HomeMy WebLinkAbout20181810.tiffRESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR AMENDMENT 35 TOBACCO USE
PREVENTION AND CESSATION EDUCATION 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 for Amendment
35 Tobacco Use Prevention and Cessation Education 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 July 1, 2018, and ending June 30, 2021, with further
terms and conditions being as stated in said task order contract, and
WHEREAS, after review, the Board deems it advisable to approve said task order
contract, 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 for Amendment 35 Tobacco Use Prevention and
Cessation Education 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 task order contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 11th day of June, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: dititadv jdo;ok.
Weld County Clerk to the Board
BY:
AP
Deputy Clerk to the B
ounty Attorney
Date of signature: 07-/o9
Steve Moreno, Chair
EXCUSED
Barbara Kirkmey Pro-Tem
Sean P. C. nway
ozad 1
Mike Freeman
CL' Nt-C, ► G�
1I3O11`T
2018-1810
H L0050
JW711
Memorandum
TO: Steve Moreno, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: June 4, 2018
SUBJECT: Amendment 35 Tobacco Use Prevention and
Cessation Education
For the Board's approval is a FY18-19 Tobacco Use Prevention Cessation Education continuation
contract 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 (WCDPHE).
Tobacco use continues to be one of the main causes of death and disability in Colorado and
Weld County. The State Health Department provides tobacco use prevention and cessation
funding to local public health agencies from monies received via Amendment 35, a voter
approved initiative to use a portion of state tobacco excise taxes to fund prevention and
cessation activities.
With the approval of the Board, the WCDPHE will enter into a tobacco use prevention
continuation contract with CDPHE. The funding is for three (3) years. The contract becomes
effective July 1, 2018, and ends June 30, 2021. The budget amount for year -one is $318,903.
Activities will be conducted by current staff; no additional FTE is being requested.
Assistant Weld County Attorney, Bob Choat, has reviewed this contract and determined that its
terms are acceptable.
This contract was approved for placement on the Board's agenda via pass -around dated May 11,
2018
I recommend approval of this continuation contract for tobacco use prevention with CDPHE.
2018-1810
!A1_OO5O.
DEPARTMENT OF PUBLIC FIEALTH AND
ENVIRONMENT
CMS ROUTING NO. 19 FI-ILA 108542
APPROVED TASK ORDER CONTRACT - WAIVER #154
This task order contract is issued pursuant to master contract made on 11/23/2016, with routing number 18 FAA 00051.
STATE:
State of Colorado for the use & benefit of the
Department of Public Health and Environment
Prevention Services Division - Tobacco
4300 Cherry Creek Drive South, A-5
Denver, Colorado 80246
CONTRACT MADE DATE 4/25/2018
CORE ENCUMBRANCE NUMBER.
CT FAAA FHLA 201900000095
TERM
This contract shall be effective upon approval by
the State Controller, or designee, or on 07/01/2018,
whichever is later. The contract shall end on 06/30/2021.
PROCUREMENT METHOD:
Exempt
BID/REP/LIST PRICE AGREEMENT NUMBER:
N/A
LAW SPECIFIED VENDOR STATUTE:
N/A
STATE REPRESENTATIVE:
Natalya Verscheure, MA
Tobacco Program Manager
Prevention Services Division
4300 Cherry Creek Drive South
A-5
Denver, Colorado 80246
CONTRACTOR:
Board of County Commissioners of Weld County
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, Colorado 80631
CONTRACTOR DUNS: 075757955
CONTRACTOR ENTITY TYPE
Political Subdivision Colorado
BILLING STATEMENTS RECEIVED
Monthly
STATUTORY AUTHORITY: C.R.S. 25-3.5-804, et-seq., as
amended
CLASSIFICATION Subrecipient
CONTRACT PRICE NOT TO EXCEED: $318,903.00
FEDERAL FUNDING DOLLARS
STATE FUNDING DOLLARS.
OTHER FUNDING DOLLARS:
$0.00
$318,903.00
$0.00
Specify "Other N/A
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY19: $318,903.00
PRICE STRUCTURE Cost Reimbursement
CONTRACTOR REPRESENTATIVE:
Tanya Geiser
Director of Public Health Admin. Services
1555 North 17th Avenue
Greeley, Colorado 80631
PROJECT DESCRIPTION.
