and
Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease
and Tuberculosis Programs. This document can be accessed at
http://www. cdc. gov/nchhstn/programintegration/docs/PCSIDataSecurityGuidelines.p
df is incorporated and made part of this Contract by reference.
11. The Contractor shall comply with the following Standards of Prevention for
HIV/STI/VH and Harm Reduction Services. These Standards are incorporated and
made part of this contract by reference:
https://drive.google.com/file/d/ l gASKKpergZ-0-PatSydhWjnYCmAjwJb-/view.
12. The Contractor shall comply with the following rules and regulations when
performing data collection and entry, reporting, and the implementation of activities.
These guidelines and standards are located on the state of Colorado website
http://www.sos.state.co.us/CCR/Welcome.do and are incorporated and made part of
this Contract by reference:
a. Colorado Revised Statute § 25-4-14 concerning HIV acquisition.
b. Colorado Revised Statute § 18-4-412 concerning the theft of medical
records.
c. Colorado State Board of Health Rules for the Reporting, Prevention and
Control of AIDS, HIV Related Illness and HIV Infection (6CCR 1009-9), as
found at
https://www. sos.state. co.us/CCR/eDocketDetails. do?trackingNum=2017-
00053, incorporated and made part of this Contract by reference:
13. The Contractor shall complete a monthly progress report in the format provided by
CDPHE.
a. The Contractor shall complete a monthly progress report for all clinical
settings where individuals for whom a STI test is performed:
i. number of individuals screened for STI
Page 3 of 4
Amendment Contract Number 2020*3023 Amendment #4
Ver. 01.11.19
DocuSign Envelope ID: 0607B20E-C2B4-42F6-BDD8-D20E1 B2DE6BB
EXHIBIT B
ii epidemiologic data
ii. test results (# positive, # negative)
iv. number of individuals treated for positive STI results
b. The Contractor shall complete a monthly progress report for all non -clinical
settings where individuals for whom a STI test is performed:
i. number of individuals screened for STI
ii epidemiologic data
ii. test results (# positive, # negative)
iii. number of individuals treated for positive STI results
14. The Contractor shall submit deliverables to the CDPHE Contracts Monitor via email
at cdphe sthv contractmonitoringastate.co.us.
Expected Results of
the Activity
1. Increased access to STI screening for priority populations at increased risk of
acquiring STIs
2. Increased documentation of treatment using CDC Treatment guidelines for
individuals exposed to or testing positive for CT, GC or Syphilis.
Measurement of
Expected Results
1. Data contained in monthly narrative reports.
Completion Date
Deliverables
1. The Contractor shall submit a valid STI Testing
Certificate.
No later than 30 calendar
days from the beginning
of the contract.
2. The Contractor shall submit the monthly narrative report.
No later than 30 calendar
days following the last
day of each month for
months one through
eleven.
3. The Contractor shall submit the final monthly narrative
report
No later than 14 calendar
dates prior to contract end
date.
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted
throughout the contract period by the CDPHE Contract Monitor. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include progress reports and other
fiscal and programmatic documentation as applicable. The Contractor's performance will be evaluated at
set intervals and communicated to the contractor. A Final Contractor Performance Evaluation will be
conducted at the end of the life of the contract.
VI. Resolution of Non -Compliance:
The Contractor will be notified in writing within 15 calendar days of discovery of a compliance issue. Within
30 calendar days of discovery, the Contractor and the State will collaborate, when appropriate, to determine
the action(s) necessary to rectify the compliance issue and determine when the action(s) must be completed.
The action(s) and timeline for completion will be documented in writing and agreed to by both parties. If
extenuating circumstances arise that requires an extension to the timeline, the Contractor must email a request
to the CDPHE Contract Monitor and receive approval for a new due date. The State will oversee the
completion/implementation of the action(s) to ensure timelines are met and the issue(s) is resolved. If the
Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may
exercise its rights under the provisions of this contract.
