HomeMy WebLinkAbout20183848.tiffRESOLUTION
RE: APPROVE TASK ORDER CONTRACT AMENDMENT #3 FOR WISEWOMAN
PROGRAM UNDER THE WOMEN'S WELLNESS CONNECTION 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 Task Order Contract Amendment #3
for the WISEWOMAN (Well -Integrated Screening and Evaluation for WOMan Across the Nation)
Program under the Women's Wellness Connection Program between the County of Weld, State
of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of
the Weld County Department of Public Health and Environment, and the Colorado Department of
Public Health and Environment, commencing upon execution of signature, and ending
May 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 Task Order Contract Amendment #3 for the WISEWOMAN II -
Integrated Screening and Evaluation for WOMan Across the Nation) Program under the Women's
Wellness Connection Program between the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the Weld County 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 3rd day of December, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: xi,„);„k.
Weld County Clerk to the Board
orney
Date of signature: /19
Ste Moreno, Chair,
CC: I-ILC TCs)
113119
2018-3848
H L0050
Lt- 164-9 D
Memorandum
TO: Steve Moreno, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: November 21, 2018
SUBJECT: CDPHE FY18-19 WISEWOMAN Renewal
Contract
For the Board's approval is Task Order Amendment #3 between the Colorado Department of
Public Health and Environment (CDPHE) and the Board of County Commissioners for the use
and benefit of the Weld County Department of Public Health and Environment (WCDPHE) for
our Women's Wellness Connection, WISEWOMAN program.
The purpose and mission of the Well -Integrated Screening and Evaluation for WOMen Across the
Nation (WISEWOMAN) program is to provide cardiovascular screenings. risk reduction
counseling, referrals, lifestyle programs and other healthy behavior support options to improve
control of hypertension and other cardiovascular disease risk factors to women residing in
Colorado who are not insured or underinsured, enrolled in the Women's Wellness Connection
program and meet the age, income, and lawful presence requirements.
The purpose of this task order amendment is to reflect changes that were required to extend the
term by three months and modify the budget to include additional funding for this extension. The
period of performance of the current term will be extended by three (3) months, changing the
current ending date from February 29, 2019, to May 31, 2019. The maximum amount payable by
the State for the work to be performed by the Contractor during this extended term is $12,751.00.
This contract amendment has been reviewed by Assistant County Attorney, Bob Choate, and it
meets with his approval.
Furthermore, this amendment was approved for placement on the Board's agenda via pass -around
dated November 19, 2018.
I recommend approval of this WISEWOMAN Task Order Contract amendment with CDPHE.
2018-3848
t -1 t O
O/3
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
FHLA - WIWO
DEPARTMENT OR AGENCY NUMBER
FAAA
TASK ORDER AMENDMENT ROUTING NUMBER
19 FHLA 113511
To Original Task Order Routing Number
15 FHLA 77061
TASK ORDER AMENDMENT #3
This Task Order Amendment is made this 9th day of November, 2018, by and between the State of Colorado, acting by
and through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal place
of business is 4300 Cherry Creek Drive South, Denver, Colorado 80246, hereinafter referred to as the "State"; and,
BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, (a political subdivision of the state of
Colorado) whose address or principal place of business is 1150 "O" Street, Greeley, CO 80631, for the use and
benefit of the Weld County Department of Public Health and Environment, whose address or principal place of
business is 1555 North I7`!' Avenue, Greeley, Colorado 80631, hereinafter referred to as the "Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract dated January 17, 2012, with contract routing number 13 FAA 00051.
Pursuant to the terms and conditions of the Master Contract the parties entered into a Task Order Contract dated
February 12, 2015, with encumbrance number CT FAAA FHLA 201800003211, and task order contract routing
number 15 FHLA 77061, hereafter referred to as the "Original Task Order Contract", whereby the Contractor was to
provide to the State the following:
Provide cardiovascular screenings, risk reduction counseling, referrals, lifestyle programs and other healthy
behavior support options to improve control of hypertension and other cardiovascular disease risk factors to
women residing in Colorado who are uninsured or underinsured and are enrolled in the Women's Wellness
Connection program who meet the share age, income and lawful presence requirements
Changes were required to extend the term by three months and modify the budget to include additional funding.