This project serves to build/enhance comprehensive tobacco control programming efforts and explore opportunities to significantly impact the
tobacco usage rates of low socioeconomic status (low-SES) community members; increase access to/uptake of evidence -based tobacco
treatment services: provide education to facilitate/promote adoption of smoke -free policies to eliminate secondhand smoke/vapor
19 FHLA 108542 OC ver 25.4.18
Page 1 of 6
al-Da-it/0(o
EXHIBITS
The following exhibits are hereby incorporated:
Exhibit A -
Exhibit B -
Exhibit C -
Exhibit D -
Exhibit E -
Additional Provisions (and any of its Attachments; e.g., A-1, A-2, etc.)
Statement of Work (and any of its Attachments; e.g., B -1, B-2, etc.)
Budget (and any of its Attachments; e.g., C-1, C-2, etc.)
Option Letter
Grant Funding Change Letter
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made
more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task
Order Contract provide more specificity than these general clauses, the more specific provision shall control.
This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including any
renewals or extensions, may not exceed five (5) years. The parties intend and agree that all work shall be
performed according to the standards, terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(I ), C.R.S., as amended, this Task Order Contract is not valid until it has
been approved by the State Controller, or an authorized delegee thereof. The Contractor is not authorized to,
and shall not; commence performance under this Task Order Contract until this Task Order Contract has been
approved by the State Controller or delegee. The State shall have no financial obligation to the Contractor
whatsoever for any work or services or, any costs or expenses, incurred by the Contractor prior to the effective
date of this Task Order Contract. If the State Controller approves this Task Order Contract on or before its
proposed effective date, then the Contractor shall commence performance under this Task Order Contract on
the proposed effective date. If the State Controller approves this Task Order Contract after its proposed
effective date, then the Contractor shall only commence performance under this Task Order Contract on that
later date. The initial term of this Task Order Contract shall continue through and including the date specified
on page one of this Task Order Contract, unless sooner terminated by the parties pursuant to the terms and
conditions of this Task Order Contract and/or the Master Contract. Contractor's commencement of
performance under this Task Order Contract shall be deemed acceptance of the terms and conditions of this
Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made a
part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task Order
Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated, the terms of
this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event of conflicts or
inconsistencies between the Master Contract and this Task Order Contract (including its exhibits and/or
attachments), or between this Task Order Contract and its exhibits and/or attachments, such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: I ) the
Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its
exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the
Page 2 of 6
19 FF{LA 108542 OC ver 25.4.18
Additional Provisions - Exhibit A, and its attachments if included, to this Task Order Contract; 5) the
Scope/Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner, all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B" and "Exhibit C".
5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend the
term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this Task
Order Contract's Statement of Work through a contract amendment. To be effective, the amendment must be
signed by the State and the Contractor, and be approved by the State Controller or an authorized delegate
thereof. This contract is subject to such modifications as may be required by changes in Federal or State law,
or their implementing regulations. Any such required modification shall automatically be incorporated into and
be part of this Task Order Contract on the effective date of such change as if fully set forth herein.
6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope/Statement of Work - Exhibit
B, establishes or creates standards of performance greater than those set forth in the RFP, then the Contractor
shall also meet those standards of performance under this Task Order Contract.
7. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective Date
is on or after July I, 2009 and the maximum amount payable to Contractor hereunder is $100,000 or higher]
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the provisions of
CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning the monitoring of
vendor performance on state contracts and inclusion of contract performance information in a statewide
contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies and Guidance. Evaluation
of Contractor's performance shall be part of the normal contract administration process and Contractor's
performance will be systematically recorded in the statewide Contract Management System. Areas of review
shall include, but shall not be limited to quality, cost and timeliness. Collection of information relevant to the
performance of Contractor's obligations under this Task Order Contract shall be determined by the specific
requirements of such obligations and shall include factors tailored to match the requirements of the Statement
of Project of this Task Order Contract. Such performance information shall be entered into the statewide
Contract Management System at intervals established in the Statement of Project and a final review and rating
shall be rendered within 30 days of the end of the Task Order Contract term. Contractor shall be notified
following each performance and shall address or correct any identified problem in a timely manner and
maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project, the Executive Director of the Colorado
Department of Personnel and Administration (Executive Director), upon request by the Colorado Department
of Public Health and Environment and showing of good cause, may debar Contractor and
Page 3 of 6
19 FHLA 108542 OC ver 25.4.18
prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result by:
(i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS §24-105-
102(6)), or (ii) under CRS §24-105-I02(6), exercising the debarment protest and appeal rights provided in
CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and reinstatement of
Contractor, by the Executive Director, upon showing of good cause.
8. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and its
agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws, state
laws, Executive Orders and implementing regulations as they currently exist and may hereafter be amended.