Page 4 of 4
Amendment Contract Number 2020*3023 Amendment 144 Ver. 01.11.19
Exhibit I
DocuSign Envelope ID: 0607820E-C284-42F6-BDDS-D20E1B2DE6BB
COLORADO
Department el Pahhe
Health b Mama*
Colorado Department of Public Health and Environment
BUDGET JUSTIFICATION FORM
Contract Routing # 2020*3023 Amendment #5
Contractor Name
Board of County Commissioners of Weld
County for the use and benefit of the Weld
County Department of Public Health and
Environment
Budget Period
I/1/2023-12/31/2023
Project Name
Prevention of STI, CT, GC and Syphilis
Screening and Treatment
Program Contact Name
Title, Phone and Email
Fiscal Contact Name
Title, Phone and Email
Core Encumbrance
Annette Odell, NP
Coordinator
970-400-2324
aodc11@weldgov.com
Tanya Geiser
970-400-2122
tgeiserLweldgov.com
2023*2868
Expenditure Categories
Personnel Services
Salary/hourly
Fringe Benefits
Percent of Actual Time
on Contract/
Purchase Order
Funding Source
(Base or SUPP)
Original Amount
Requested
Position Title/Employee Name
Description of Work
(for hourly employees, please include the
hourly rate and number of hours in your
description)
43.49%
Medical Assistant
Process and collect samples and prepare
them for lab $22 per hour (63 hours)
Nurse
Collect samples, review results and
provide treatment if needed
Nurse Practitioner/ Program Supervisor
Collect samples. review results and
provide treatment if needed
Chief Nursing Officer
Outreach Coordinator & Administration Personnel
Nurse - Madeline Berg RN
Provide program oversight, run reports an
submit data to CUP! IE for grant
novice outreacn program oversignt,
logistical, scheduling, and operational
oversight. Increase local capacity around
testing and treatment for those at greatest
risk of contracting and/or transmitting STIs
in the community
Process and collect samples and prepare
them for lab outreach events
$46,000.00
$70,000.00
$117,000.00
$145,000.00
$100,000.00
$72,873.21
$20,005.40
$30,443.00
$50,883.30
$63,060.50
$43,490.00
$31,692.56
3.00%
1.50%
2.00%
1.00%
25.00%
11%
Total Personal Services(lncluding Fringe Benefits)
Base
Base
Base
Base
SUPP
SUPP
$2,091.00
$1,568.00
$4,124.00
$2,276.00
$26,518.00
$11,502.00
$48,079.00
Supplies & Operating Expenses
Item
Description
CT/GC Screening Test
Rate
CT/GC Screening Test
$20.00
Quantity
342
Base
Budgeted Amount
$6,840.00
Syphilis RPR Screening Test
Syphilis RPR Screening Test
$4.00
130
Base
$520.00
Syphilis RPR Confirmatory Test
S
upplics & Operating Expenses
CT/GC Screening Test
Syphilis RPR Screening Test
Syphilis RPR Confirmatory Test
Syphilis RPR Confirmatory Test
$8.00
5
Supply costs such as advertisement, office
supplies, councr services or other
operational supplies
$275.00
CT/GC Screening Test
Syphilis RPR Screening Test
Syphilis RPR Confirmatory Test
$20.00
$4.00
$8.00
80
301
10
Base
Base
SUPP
SUPP
SUPP
I II Confirmatory Test
I IIV lnsti Rapid Test
Education and Materials
Supplies & Operating Expenses
I 11 V Confirmatory Test
HIV insti Rapid Test
Education materials for clients or materials
needed for promoting the program to the
community
Supply costs such as advertisement, office
supplies, courier services or other
operational supplies
$8.00
$12.00
$50.00
$50.00
6
21
SUPP
SUPP
I
SUPP
Total Supplies & Operating Expenses
SUPP
$40.00
$275.00
$ l ,600.00
$1,204.00
$80.00
$48.00
$252.00
$50.00
$50.00
$10,959.00
Travel
Item
Description
Rate
Mileage
Budgeted Amount
Mileage
Travel to and from events or necessary
travel for the program
$0.63
703
SUPP
$437.00
Total Travel
$437.00
Other Costs
Total Other Costs
$0.00
Contractual (payments to third parties or entities)
Amendment Contract Number: 2020'3023 Amendment #5
Page 1 of
DocuSign Envelope ID: 0607B20E-C2B4-42F6-BDD&D20E1 B2DE6BB
Exhibit I
Total Contractual
$0.00
Sub -Total Before Indirect
Base
$17,734.00
Sub -Total Before Indirect
SUPP
$41,741.00
Indirect
2023 Indirect Rate = 19.92%
Base
$3,532.61
2023 Indirect Rate = 19.92%
SUPP
$8,315.00
Total Indirect
$3,532.61
.
Base
$21,266.00
Total PCHD Funding
SUPP
$50,494.00
Total PCHD Funding
TOTAL
$71,760.00
Amendment Contract Number: 2020*3023 Amendment #5 Page 2 of
Contract Form
New Cone
oR
COLORADO DEPT OF PUBLIC
HEALTH, ENVIRONMENT
Entity ID
O0O001926
Contract Name
CDPHE 2023 ST1 CONTRACT AMENDMENT #5
Contract Status
CTB REVIEW
❑ New Entity?
Contract ID
6592
Contract Lead
BMANRIQUEZ
Contract Lead Entail
bmanriquez@weldgov.com
Parent Contract ID
Requires Board Approval'.
YES
Department Project #
Contract Description*
CDPHE CY2023 STI CONTRACT AMENDMENT #5- STI PREVENTION AND TREATMENT SERVICES
Contract Description 2
17 FHHA 95844
Contract Type
AMENDMENT
Amount
571,760.00
Renewable:
NO
Automatic Renewal
NO
Grant
YES
IGA
NO
Department
HEALTH
Department Email
CM-Health@weldgov.com
Department Head Email
CM-Health-
DeptHearLErveldgov,com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL.
County Attorney Email
CM-
COUNTYATTORNEY0WELDG
RNEYOWELDG
OV.COM
Grant Deadline Date
If this is a renewal enter previous Contract ID
5534
If this is part of a MSA enter MSA Contract ID
Requested BOCC Agenda
Date.
12;'281`2022
Due Date
12/24/2022
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be included?
NO
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in
On Base
Effective Date
01/01/2022
Review Date*
10/01/2023
Renewal Date
Termination Notice Period
Purchasing Approver
Approv
r+rcess
Department Head
TANYA GEISER
DH Approved Date
12/20/2022
al Approva
RDCC Approved
11OCC Signed Date
IBOCC Agenda Date
12/28/2022
Originator
BMANR1QUEZ
Committed Delivery Date
Expiration Date.
12/31/2023
Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing Approved Date
Finance Approver
CHRIS D'OVIDIO
Finance Approved Date
12/20/2022
Tyler Ref #
AG 122822
Legal Counsel
MATTHEW CONROY
Legal Counsel Approved Date
12/21/2022
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