The State promises to pay the Contractor the sum of Twelve Thousand Seven Hundred Fifty One Dollars,
($12,751.00) for the extended term of three (3) months, ending on May 31, 2019, in exchange for the promise of the
Contractor to perform the specifications to the work described herein.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below. the parties hereto agree as
follows:
1. Consideration for this Contract Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Contract Amendment, and promises and agreements herein set
forth.
It is expressly agreed to by the parties that this Contract Amendment is supplemental to the Original Task
Order Contract, contract routing number 15 FHLA 77061, as amended by Grant Funding Change Letter I,
routing number 16 FHLA 80204, Grant Funding Change Letter 2, routing number 16 FHLA 81.529. Contract
Amendment 1 routing number 16 FHLA 87648, Grant Funding Change Letter 3 routing number 17 FHLA
89789, Option Letter I routing number 17 FHLA 97673, Option Letter 2 routing number 17 FHLA 103273,
Contract Amendment 2 routing number 18 FHLA 100917, Option Letter 3 routing number 18 FHLA 107942,
Option Letter 4 routing number 18 FHLA 110727, and Grant Funding Change Letter 4 routing number
Page I of 4
19 FI ILA 113511 AMD 3 ver 14.11.18
19 FHLA 113243. collectively referred to herein as the Original Task Order Contract, which is by this
reference incorporated herein. All terms, conditions. and provisions thereof, unless specifically modified
herein, are to apply to this Contract Amendment as though they were expressly rewritten, incorporated, and
included herein.
3. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified, altered,
and changed in the following respects only:
A. The period of performance of the current term is hereby extended by three (3) months, changing the
current ending date from February 29, 2019 to May 31, 2019. The revised period of performance is
March 1, 2015 through and including May 31, 2019.
B. This Contract Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract. This
Contract Amendment is for the extended term of September 30, 2018, through and including May 31,
2019. The maximum amount payable by the State for the work to be performed by the Contractor during
this extended term is Twelve Thousand Seven Hundred Fifty One Dollars, ($12,751.00) for an
amended total contract financial obligation of the State of One Hundred Nine Thousand Fifty Six
Dollars, ($109,056.00).
1. For this renewal term the maximum amount payable attributable to United States Government
funding source (see Catalog of Federal Domestic Assistance (CFDA) number 93.094) is Twelve
Thousand Seven Hundred Fifty One Dollars, ($12,751.00), and the amended total contract
financial obligation attributable to United States Government funding source (see Catalog of Federal
Domestic Assistance (CFDA) number 93.094) is One Hundred Nine Thousand Fifty Six Dollars,
($109,056.00) .
The modified specifications to the original Statement of Work and Budget are incorporated herein by
this reference and identified as "Exhibit I and Exhibit J-
4. The Effective Date of this Contract Amendment is November 26, 2018, or upon approval of the State
Controller, or an authorized delegate thereof, whichever is later.
5. Except for the General Provisions and Special Provisions of the Original Task Order Contract, in the event of
any conflict, inconsistency, variance, or contradiction between the terms and provisions of this Contract
Amendment and any of the terms and provisions of the Original Task Order Contract, the terms and provisions
of this Contract Amendment shall in all respects supersede. govern, and control. The Special Provisions shall
always control over other provisions of the Original Task Order Contract or any subsequent amendments
thereto. The representations in the Special Provisions to the Original Task Order Contract concerning the
absence of personal interest of state of Colorado employees are presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE. AFTER THE CURRENT FISCAL YEAR ARE
CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED, AND
OTHERWISE MADE AVAILABLE.