Without limitation, these federal laws and regulations include the Federal Funding Accountability and
Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law 110-252, including
without limitation all data reporting requirements required there under. This Act is also referred to as FFATA.
Page 4 of 6
19 FHLA 108542 OC ver 25.4.18
SIGNATURE PAGE
Contract Routing Number: 19 FHLA 108542
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
Each person signing this Contract represents and warrants that he or she is duly authorized to execute this Contract and to bind the party authorizing his or her
signature.
Signature of Authorized Individual
JUN 11 2018
By:
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
Print Name of Authorized Individual
Chair
Print Title of Authorized Individual
Date
PROGRAM APPROVAL
Colorado Department of Public Health and Environment
Si =,t're of Authorized CDPHE Program ;6prover
STATE OF COLORADO
John W. Hickenlooper, Governor
Colorado Department of Public Health and
Environment
Larry Wolk, MD, MSPH, Executive Director and
Chief Medical Officer
By: a ► .� ,, k!*g y�-.r.r
Lisa McGovern
Purchasing and Contracting Section Director, CDPHE
e=-ia-l' I S'
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 CONTR I L R
Rob : Jaro , CPA a ' A, JD
By:
Effective Date:
Page 5 of 6
19 FHLA 108542 OC ver 25 4.18
This page left intentionally blank.
Page 6 of 6
19 FHLA 108542 oC ver 25.4.18
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 04/25/2018 CMS Task Order Routing Number 19 FHLA 108542
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
1. This Task Order Contract contains state funds.
2. To receive compensation under the Task Order Contract, the Contractor shall submit a signed Monthly
CDPHE Reimbursement Invoice Form. This form is accessible from the CDPHE internet website
https://www.colorado.gov/pacific/cdphe/standardized-invoice-form-and-links and is incorporated and made
part of this Contract by reference. CDPHE will provide technical assistance in accessing and completing
the form. The CDPI-IE Reimbursement Invoice Form and Expenditure Details page 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 and Budget
Scan the completed and signed CDPHE Reimbursement Invoice Form into an electronic document. Email
the scanned invoice with the Excel workbook containing the Expenditure Details page to:
Tobacco Program Generalist via email at cdphe stepp pg@state.co.us
Final billings under the Contract must be received by the State within a reasonable time after the expiration
or termination of the Contract; but in any event no later than forty-five (45) calendar days from the
effective expiration or termination date of the Contract.
Unless otherwise provided for in the Contract, "Local Match", if any, shall be included on all invoices as
required by funding source.
The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless
approved in writing by CDPHE.
3. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have fifteen (15) 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 fifteen (15) calendar days of: 1) 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 fifteen (15)
calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within fifteen (15) calendar days, the Contractor shall be in default of its obligations under this
Task Order Contract and the State, at its option, may elect to terminate this Task Order Contract or
the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract.
Page 1 of 3
Contract Kxhibit-,\_.\dditionalProvisions_ I'ask ( )rdcr_17.5.3
EXHIBIT A
4. Health Insurance Portability and Accountability Act (HTPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship under
HIPAA.
5. This award does not include funds for Research and Development.
6. The State, at its discretion, shall have the option to extend the term under this Task Order beyond the Initial
Term for a period or for successive periods, of I year at the same rates and under the same terms specified
in the Task Order. In order to exercise this option, the State shall provide written notice to Contractor in a
form substantially equivalent to Exhibit D. If exercised, the provisions of the Option Letter shall become
part of and be incorporated in the original Task Order. The total duration of this Task Order shall not
exceed 5 years.
7. The State, at its discretion, shall have the option to increase or decrease the statewide quantity of Goods
and/or Services based upon the rates established in this Task Order and increase the maximum amount
payable accordingly. In order to exercise this option, the State shall provide written notice to Contractor in
a form substantially equivalent to Exhibit D. Delivery of Goods and/or performance of Services shall
continue at the same rates and terms as described in this Task Order.
8. The State, at its discretion, may unilaterally increase or decrease the total funds available under this Grant,
the funds available under the Grant during any State fiscal Year or the funds available for any specific line
items described in this Grant. In order to exercise this right, the State shall provide written notice to
Grantee in a form substantially equivalent to Exhibit E. The exercise of this right shall not be valid until it
has been approved by the State Controller or designee.
9. All data collected, used or acquired shall be used solely for the purposes of this Contract. The Contractor
and its subcontractors 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.
10. If Contractor indicates full expenditure of funds under this Contract by March 31st 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. CDPHE will notify the Contractor of the potential
need to decrease the current or upcoming budget. If the Contractor indicates at a later date than March
31st of each grant year an expectation of surplus of funds or inability to fully expend said funds for
unforeseen circumstances that Contractor had not anticipated by March 31st, CDPHE will reallocate
unspent funds without any penalties to the Contractor.
