HomeMy WebLinkAbout20191088.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #3 FOR TITLE X FAMILY PLANNING
PROGRAM AND AUTHORIZE CHAIR TO SIGN
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 Contract Amendment #3 for the Title X
Family Planning Program 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
April 1, 2019, and ending December 31, 2019, 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 the Contract Amendment #3 for the Title X Family Planning Program
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, be and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 13th day of March, A.D., 2019.
BOARD OF COUNTY COMMISSIONERS
WE COUNTY, COLO ' DO
ATTEST:
dith,A) .1dO;eA
Weld County Clerk to the Board
BY:
Deputy Cler to the Board
County ttorney
Date of signature: 'J-19
arbara Kirkmeyer, • hair
Mike Freeman, Pro-Tem
Steve Moreno
cc; I�LCTC'�
1-115O/Ici
2019-1088
HL0051
edeAcod O4-a4`l9
Memorandum
TO: Barbara Kirkmeyer, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: March 6, 2019
SUBJECT: CDPHE Family Planning Program FY18-19
Task Order Contract Amendment #3
For the Board's approval is a Task Order Contract Amendment #3 between the Colorado
Department of Public Health and Environment (CDPHE) and the Weld County Board of
Commissioners for the benefit and use of the Weld County Department of Public Health and
Environment (WCDPHE) for our Family Planning Program.
The purpose of this contract amendment is to extend the current year's contract term by six months
and provide additional federal funding in the amount of $85,037, in exchange for services that will
be provided during the contract extension period. The term of this contract extension is from April
1, 2019, to December 31, 2019. This contract amendment also includes changes to Exhibit A,
Additional Provisions, to reflect changes made over the course of the contract term.
Under the provisions of this contract, WCDPHE will continue providing comprehensive family
planning services to reduce unintended pregnancy by insuring access to quality reproductive health
services to all Coloradans.
Assistant Weld County Attorney, Bob Choate, has reviewed the this amended contract and
determined that its terms are acceptable.
Furthermore, this amendment was approved for placement on the Board's agenda via pass -around
dated March 5, 2019.
I recommend the approval of this contract amendment #3 with CDPHE for our Family Planning
Program.
2019-1088
GG H L OnPaast,
03/(31 I9
CONTRACT AMENDMENT #3
SIGNATURE AND COVER PAGES
State Agency:
Colorado Department Of Public Health and Environment
4300 Cherry Creek Dr S
Denver, CO 80246
Original Contract #
15 FLA 67059
Amendment Contract #
19 FHLA 127641
Contractor:
Board of County Commissioners of Weld County
1150 "O" Street
Greeley, Colorado 80631
for the use and benefit of the Weld County Department of Public
Health and Environment
1555 North 17th Avenue, Greeley, Colorado 80631
CORE Encumbrance #
CT FAAA FHLA 201800003249
Contract Performance Beginning Date:
July 1, 2014
Current Contract Expiration Date:
December 31, 2019
CONTRACT MAXIMUM AMOUNT TABLE
Document Type
CMS Routing #
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Dollar
Amount
Original
Contract
►5 FLA 67059
$105,523.00
$45,195.00
$51,676.00
7/1/14-6/30/15
$202,394.00
GFCL #1
15 FHLA 77335
$0.00
$0.00
$8,125.00
3/2/15-6/30/15
$8,125.00
GFCL #2
16 FHLA 79248
$51,512.00
$23,152.00
$0.00
7/1/15-12/31/15
$74,664.00
GFCL #3
16 FHLA 84173
$0.00
$0.00
$34,921.00
11/1/15-6/30/16
$34,921.00
Amendment #1
16 FHLA 84934
$51,512.00
$23,151.00
$28,164.00
1/1/16-6/30/16
$102,827.00
GFCL #4
16 FHLA 86121
$0.00
$0.00
$37,289.00
4/1/16-6/30/16
$37,289.00
Option Letter #1
17 FHLA 86977
$119,708.00
$50,184.00
$0.00
7/1/16-6/30/17
$169,892.00
GFCL #5
17 FHLA 94870
$0.00
$84,946.00
$0.00
10/20/16-6/30/17
$84,946.00
GFCL #6
17 FHLA 100584
$0.00
$50,000.00
$0.00
5/15/17-6/30/17
$50,000.00
Option Letter #2
18 FHLA 110478
$108,415.00
$151,231.00
$0.00
7/1/17-6/30/18
$259,646.00
Option Letter #3
19 FHLA 110479
$0.00
$134,315.00
$0.00
7/1/18-6/30/19
$134,315.00
GFCL #7
19 FHLA 110874
$18,069.00
$0.00
$0.00
7/1/18-8/31/18
$18,069.00
Amendment#2
(CFFP)
19 FHLA 113551
$69,126.00
$0.00
$0.00
11!1/18-3/31/19
$69,126.00
Amendment#2
(STD)
19 FHLA 113551
$0.00
$0.00
$7,907.00
11/1/18-6/30/19
$7,907.00
Amendment #3
19 FHLA 127641
$85,037.00
$0.00
$0.00
4/1/19-12/31/19
$85,037.00
Current Contract Maximum
Amount (Year To Date)
$1,339,158.00
Amendment Contract Number. 19 FIII,A 127641
Page I of 4
(Ot9-10880
SIGNATURE AND COVER PAGES
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 for
the use and benefit of the Weld County Department
of Public Health a Environment
STATE OF COLORADO
Jared S. Polls, Governor
Colorado Department Of Public Health and Environment
Jill Hunsaker Ryan, MPH
Executive Director
By: Prin ame & Tit AR 13 2013
Barbara Ki_rkmeyer, Chair
Date: 3/13/2019
By: Lisa McGovern
Director, Procurement and Contracting Section
'PP ,
Date: v�
I' G;RA A
By:
VAL
In accordance with §24-30-202 C.R.S., this Amendment is
not valid until signed and dated below by the State Controller
or an authorized delegate.