Page 2 of 4
19 HIT A 11 351 1 AMD 3 ver 14.1 1.18
SIGNATURE PAGE
Contract Routing Number I9 Fl Ii. \ 113511
THE PARTIES HERETO HAVE EXECUTED THIS TASK ORDER AMENDMENT
I ach person signing this I ask Order Amendment represents and %%arrtalls that he or she is dolt authorized to execute this I ask Order Amendment and to
hind 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 and Environment
(a political subdivision of the state of Colorado)
Steve Moreno
By:
Print Name of Authorized Individual
Chair, Board of Weld
County Commissioners
riot Title of Authorized Individual
,....i
I isa McGovern
Purchasing and Contracting Section Director. CDPI II.
Signature of Authorized Individual
DEC 03 2018
Date
PROGRAM APPROVAI.
Colorado Department of Public Health and Environment
Signature of Authorized C'DPHE Program Approver
(2( LO ( lC(
Date
By:
STATE OF COLORADO
John W. Hickenlooper. Governor
Colorado Department of Public Health and
Environment
Executive Director
Signature — Senior Assi ft Attorney General
Date
LEGAL REVIEW
Cynthia H. Coffin turney General
ito tt
Date
In accordance with §24-30-202 C.R.S . this I ask Order Amendment is not valid until signed and dated below by the State
Controller or an authorized delegate.
STATE CONTROL,
Robert Jars, CPA,
By:
Effective Date:
l)till.\IIiii' \bbl);
Page 3014
Q018-38'48- (Q)
EXHIBIT I
STATEMENT OF WORK
Contract Amendment #3, Routing Number 19 FHLA 1 1351 1
To Original Contract Routing Number 15 FHLA 77061
These provisions arc to be read and interpreted in conjunction with the provisions of the contract specified above.
I. Entity Name: Weld Department of Public Health and Environment
Term: PROJECT PERIOD: July 1, 2017 through May 31, 2019
PERIOD FOR COMPLETING ACTIVITIES: July I, 2017 through March 31, 2019
11. Project Description:
This project serves to provide Women's Wellness Connection (WWC) participants with access to additional
preventive health services through the Well -Integrated Screening and Evaluation for WOMen Across the Nation
(WISEWOMAN) program. These medical services include cardiovascular health screening; health risk
assessments; risk reduction counseling; referrals for women with abnormal screening values to health care
providers for medical evaluation and management of condition(s); follow-up for uncontrolled hypertension;
linking participants to free or low-cost medication resources; and referrals to health coaching, approved lifestyle
programs and other healthy behavior support options.
Program Purpose and Mission:
The purpose and mission of the WISEWOMAN program is to provide cardiovascular screenings, risk reduction
counseling, referrals, health coaching, lifestyle programs and other healthy behavior support options to improve
control of hypertension and other cardiovascular disease risk factors.
Beneficiaries:
Direct beneficiaries are women residing in Colorado who are uninsured or underinsured; who meet the age,
income and lawful presence requirements of both WWC and WISEWOMAN programs. Target populations
include women of diverse ethnic backgrounds, women living in geographically isolated and medically underserved
areas and women who have a high burden of cardiovascular disease.
III. Definitions:
I. Case Management- Case management services are provided to WISEWOMAN clients who have initial
abnormal or "alert" screening values for blood pressure or glucose or who have uncontrolled hypertension.
All women with alert values must receive these services to ensure access to the indicated medical care.
2. CDC: Centers for Disease Control and Prevention
3. DPP: Diabetes Prevention Program
4. eCaST: Colorado Department of Public Health and Environment's (CDPHE) Electronic Cancer
Surveillance Tracking data system
5. WISEWOMAN: Well -Integrated Screening and Evaluation for WOMen Across the Nation
6. WISEWOMAN Program: Ran by the Colorado Department of Public Health and Environment, Prevention
Services Division, WWC.