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
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.
11. 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. Any request for modifications to the Budget in excess of twenty-five percent
(25%) of the total budget for direct costs shall be submitted to the State at least 90 days prior to the end of
Page 2 of 3
Contract_1,:xhibit-,A_,AdditionalProvisions_Iask()rder 175.3
EXHIBIT A
the contract period and may require an amendment in accordance with Section 5, Contract Modifications,
of this Task Order Contract.
12. 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.
13. 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).
14. Funds provided under this Contract may not be used to: supplant funding for any existing programs/
models; develop new cessation programs/models; develop curricula for youth or adults not reviewed and
approved by the State; pay for individual cessation aids or nicotine replacement therapy; fund capital
improvements; or fund costs of enforcement of state or local laws and ordinances unless approved by
CDPHE.
15. Contractor affirms that it maintains no affiliations or contractual relationships, direct or indirect, with
tobacco companies, owners, affiliate, subsidiaries, holding companies or companies involved in any way in
the production, processing, distribution, promotion, sales, or use of tobacco.
16. Contractors that provide direct services of benefit to individuals 18 years of age or older shall ensure, as
specified by regulation, they only provide services to individuals lawfully present in Colorado. Contractor
shall maintain documentation demonstrating the individual's establishment of lawful presence, which shall
include documentation of an appropriate identification document and an affidavit as required by section 24-
76.5-103, C.R.S.
17. Publications, presentations, or public events resulting from Amendment 35 Tobacco Grants Program
funding must include the following acknowledgment of grant support and disclaimer:
Funding for this event, projectprogram was provided (in part) by Amendment 35 Tobacco
Education, Prevention and Cessation Grant Program funding. The views expressed do not
necessarily reflect the official policies of nor does the mention of imply endorsement by, the
Colorado Department of Public Health and Environment.
Page 3 of 3
Contract_I .:xhibit-. \_. \dditional1rovisions_ I'ask( )rdcr_17.5.3
EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 19 FHLA 108542
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
I. Entity Name:
Term:
Weld County Department of Public Health and Environment
July 1, 2018 — June 30, 2021
H. Project Description:
This project serves to build and enhance comprehensive tobacco control programming efforts and explore
opportunities to more significantly impact the tobacco usage rates of low socioeconomic status (low-SES)
community members. Weld County Department of Public Health and Environment shall assess community and
organizational needs, opportunities and readiness to identify strategies and interventions to further advance the
State Tobacco Education and Prevention Partnership (STEPP) Strategic Plan goals.
This project serves to work towards increasing access to and uptake of evidence -based tobacco treatment services,
such as but not limited to referrals to the Colorado QuitLine and Not on Tobacco, preventing tobacco use initiation
and encouraging cessation through promotion of tobacco -free social norms.
This project serves to provide education that facilitates and promotes adoption of comprehensive smoke -free
policies to eliminate exposure to secondhand smoke and vapor. Weld County Department of Public Health and
Environment shall utilize evidence -based practices, such as comprehensive media and communications strategies
and community task forces to advance efforts across identified goal area strategies.
III. Definitions:
1. A35: Amendment 35
2. ACA: Affordable Care Act
3. 5As: Ask Advise Assess Assist Arrange
4. AAR: Ask Advise Refer
5. CDC: Centers for Disease Control and Prevention
6. CDPHE: Colorado Department of Public Health and the Environment
7. LPHA: Local Public Health Agency
8. Low-SES: Low socioeconomic Status
9. PhotoVoice: a qualitative method used for community -based participatory research to document and
reflect reality, combining photography with grassroots social action.
10. POC: Point of Contact
I I . STEPP: State Tobacco Education and Prevention Partnership
12. TA: Technical assistance
13. TFCP: Tobacco -focused Community Profile
14. TTA: Training and technical assistance
IV. Work Plan:
Goal #1: Tobacco use prevalence will decline across all populations in Colorado.
Objective #1: No later than the expiration date of this contract, advance the implementation of community -
oriented public health tobacco control, prevention, and education work to maximize effective use of state tax
dollars by adhering to best public health planning practices and evidence -based population -level prevention
practices.
Primary Activity
#1
By December 31, 2018, the Contractor shall complete a tobacco -focused community
profile (TFCP) by conducting a community and organizational needs and readiness
assessment in order to identify the most appropriate opportunities for tobacco policy
change, health systems transformation and improvement, advancing youth -oriented
awareness and understanding of the dangers of tobacco products, community education,
and reductions in exposure to second-hand smoke.