STATC0 ROLLER
R rt s ros, `' , MBA, JD
By:
Jody Cam y la '
Date:
rogram Unit Manager
�,��t �f
w�� Y C.Z (9
David N+rris, w'ontral[=
a
Amendment Effective Date:
Amendment Contract Numher 19 FH1A 127641
Page 2 of 4
goict -I088'CI)
I. PARTIES
This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover
Pages 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 April 1, 2019. whichever is later and shall terminate on the
termination of the Contract.
4. PURPOSE
The Parties entered into the agreement to reduce unintended pregnancy by insuring access to
quality reproductive health services to all Coloradans.
The Parties now desire to extend the term, change Exhibit A, Additional Provisions, and to
increase funding for the following reason: New FYI 9 Federal funding award to pay for
additional work.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Maximum Amount listed on the Contract's Signature and Cover Pages is
hereby deleted and replaced with the Current Contract Maximum Amount shown on the
Signature and Cover Pages 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 Amendment and all prior amendments thereto, if any, are modified as follows:
Amendment Contract Number 19 FIIIA 127641
Page 3 of 4
i. The Parties now agree to modify Exhibit: A, Additional Provisions of the agreement.
Exhibit A, Additional Provisions is deleted and replaced in its entirety with Revised
Exhibit A, Additional Provisions to reflect the changes made over the course of the
contract term and to add the FYI 9 Federal Funding award.
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.
Amendment Contract Number 19 FIt1.A 127641
Page 4 of 4
REVISED EXHIBIT A
ADDITIONAL PROVISIONS
To Contract Dated 03/28/2014 - Contract Routing Number 15 FLA 67059
Contract Amendment #3 Routing Number 19 FHLA 127641
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified
above.
I . This Contract contains federal funds (see Catalog of Federal Domestic Assistance (CFDA) number TBD)
2. The United State Department of Health and Human Services ("USDHHS"), through the US Public Health
Service ("USPHS") has awarded as of TBD (insert federal award date) anticipated federal funds of TBD
(insert total anticipated amount of federal award to CDPHE) under Notice of Cooperative Agreement
Award, hereinafter "NCAA", number TBD, to perform the following: contraceptive education and clinical
services, preventative health counseling and education services, reproductive health related testing and
screening and referrals, training, outreach, client recruitment and community engagement.
If the underlying Notice of Cooperative Agreement Award "NCAA" authorizes the State to pay all
allowable and allocable expenses of a contractor as of the effective date of that NCAA, then the State shall
reimburse the Contractor for any allowable and allocable expenses of the Contractor that have been
incurred by the Contractor since the proposed effective date of this Contract. If the underlying NCAA does
not authorize the State to pay all allowable and allocable expenses of a contractor as of the effective date of
that NCAA, then the State shall only reimburse the Contractor for those allowable and allocable expenses
of the Contractor that are incurred by the Contractor on or after the effective date of this Contract, with
such effective date being the later of the date specified in this Contract or the date the Contract is signed by
the State Controller or delegee.
3. To be considered for payment, all Family Planning services must be entered into iCare within thirty (30)
days of service being performed. Contractors shall only be paid for cases that meet eligibility, performance
and data requirements. Contractors shall be reimbursed 14 21h of an annual award on monthly basis. The
total contract amount is based on an annual award that was determined by number of clients served in the
previous year and total available funds. In addition, Contractor shall be reimbursed an amount pre-
determined by CDPHE for the purchase of Long Acting Reversible Contraception (LARC) methods.