7. WWC: Women's Wellness Connection. The local name in Colorado for the National Breast and Cervical
Cancer Early Detection Program
IV. Work Plan:
Goal #1: Reduce the rate of cardiovascular disease risk in program eligible women in Colorado
Objective #1: No later than the expiration date of the Contract, women that meet WISEWOMAN eligibility
criteria are provided with cardiovascular screening services.
Primary
Activity #1
The Contractor shall perform cardiovascular screening services onsite at the Contractor's
place of business.
Sub -Activities
#1abnormal
I. The Contractor shall provide medical evaluation and treatment to WISEWOMAN
clients with alert lab values.
2. The Contractor shall provide case management to WISEWOMAN clients with
screening values.
3. The Contractor shall provide referrals to medical care for WISEWOMAN clients with
abnormal screening values.
version. (ontr.,ct Statement of Work —Exhibit B
December 21115
Page I of S.
19 FIIIA 113511 1'.xii 1
EXHIBIT
Primary
Activity #2
The Contractor shall provide face -to face risk reduction counseling onsite, at the
Contractor's place of business, at the time of their screening visit.
Objective #2: No later than the expiration date of the Contract, women that meet WISEWOMAN eligibility
criteria are offered healthy behavior support options.
Primary
Activity #1
The Contractor shall offer WISEWOMAN clients to the Diabetes Prevention Program
(DPP), Cooking Matters or to another comparable CDPHE approved lifestyle program,
either onsite or at another site.
Primary
Activity #2
The Contractor shall offer WISEWOMAN clients paid -for referrals to health coaching
services either onsite or to a CDPHE approved entity that provides health coaching.
Primary
Activity #3
The Contractor shall offer WISEWOMAN clients other referrals to other healthy behavior
support options such as other community based resources that support the woman's health
goals
Objective #3: No later than 30 days after the end of the performance period of this contract, WISEWOMAN
data is entered into the eCaST data system.
Primary
Activity #1
The Contractor shall record WISEWOMAN qualifying procedures into the eCaST data
system on a monthly basis.
Objective #4: No later than the expiration date of the Contract, participate in the Baseline Screening
Assessment and Clinic Quality Improvement project.
Primary
Activity #1
The Contractor shall participate in the Baseline Screening Assessment and Clinic Quality
Improvement project by CDPHE related to breast, cervical, colorectal cancer and
cardiovascular screening rates.
Sub -Activities
#1
The Contractor shall participate in collection of baseline cardiovascular and cancer
screening data from Contractor's electronic health record.
I. 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.
2. The Contractor shall comply with the WISEIf"Otl,l,V Program Eligibility Criteria in the
WISEWOMAN Colorado Program Manual, found in the WISEWOMAN Provider
Resources page on the WISEWOMAN website. This document is incorporated and
made part of the Contract by reference and is available on the following website:
https://www.colorado.gov/pacific/sites/default/files/WISEWOMAN Manual.pdf
3. The Contractor shall comply with the lawful presence requirements for WWC.
a. Comply with Lawful Presence Requirements according to Colorado Department of
Revenue guidelines. This information is incorporated and made part of this Contract
by reference as is available at the following Department of Revenue website:
https://www.colorado.gov,'pacific/dmv/identification-requirement-charts
b. Annually obtain a signed Lawful Presence .1/jIdavit. The Contractor shall keep a
copy in the patient's medical record before services are rendered. This form is
incorporated and made part of this Contract by reference and is available at the
WWC website on the Women's Wellness Connection Provider Resources page:
https://www.colorado.gov/pacific/cdphe/wwc-provider-resources; and
c. Attest by checking the I erified Legal Presence box in the electronic record in
eCaST.
4. The Contractor shall complete the JIM(' ff'1SE61'O:11,1,V Combined Consent, Patient
Information and Risk Reduction Counseling and Referral forms. These forms are
incorporated and made part of this Statement of Work by reference and are available in
the WISEWOMAN Provider Resources page on the WISEWOMAN website.