To receive compensation under the Contract, the Contractor shall submit a signed Monthly Fee for Service
Reimbursement Invoice Form. This form is accessible from https://www.colorado.gov/cdphe/titlex-
familyplanning and is incorporated and made part of this Contract by reference. CDPHE will provide
technical assistance in accessing and completing the form. The CDPHE Monthly Fee for Service
Reimbursement Invoice must be submitted no later than forty-five (45) calendar days after the end of the
billing period for which services were rendered. Expenditures shall be in accordance with this Statement
of Work. LARC method purchase must be detailed on the invoice and should be accompanied by evidence
of payment, including a receipt or invoice and a financial ledger report that shows the posted expense.
The Monthly Fee for Service Reimbursement Invoice should be scanned into an electronic document and
emailed to cdphe familyplanning(n,state.co.us
To be considered for payment, billings for payments pursuant to this Contract must be received within a
reasonable time after the period for which payment is requested, but no later than forty-five (45) calendar
days after the relevant performance period has passed. Final billings under this Contract must be received
by the State within a reasonable time after the expiration or termination of this Contract; but no later than
forty-five (45) calendar days from the effective expiration or termination date of this Contract.
The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
Page 1 of5
REVISED EXHIBIT A
Sliding Fee Scale: The Contractor's charges for services to clients who are above 100% of poverty level
shall be based on a sliding fee scale that takes into account a client's family size and/or individual income
and is approved by the State. These charges and the sliding fee scale shall be made available to all clients
of the Contractor, the general public, and the State. This document is available on the following website
https://www.colorado.gov/cdphe/titlex-familyplanning. Charges shall be based upon the Contractor's actual
costs to provide these services as determined by a cost analysis. The Contractor and the State shall review
these costs annually. The Contractor shall insure that all clients understand that they will not be denied
services because of an inability to pay any of the Contractor's sliding fee charges.
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 all updates.
Fiscal and Spending Contract Award: It is important that accurate expenses are reflected in each Contract
budget. The Contractor must spend the entire awarded and budgeted amount for services identified in the
annual approved project budget. Failure to provide projected services, submit invoices in a timely manner,
and/or failure to spend the award at a rate that results in the full award being expended at the end of the
program year may result in reduced funds the following year and/or lack of eligibility for mid -year and
other additional funding opportunities.
4. This award does not include funds for Research and Development.
5. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty (30) calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable, or is otherwise deficient, then the State shall notify
the Contractor of the failure or deficiencies, in writing, within thirty (30) calendar days of: I) the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable, the Contractor shall have a reasonable period of time, not to exceed thirty (30)
calendar days, to correct the noted deficiencies.
6. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship under
HIPAA.
7. The list of acronyms attached hereto as Exhibit C may be referenced to in Revised Exhibit A, Exhibit B,
and all and any attachments thereof in this Contract.
8. If Contractor indicates full expenditure of funds under this Contract by March 31 (Federal funds) and
June 30 (State Funds) of each grant year and the full expenditure does not occur, CDPHE has the option
to reduce current or upcoming Contract by said amount or a percent deemed reasonable by CDPHE. The
State will notify the Contractor of the potential need to decrease the current or upcoming budget.
Upon receipt of timely written notice of an objection by the State for inability to fully expend funds, the
Contractor shall have a reasonable period of time not to exceed ten (10) calendar days to respond to the
Page 2 of 5
REVISED EXHIBIT A
action. If no dispute is received by the State within ten (10) calendar days, the State has the option to
reduce the current budget for the current year and any upcoming budget for future contractual agreements.
9. Contractor shall request prior approval in writing from the State for all modifications in the Statement of
Work/Work Plan or for any modification to the direct costs in excess of twenty-five percent (25%) of the
total budget for direct costs or $250,000, whichever is less, shall be submitted to CDPHE at least ninety
(90) days prior to the end of the contract period and may require an amendment in accordance with General
Provisions, Section 5, of this Contract.
10. Contractor shall only use program income generated from client fee collections and donations for family
planning purposes that further the objectives of the legislation under which this Contract is entered into. In
accordance with Title X guidelines, the Contractor shall not charge for any Title X required services
provided to clients who are at or below 100% of the official poverty line as defined by the Federal Register
by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2). If the
State receives new poverty guidelines during the term of this Contract, then the State will immediately
notify the Contractor. The Contractor shall use these new poverty guidelines, if any, upon receipt of
notification thereof from the State.
11. All money received by the Contractor from the State under this Contract shall be used by the Contractor to
provide contraceptive services to qualified family planning clients.
12. The State may require forms attached to this Contract and incorporated herein to be updated by the
Contractor during the term of this Contract. The State shall notify the Contractor of newly developed
forms. Forms are incorporated and made part of this Contract by reference and located on
https://www.colorado.gov/pacific/cdphe/title-x-forms.
13. The Contractor agrees to follow the Colorado Constitution and the Title X rules and regulations
incorporated and made part of this Contract by reference and available on the following websites:
a. Title X Legislative Mandates: https://www.hhs.gov/opa/title-x-family-planning/about-title-x-
grants/legislative-mandates/i ndex.htm l
b. Title X Statutes and Regulations: https://www.hhs.gov/opa/title-x-family-planning/about-title-x-
grants/statutes-and-regulations/index.htm I
c. Title X Program Guidelines: https://www.hhs.gov/opa/guidelines/program-guidelines/index.html
d. In accordance with the Colorado Constitution, Article V, Section 50, Contractor agrees that no requests
for direct or indirect reimbursement or payment will be submitted for the performance of any induced
abortions.
14. Notwithstanding the terms contained in General Provisions, Section 9, Rights in Data, Documents and
Computer Software or Other Intellectual Property, unless otherwise provided for, all data collected or
produced or derived exclusively from the Contractor's work under this Contract shall remain the sole
property of the State, whether in individual, aggregate, identified or de -identified form or any other form
required by the State. To facilitate follow-up, research, surveillance and evaluation, any such data
collected, used or acquired shall be made available in any form required by the State, to the State and any
other entity designated by the State.
Any such data collected, used or acquired shall be used solely for the purposes of this Contract. The
Contractor agree not to release, divulge, publish, transfer, sell, or otherwise make known any such data to
unauthorized persons without the express prior written consent of the State or as otherwise required by law.
This includes a prior written request by the Contractor to the State for submission of abstracts or reports to
conferences, which utilize data collected under this Contract.
Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or
work papers necessary to perform its duties under this Contract and in accordance with professional
standards.
Page 3 of 5
REVISED EXHIBIT A
15. Notwithstanding the terms contained in General Provisions, Section 9, Rights in Data, Documents and
Computer Software or Other Intellectual Property, or Section 23.i, General Provisions, .tledia or Public
Announcements, the State of Colorado, specifically the Department of Public Health and Environment,
shall be the owner of all printed materials, graphic representations, educational materials, audio-visual
products, or any other media, in whatever form, created under this Contract. This requirement applies, but
is not limited to, any brochure, flyer, presentation, billboard, radio spot, website, banner advertisement.
The State reserves the right to require logos, or other wording on any material, representation, product or
other media form created under this Contract.
Any material, representation, product or other media form that will use the State's or logo or information
must be approved by the State prior to production and distribution. A minimum of ten (10) business days is
required for the review and approval process.
16. Contractor agrees to provide services to all Program participants and employees in a smoke -free
environment in accordance with Public Law 103-227, also known as "the Pro -Children Act of 1994", (Act).
Public Law 103-227 requires that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or regularly for the provision of health, day care,
early childhood development services, education or library services to children under the age of 18, if the
services are funded by Federal programs either directly or through State or local governments, by Federal
grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in
indoor facilities that are constructed, operated, or maintained with such Federal funds. The law does not
apply to children's services provided in private residences; portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or
Medicaid; or facilities where Women, Infants and Children (WIC) coupons are redeemed. Failure to
comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty
of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the
responsible entity. By signing this Contract, Contractor certifies that Contractor shall comply with the
requirements of the Act and shall not allow smoking within any portion of any indoor facility used for the
provision of services for children as defined by the Act.
17. Notwithstanding the terms contained in the General Provisions, Section 10, Confidential or Proprietary
Information, Contractor shall protect the confidentiality of all applicant or recipient records and other
materials that are maintained in accordance with this Contract. Except for purposes directly connected with
the administration of this Contract, no information about or obtained from any applicant or recipient shall
be disclosed in a form identifiable with the applicant or recipient without the prior written consent of the
applicant or recipient, or the parent or legal guardian of a minor applicant or recipient with the exception of
information protected by Colorado Statute as it applies to confidentiality for adolescent services in which
case the adolescent minor and not the parent or legal guardian must provide consent or as otherwise
properly ordered by a court of competent jurisdiction. Contractor shall have written policies governing
access, duplication, and dissemination of all such information. Contractor shall advise its employees,
agents, servants, and any subcontractors that they are subject to these confidentiality requirements.
18. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be
the owner of all equipment as defined by Federal Accounting Standards Advisory Board (FASAB)
Generally Accepted Accounting Principles (GAAP) purchased under this Contract. At the end of the term
of this Contract, the State shall approve the disposition of all equipment.