5. The Contractor shall perform cardiovascular screening services in accordance with the
et aiun_ Cuntrao Statement of Work —L: 'tuba H
Decanher 201
19 1:111A 113511 I :xh I
Page 2ot5
EXHIBIT I
Standards
and
Requirements
YI'/SEYt'OL1.-1VService Deliver] Plow Diagram and clinical and program guidelines in
the WISEWOMAN Colorado Program Manual.
6. The Contractor shall use as a guideline the published alert values, disease values, flow
chart, clinical guidelines and risk reduction counseling as described in the
WISEWOMAN Colorado Program Manual.
7. The Contractor shall provide face-to-face risk reduction counseling in accordance with
the 7SL'WOa1.IN Service Delivery Flow Diagram and the WISEWOMAN Colorado
Program Manual.
8. The Contractor shall provide all women, with alert lab value.s. medical evaluation and
treatment immediately or within seven (7) days of the alert measurement, in accordance
with national standards of care and the judgment of the Contractor's Medical Director.
9. The Contractor shall provide all women, with alert level blood pressure or laboratory
alert values, referrals for medical evaluation and management of condition(s) if not
currently being treated.
10. The Contractor shall provide all women, with uncontrolled hypertension, case
management and other appropriate follow-up.
II. The Contractor shall follow the guidelines and comply with the requirements for case
management of WISEWOMAN clients stated in the WISEWOMAN Colorado Program
Manual.
a. Clinical aspects of case management shall be overseen by a Registered Nurse,
Physician Assistant or Physician licensed and in good standing to provide healthcare
in the state of Colorado.
b. Case management shall begin from the first abnormal result through referral to
additional medical follow-up or evaluation.
12. The Contractor shall have a Medical Director to develop and implement medical
protocols to cover situations not addressed by WISE WOMAN national guidelines.
13. The Contractor shall refer all women to free or low-cost medication resources, if
needed.
14. The Contractor shall have an established referral process for abnormal findings.
15. The Contractor shall provide services referenced on the Current Procedural Technology
(CPT) Code List directly or through a subcontractor agreement and is available in the
WISEWOMAN Provider Resources page on the WISEWOMAN website.
16. If the Contractor is a CDC recognized Diabetes Prevention Program (DPP) site, or
pending recognition, then DPP services may be provided by the Contractor.
17. For services that may not be provided onsite, including the DPP services, the Contractor
shall maintain a network of subcontractors. Contractor shall forward a copy of the fully
executed Memorandum of Understanding or other binding contractual agreement to the
WISEWOMAN Program within 15 calendar days of execution.
a. Subcontracts shall be secured with local providers to the extent possible.
b. Services performed by subcontractors shall be agreed upon in writing through the use
of a binding contract which includes the period of service.
c. This agreement shall cover referral of eligible clients for services in accordance with
WISEWOMAN guidelines in the WISEWOMAN Colorado Program Manual: utilize
approved reimbursement rates; obtain written monthly feedback on client
participation: access and barriers to participation: and date and length of DPP
classes/sessions.
version. Contract Statement of Work — ahibn B
December 2111 TS
Page 3 of 5
19 FULA 1 1351 1 [xh I
EXHIBIT I
Standards
and
Requirements
18. The Contractor shall comply with requirements stated in the most current national
clinical, diet and lifestyle guidelines as outlined in the WISEWOMAN Colorado
Program Manual.
19. At least one (I) representative from the Contractor and/or its network provider sites shall
attend all required meetings, conference calls or trainings hosted by the WISEWOMAN
Program. This attendance can be achieved by participating at the time of the event or by
reviewing a recorded version at a later time.
20. It is expected that if a Contractor enrolls a client in WISEWOMAN and provides initial
cardiovascular screening services, the same Contractor shall be responsible for entering
all data in eCaST and assuring that clinically appropriate follow-up care is completed
through case management services and healthy behavior support options.
21. When corresponding with the WISEWOMAN Program, Contractor shall use all privacy
and security measures to protect the client's personal health information.
Accepted forms of communication include:
a. Unencrypted email conversations using the eCaST identification number;
b. Mail or fax clearly marked "Confidential" and using the eCaST identification
number;
c. HIPAA compliant files transmitted via secure File Transfer Protocol (FTP) sites; and
d. Secure encrypted email.
22. The Contractor shall enter the most recent WISEWOMAN client data into the eCaST
system by the 15th of each month in preparation for the monthly billing run.
23. The Contractor's new data entry staff shall participate in WISEWOMAN eCaST
training within 30 calendar days of hire, unless otherwise approved by the
WISEWOMAN Program.
24. The Contractor shall identify and support key personnel assigned these roles: a
WISEWOMAN Coordinator. Clinical Liaison, eCaST Coordinator. eCaST data entry
staff, Agency Director, Contract Administrator, Signature Authority. Fiscal Payment
Coordinator, Fiscal Manager, Health Coach, and Case Manager(s).
25. The Contractor shall comply with the requirements stated in the Contacts Descriptions
document, which is available in the WISEWOMAN Provider Resources page of the
WISEWOMAN website.
26. The Contractor shall report all staff changes during the contract period to
WISEWOMAN Program within 15 calendar days. The Contractor shall use the .Igency
and Site Contacts born, or another WISEWOMMAN-provided form.
27. The Contractor shall report all subcontractor changes during the contract period to the
WISEWOMAN Program within 15 calendar days of occurrence, via email to
WISEWOMAN Program Coordinator.
Expected
Results of
Activity(s)
Clients' complete cardiovascular screenings, risk reduction counseling and referrals, and
received needed treatment.
Measurement
of Expected
Results
WISEWOMAN Program will analyze data from eCaST to include the number of women
receiving cardiovascular screenings, risk reduction counseling, and referrals for lifestyle
programs .
ii �. - y iii W.� hi/J'1'g',///
�'l� >�. /-7,'.-7'7://r//-1/4//74-1' rW�i i f,�, �� „��i ,j1 ��;alfi'5 Completion Date
FioLiiv,r✓.✓rs✓.:J✓ioe �a-IJr. r„i iiiJfi,.i r„r<l „iih. ✓i.l; iJ-, ��l,r �-if7� 1��;
yersiun Contract Staicmcnt of Wnrk — F.ehihit B
Decernher 21)1 ft
Page 4 of
19FIII.A1135111'xhI
EXHIBIT
Deliverables
1. The Contractor shall identify (an) eCaST user(s) responsible for
No later than
WISEWOMAN data entry in eCaST and submit a list of eCaST
user(s) via email to WISEWOMAN Program Coordinator.
7/15/2017
2. The Contractor shall submit key personnel contact information to
No later than 15
WISEWOMAN Program within I5 calendar days of the start of
calendar days of
the fully executed contract or start of term date, whichever is
later. via email to WISEWOMAN Program Coordinator.
change
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the WISEWOMAN Program Coordinator. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include monthly check -in calls, All
Agencies Calls, eCaST data, site visits, 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 time line for completion will be documented in writing and agreed to by both parties. If extenuating
circumstances arise that requires an extension to the time line, the Contractor must email a request to the
WISEWOMAN Section Manager and receive approval for a new due date. The State will oversee the
completion/implementation of the action(s) to ensure time lines 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.