19. Contractor shall not use funds provided under this Contract for the purpose of lobbying as defined in
Colorado Revised Statutes (C.R. S.) 24-6-301(3.5)(a).
20. The State may require continued performance for a period of up to 4 years at the same rates and same terms
specified in the Contract. If the State exercises the option, it will provide written notice to Contractor at
least 30 days prior to the end of the current Contract term in a form substantially equivalent to Exhibit D. If
exercised, the provisions of the Option Letter shall become part of and be incorporated into the original
Page 4 of 5
REVISED EXHIBIT A
Contract. The total duration of this Contract, including the exercise of any options under this clause, shall
not exceed 5 years. (Note: 5 years is maximum allowable).
The State may increase or decrease the quantity of goods/services described in Exhibit B based upon the
rates established in the Contract. If the State exercises the option, it will provide written notice to
Contractor at least 1 day prior to the end of the current Contract term in a form substantially equivalent to
Exhibit D. Delivery/performance of the goods/service shall continue at the same rates and terms. If
exercised, the provisions of the Option Letter shall become part of and be incorporated into the original
Contract.
Per the private funding source, The Colorado Trust (The Trust) expressly disclaims any obligation to
employees or independent contractors hired or engaged by CDPHE to assist CDPHE in carrying out its
obligations under the Grant Contract with The Colorado Trust. Employment or engagement of such third
parties is referred to in this paragraph as "engagement." If CDPHE elects to engage third parties for such
purpose, CDPHE will: (i) notify third parties that their engagement is subject to the terms and conditions of
the Grant Contract between CDPHE and The Colorado Trust, particularly the right of The Trust to
terminate its obligations under the Grant Contract between CDPHE and The Colorado Trust and
discontinue funding; (ii) include the following language in any written agreement rights between CDPHE
and any third party: ' third party Contractor hereby acknowledges that CDPHE's rights under this
agreement are subject to all the terms and conditions of a Grant Contract with The Colorado Trust.
Page 5 of 5
Exhibit C
Commonly Used Acronyms and Abbreviations That May Be Referenced In the Scope of Work:
AC'S American Cancer Society
ACNS Alamosa County Nursing Service
ACE Administration for Children and Families
ADA Americans with Disabilities Act
ADAD Alcohol and Drug Abuse Division
Al IA American Heart Association
AIDS Acquired Immune Deficiency Syndrome
ALA American Lung Association
ALA(C) American Lung Association (of Colorado)
AMCIIP Association of Maternal Child Health Programs
ANR Americans for Non -Smokers' Rights
ARC Addiction Recovery Centers
ARRA American Recovery and Reinvestment Act
ASC Adams State College
ASSIST American Stop Smoking Intervention Study
ASTER) Association of State and Territorial I lealth Office
B&G Boys & Girls
BACCHIJS BACCHUS Peer Education Network
BAG Build a Generation
BBLHC Boulder Broomfield Latino I lealth Coalition
BC Boulder County
BCCP Breast and Cervical Cancer Program
BCHD Bent County Health Dept
BCPH Boulder County Public Health
BCPHA Baca County Public health Agency
BCDSS Baca County Dept Social Services
BCTEPP Bent County Tobacco Education Prevention Partnership
BGC Boys & Girls Club
BGCMD Boys & Girls of Metro Denver
BFIS Broomfield High School
BMTF Baby & Me Tobacco Free
BOCES Board of Cooperative Educational Services
BOH Board of Health
BRFSS Behavioral Risk Factor Surveillance System
BVBAG Buena Vista Build a Generation
BVSD Boulder Valley School District
Bx Biopsy
C Choice
CAD Coronary Artery Disease
CASB Colorado Association of School Board
CB Community -based System
CBE Clinical Breast Exam
CBO Community -based Organization
CC Clear Creek
CC Custer County
CC Community Coordination/Coordinator
CCAP Larimer County Child Care Assistance Program
CCC Colorado Cancer Coalition
CCCHE Colorado Community Coalition for health Equity
CCGC Colorado Clinical Guidelines Collaborative
CCIAA Colorado Clean Indoor Air Act
CCMC Colorado Clinical Managed Care Network