cerion. Contract Statcment of Work— F_xhlbn B
[)ecemher 2015
19 FIIIA 113511 I:xh I
Page 5ot5
Exhibit 1
CDPHE
;COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION - LESS THAN 12 MONTH BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 113511
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact Name,
Title, Phone and Email
Cynthia Horn
(970) 304-6420 x2433, chorn@co.weld.co.us
Budget Period
11/1/2018 or execution - 3/31/2019
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Director, Admin Service
970-400-2122, tgeiser@co.weld.co.us
Project Name
WISEWOMAN
Contract (CT or PO) Number
CT-2018*3211
Expenditure Categories
Personal Services
Salaried Employees
Position Title
Description of Work
Gross or
Annual Salary
Fringe
Percent of
Time on
Project
Number of
Months
Total Amount
Requested from
CDPHE
$0.00
Personal Services
Hourly Employees
Position Title
Description of Work
Hourly Wage
Hourly
Fringe
Total # of
Hours on
Project
Total Amount
Requested from
CDPHE
$0.00
Total Personal Services (including fringe benefits)
$0.00
Supplies & Operating Expenses
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Service Delivery
Billed in eCaST
$ 10,443.00
1.0
$10,443.00
Operating Supplies
Allowable purchase of supplies/operating listed on the WISEWOMAN allowable
purchase document on the WISEWOMAN website:
https://www.colorado.gov/cdphe/wisewoman-provider-resources
$ 1,875.00
1.00
$1,875.00
$0.00
Total Supplies & Operating
$12,318.00
Travel
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Travel Costs
Allowable purchase of travel costs listed on the WISEWOMAN allowable purchase
document on the WISEWOMAN website:
https://www.colorado.gov/cdphe/wisewoman-provider-resources
S 50.00
1.0
$50.00
$0.00
Total Travel
$50.00
Contractual
Subcontractor Name
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
$0.00
Total Contractual
$0.00
SUB -TOTAL OF DIRECT COSTS
$12,368.00
Indirect
Item
Description of Item
Total Amount
Requested from
CDPHE
CDPHE-Negotiated Indirect
Cost Rate
CY2018 CDPHE Negotiated Rate - 19.88%
$383.00
Total Indirect
$383.00
Page 1 of 1
Friendly Fork,
Weld County Senior Nutrition Program
Adequate nutrition is essential to staying active and maintaining a healthy lifestyle as we age.
To enhance the dietary intake of Weld County seniors, the Friendly Fork provides tasty and
nutritious lunches in a variety of warm and friendly group settings throughout the County.
Currently, we offer 37 meals which are spread out among 23 sites 5 days a week. All of the
meals meet 1/3 of the daily recommended dietary allowance and include flavorful items such
as lasagna, chicken and dumplings, hamburgers, various fruits and vegetables as well as an
assortment of dinner rolls, muffins, cookies and fruit crisps.
The Friendly Fork additionally provides meal participants with the opportunity to socialize and
interact with others while enjoying a well-balanced meal. This allows many seniors to avoid
isolation, maintain their independence, and form new friendships.
Social and educational opportunities are also available before and after meals. Guest speakers,
musicians and impersonators are quite popular among several sites. Educational classes cover
a range of topics including nutrition, health, fraud and tax assistance. Lorrie, the Registered
Dietitian is also available for nutrition counseling on a variety of nutrition topics to registered
participants of the Friendly Fork at no cost to the participant.
It is the true dedication, commitment and enthusiasm of our volunteers that keeps the Friendly
Fork going strong. Each of our annually trained volunteers willingly donate their time and effort
in helping to welcome others, serve meals, assist with paperwork, clean up and encourage
social interaction among the tables of meal participants.
All in all, it is our mission to continue providing nutritional, social and educational services to
the seniors of Weld County while additionally connecting them to supportive services that
promote independence and self sufficiency.
A complete listing of the 23 Weld County Friendly Fork meals sites and the days of service can
be found on www.weldaaa.org under Senior Nutrition. For additional information, please
contact Meredith Skoglund at 970-400-6132 or mskoglund@weldgov.com.
Powerful Tools for Caregivers Workshop:
If you are caring for a loved one at home, this workshop will help you learn to reduce
stress, guilt and anger; relaxation techniques; set goals and problem -solve (family
caregivers only). Workshop meets once a week for six weeks. FREE but registration is
required by calling 970-400-6130.
Tuesdays 1/15/19 to 2/19/19: Greeley Medical Clinic: 9:00 — 10:30 am
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