CCMC Commission for Case Manager Certification
CCPD Cancer, Cardiovascular. and Pulmonary Disease
Page 1 of 6
Exhibit C
CCTCI Colorado Chew Tobacco Collaborative Initiative
CCfEPP Custer County Tobacco Education Prevention Partnership
CDC Centers for Disease Control and Prevention
CDE Colorado Department of Education
CDPHE Colorado Department of I'ublic health and Environment
CDU Chronic Disease Unit
CEC Career Education Center
CEO Chief Executive Officer
CFDA Catalog of Federal Domestic Assistance
CFTC Colorado Foundation for Families and Children
CFPI Colorado Family Planning Initiative
CHIN Community Health Information Network
CICP Colorado Indigent Care Program
CJD Colorado Judicial Department
CM Case Management
CMC Colorado Mountain College
CMS Contract Management System
CMS Creative Media Solutions
CNCC Colorado Northwestern Community College
CNS County Nursing Service
CO Colorado
COD Colorado Donated Dental Services Program
COPAN Colorado Physical Activity and Nutrition Program
COV Colorado Van Program
CPCF Colorado Parent and Child Foundation
CI'HA Colorado Public Health Association
CPT Current Procedural Technology
CRC Colorectal Cancer
CRCCP Colorectal Cancer Screening Program
CRUE Culturally Responsive Urban Education
CSAP Colorado Student Assessment Program
CSI I Coordinated School Health
CSI Colorado State University
CSU-P Colorado State University -Pueblo's
CTC Connect to Care
Cfl-PA Colorado Tobacco Education and Prevention Alliance
CTFK Campaign for Tobacco -Free Kids
CTRP Colorado Tobacco Research Program
CTP Crossroads Turning Point
CU University of Colorado, Boulder
CWCCI Colorado Women's Cancer Control Initiative
CY Contract Year
DAISI Denver At-home Intervention Service Initiative
DASH Division of Adolescent & School Health (CDC)
DCMH Delta County Memorial I Iospital
DI' Denver Health
DHFIA Denver Health and Hospital Authority
DIIS Department of Human Services
DIJI-IS Unites States Department of Health and Human Services
DOR Department of Revenue
DOS Delta Opportunity School
DSS Department of Social Services
E&I Education and Information
EAP Employee Assistance Program
EBHV Evidence -Based Home Visiting to Prevent Child Maltreatment Grant Program
FCC Early childhood council
ECC Electrocardiogram
ECCI.C Early Childhood Council ofLarimer County
Page 2of6
Exhibit C
ECLC
L.D.
ERR
FITS
F.MR
FMT
EPA
FPE
ESL
EfS
FIRC
FICA
FDA
FIT/FORT
FNA
FPP
FPL
FRCC
FIE
FTP
FY
FYI
GASO
(GED
GASP
Get REAL (GR)
GLBT
GYN
HCP
HCYS
HHS
IIIPPA
HIPPY
HIT
HIV
HPV
IIR
hr
HRSA
FISF
ID
Ilk
ISI
IT
JAC
KIS
KMH
KPC
LAHCDIID
LBW
LC
[GBT
LEM
Li IA
LHD
LI.C
LRCC
I.RPC
Early Childhood Leadership Council/Commission
Executive Director
Electronic Health Record
Early Head Start
Electronic Medical Record
Emergency Medical Technicians
Environmental Protection Agency
Epidemiology Planning and Evaluation
English as a Second Language
Environmental Tobacco Smoke (a.k.a. secondhand smoke)
Family and Intercultural Resource Center
The Federal Insurance Contribution Act
Food and Drug Administration
Fecal Immunochemical Test/Fecal Occult Blood Test
Final Needle Aspiration
Family Planning Program
Federal Poverty Level
Front Range Community College
Full Time Equivalent
File Transfer Protocol
Fiscal Year
Family Youth Initiatives
Great American Smoke -out
General Education Development
CO Group to Alleviate Smoking Pollution of Colorado
Resist! Expose Advertising lies (Youth Empowerment Program)
Gay. Lesbian, Bisexual, and Transgender
Gynecological
I lealth Care Program For Children with Special Needs
Huerfano County Youth Services
Health and Human Services
Health Insurance Portability and Accountability Act of 1996
flume Instruction for Parents of Preschool Youngster
Health Improvement "ream
human Immunodeficiency Virus
Fluman Papillomamavirus
Human Resources
hour
I lealth Resources and Services Administration
High School Leadership
Identification
Invest in Kids
Interagency School Health Team
Information Technology
Juvenile Assessment Center
Keeping in STEPP
Keefe Memorial I lospital
Kevin Patrick Caleum
Las Animas Huerfano Counties District Health Department
Low Birth Weight
Learning Community
Lesbian, Gay, Bisexual. fransgender
Latinas en Movimiento
Local Health Agency
Local Health Department
Limited Liability Company
Latino Regional Community Coalition
Latino a Research and Policy Center
Page 3of6
Exhibit C
[ST Life Skills Training
LSTPEN Latino Statewide Tobacco Prevention and Education Netw
LWB Live Well Broomfield
MCFIA Montezuma Housing Authority
MCI ID Montezuma County Health Department
MCI IS Montezuma -Cortez High School
MCPN Metro Community Provider Network
MCRC Media Campaign Resource Center — CDC
MD Medical Doctor
MIICBBC Mental Health Center Serving Boulder and Broomfield Counties
MIECHV Maternal, Infant and Early Childhood Home Visiting Program
MO Month
MOB Medical Office Building
MOFI Memorandum of Understanding
MPA Master of Public Administration in I lealth and Human Services
MPII Master of Public Health
MRI Magnetic Resonance Imaging Scan
MS Master of Science
MSA Master Settlement Agreement
WI I Multi-user Housing
MYAT Multi -Disciplinary Youth Assessment Team
N/A Not Applicable
NACCHO National Association of County and City Health Officials
NACR Native American Cancer Research
NAQC North American Quitline Consortium
NASBE National Association of State Board of Education
NCCRT National Colorectal Cancer Round "fable
NCIID Northeast Colorado I lealth Department
NCI National Cancer Institute
NE North East
NFP Nurse -Family Partnership
NFPNSO Nurse -Family Partnership National Service Office
NH VP Nurse Home Visitor Program
NIDA National Institute on Drug Abuse
NII I National Institute of Health
NJl I National Jewish Medical and Research Center
N -O -/f Not -on -Tobacco. (ALA's Youth Smoking Cessation Program)
NP Nurse Practitioner
NPP Nurturing Parenting Program
NRT Nicotine Replacement Therapy
NSBA National School Boards Association
OSH Office on Smoking or Health (CDC)
OTC Over the Counter
PA Physician's Assistant
PAC Prevention Awareness Crew
PACT Partners Assessing Chew Tobacco
PAT Parents as Teachers
PCCHD Pueblo City -County Health Department
PPC Personal Care Providers
PE Presumptive Eligibility
PEN Parent Engagement Network
PVCHC Peak Vista Community I lealth Center
Pi N Public Health Nurse
PIO Public Information Officer
PM Peer Mentor
PMC Parkview Medical Center
PMR Planning Management Region
PN Patient Navigator
Page 4 of 6
Exhibit C
PO Purchase Order
PPC Policy Partner Committee
PPFC Pikes Peak Family Connections
PPN Prevention Policy Network
PRA Policy Resource Alliance
PRAMS Pregnancy Risk Assessment and Monitoring Survey
PRIDE Pure Respect Initiative Direct Education
PSA Public Service Announcement
PSD Prevention Service Division
PTEPP Pueblo •tobacco Education and Prevention Partnership
PVC Prairie View Clinic
Q1 Quarter One
Q2 Quarter Two
Q3 Quarter Three
Q4 Quarter Four
QI Quality Improvement
QOL Quality of Life
RDAC Regional Disparities Advisory Council
RFA Request for Applications
REP Request For Proposals
RIE Reach, Implementation and Effectiveness
RIHEI. Regional Institute for Health and Environment
RMC Rocky Mountain Center for I lealth Promotion & Education
RMRH Rocky Mountain Rural Health
RMYC Rocky Mountain Youth Corps
RN Registered Nurse
Rx Prescription
RY Reconnecting Youth
SafeCare
SAMHSA Substance Abuse Mental Health Services Administration
SB School -based System
SBAG Salida Build A Generation
SBHC School -Based Health Centers
SCYC School Community Youth Coalition
SCRI IC Southern Colorado Regional Health Collaborative
SD Service Delivery
SECH Southeast Colorado Hospital
SEMFIS Southeast Mental Health Services
SES Socio-Economic Status
SEW School Employee Wellness
SGR Surgeon General's Report
SHAC Smoke -free Housing Action Committee
SHI School Health Index
SHS Secondhand Smoke
SIDS Sudden Infant Death Syndrome
SLV San Luis Valley
SMART Staying Motivated at Reducing Temptations
SMART OUTCOME OBJECTIVE Specific, Measurable. Achievable. Realistic, Time -Bound
SMSU Self Management Service Unit
SOW Scope of Work
SRO School Resource Officer
STD Sexually Transmitted Disease
STEPP State Tobacco Education and Prevention Partnership
STW Straight -to -Work
SVVSD St. Vrain Valley School District
SWOT Strengths, Weaknesses, Opportunities. Threats
SYNAR Synar Regulation
TA Technical Assistance
Page 5of6
Exhibit C
TABS
TAG
TANF
TARP
TBD
TCP
TDAC
TDG
TDS
TEACI I
TEFAP
TEPCGP
TEPP
TFCCI
TFLC
TFS
TFS Law
TGYS
Title V
TND
TPEG
TPI
TRC
TRl
TRIA
TTI
UCD
UCDIISC
UCDI ISC
URL.
US
USSTC
VP
Well COA
WHIZ
WIC
WWC
Y@C
YE
YPH
Yr
YRBS
YSAP
YTS
YVMC
5 A's
2A's R
Tobacco Attitudes and Behavior Survey
Technical Advisory Group (for evaluation & TPEG)
Temporary Aid to Needy Families
Tobacco Advocacy and Resource Partnership
To Be Determine
Tobacco Control Partners
Tobacco Disparities Advisory Council
Tobacco Disparities Grant
Tobacco Disparities Subcommittee
Teaching Equity to Advance Community Health
The Emergency Food Assistance Program
Tobacco Education Prevention and Cessation Grant Program
Tobacco Education Prevention Partnership
Tobacco -Free Colorado Communities Initiative
Tobacco Free Larimer County
Tobacco -Free Schools
Tobacco -Free Schools Law
Tony Grampsas Youth Services
Title V of the Social Security Act
Project Toward No Drug Abuse
Tobacco Program Evaluation Group
Tobacco Prevention Initiative
Tobacco Education and Prevention and Cessation Program Review Committee
Tobacco Rapid Improvement Activity
Tobacco Rapid Improvement Assessment
Tony Grampsas Tobacco Initiative
University of Colorado — Denver
Health Sciences Center at UCD (sometimes abr. UCHSC)
University of Colorado at Denver and Health Sciences Center
Uniform Resource Locator
United States of America
US Smokeless Tobacco Company
Vice President
Wellness Councils of America
Women's I Iealth Unit
Women, Infants, Children
Women's Wellness Connection
Youth at Crossroads
Youth Empowerment
Youth Partnership for Health
Year
Youth Risk Behavior Survey
Youth Substance Abuse Prevention Coalition
Youth Tobacco Survey
Yampa Valley Medical Center
Ask, Advise, Assess, Assist, Arrange
Ask, Advise. Refer
Page 6 of 6
EXHIBIT D
OPTION LETTER #: Click here to enter text.
State Agency :
Colorado Department Of Public Health and Environment
4300 Cherry Creek Dr S
Denver, CO 80246
Original Contract #
Click here to enter text.
Contractor (Name and Address)
Click here to enter text.
Option Contract Number
Click here to enter text.
Contract Performance Beginning Date :
Click here to enter a date.
Current Contract Expiration Date :
Click here to enter a date.
CONTRACT MAXIMUM AMOUNT TABLE
Document
Type
CMS Routing #
Federal Funding
Amount
State Funding
Amount
Other Funding
Amount
Term (dates)
Total
OL # l
$
Original
$
Current Contract Maximum
Amount (YTD)
$
1) OPTIONS
A. Option to extend for an Extension Term
B. Option to change quantity of goods under the Contract
C. Option to change quantity of services under the Contract
D. Option to change Contract rates
E. Option to initiate next phase of Contract
2) REQUIRED PROVISIONS:
A. In accordance with Section(s) Click here to enter text. of the Original Contract referenced
above the State hereby exercises its option for an additional term, beginning Click here to enter a
date. and ending on the current contract expiration date shown above, at the rates stated in the
Original Contract, as amended.
B. In accordance with Section(s) Click here to enter text. of the Original Contract referenced
above, the State hereby exercises its option to Choose an item. the quantity of Choose an item. at
the rates stated in the Original Contract as amended for the following reason: Click here to
enter text..
C. In accordance with Section(s) Click here to enter text. of the Original Contract referenced
above the State hereby exercises its option to modify the Contract rates specified in Click here to
enter text. for the following reason: Click here to enter text.. The Contract rates attached to this
Option Letter replace the rates in the Original Contract as of the Option Effective Date of this
Option Letter.
D. In accordance with Section(s) Click here to enter text. of the Original Contract referenced
above, the State hereby exercise its option to initiate Phase Click here to enter text., which shall
begin on Click here to enter a date. and end on Click here to enter a date. at the cost/price
specified in Section Click here to enter text..
E. The Contract Maximum Amount table is deleted and replace with the Current Contract
Maximum Amount Maximum Amount table shown above.
3) OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or Click here
to enter a date. whichever is later.
Ver. 27.2.18
EXHIBIT D
PROGRAM APPROVAL
By:
Date:
STATE OF COLORADO
John W. Hickenlooper, Governor
Department of Public Health and Environment
By: Lisa McGovern, Purchasing & Contracts Section
Director
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This
Contract is not valid until signed and dated below by the State Controller or delegate.
Contractor is not authorized to begin performance until such time. If Contractor begins
performing prior thereto, the State of Colorado is not obligated to pay Contractor for
such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
Ver. 27.2.18
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