Primary Activity
#2
The Contractor shall, using the information in the TFCP, draft an implementation plan
outlining the strategy(ies)/strategic areas in which the community will focus and the
detailed steps and tasks which the Contractor shall take to address the objectives of this
agreement.
version: Contract Statement of Work - Exhibit B
December 2015
Page I of 7
19 FHLA 108542 Ex B
EXHIBIT B
Primary Activity
#3
The Contractor shall update, at a minimum, annually, an implementation plan in
collaboration with the CDPHE-approved Technical Assistance provider(s) and STEPP
POC.
Primary Activity
#4
The Contractor shall, at a minimum, annually, and in collaboration with TA provider,
create and utilize an evaluation plan to review, update, and implement activities
documented in a project evaluation plan.
Primary Activity
#5
The Contractor shall participate in a minimum of two (2) STEPP approved trainings or
capacity building opportunities, annually.
Objective #2: No later than the expiration date of this contract, engage in tobacco policy change processes
using a CDPHE-provided framework in order to advance community understanding and eventual adoption of
policy changes that can reduce prevalence and initiation of tobacco use.
This advances the program's goals to see that tobacco prevalence and initiation among youth and young adults
(18-24 years old) and, with an emphasis on low SES population will both decrease by fifty percent (50%) in
Colorado.
Primary Activity
#1
The Contractor shall, following the implementation plan and with support from CDPHE
and other technical assistance providers, work to prevent tobacco use initiation and
encourage cessation among youth and young adults through promotion of tobacco -free
social norms, including school -based tobaccofree policies, community mobilization, or a
combination of both, with focus on access to tobacco products strategies.
Objective #3: No later than the expiration date of this contract, engage in tobacco policy change processes
using a CDPHE-provided framework in order to advance community understanding and eventual adoption of
policy changes that can reduce exposure to secondhand smoke.
This advances the program's goals to see that exposure to secondhand smoke and vapor, with an emphasis on
low SES population will both decrease by fifty percent (50%) in Colorado.
Primary Activity
#1
The Contractor shall, following the implementation plan and with support from CDPHE
and other technical assistance providers, work to provide education that facilitates,
promotes or supports the adoption, implementation or enforcement of local community or
place -based smoke/vapor/tobacco-free policies.
Objective #4: No later than the expiration date of this contract, increase access to and uptake of evidence -based
tobacco treatment services through culturally appropriate strategies applied within varied community care
settings.
This work advances the program's goals that the cessation success gap affecting low SES youth and adult
smokers decreases by fifty percent (50%) and tobacco dependence is treated as a chronic condition by all health
systems in Colorado.
Primary Activity
#1
1.a. The Contractor shall, following the implementation plan and with the support from
CDPHE and other technical assistance providers, promote and support the widespread
adoption of tobacco cessation interventions, including environmental approaches, in a
variety of medical and social services settings.
1 .b. The Contractor shall educate and train health care decision makers about the health
and economic burden imposed by tobacco use and the evidence base for clinical
cessation interventions, including the cost-effectiveness and return on investment of
these interventions, and the importance of treating tobacco use as a chronic condition.
Primary Activity
#2
I .a. The Contractor shall, following the implementation plan and with the support from
CDPHE and other technical assistance providers, provide education and technical
assistance to maximize opportunities to screen for tobacco use and link tobacco users
to evidence -based tobacco dependence counseling and medications.
1.b. The Contractor shall work with health systems to support the reduction of barriers to
accessing cessation services by integrating treatment and referral processes into
existing medical and social care settings and promoting availability of low or no cost
cessation benefits, including those offered through the Colorado QuitLine and
Medicaid. Where applicable, the Contractor shall support the adoption of tobacco -free
policies.
version: Contract Statement of Work - Exhibit B
December 2015
Page 2 of7
19 FHLA 108542 Ex B
EXHIBIT B
Objective #5: No later than the expiration date of this contract, support activities that focus on advancing health
equity and eliminating tobacco -related health disparities by intentionally incorporating these activities into the
work of each strategy area across all objectives listed above.
This advances the statewide objective to identify and eliminate tobacco -related disparities among population
groups.
Primary Activity
#1
1.a. The Contractor shall, following the implementation plan and with support from
CDPHE and other technical assistance providers, provide education, as the Contractor
introduces and supports policy solutions and other tobacco control strategies at the
local level, to build awareness around tobacco -related health disparities and the
importance of policies that influence tobacco use.
1.b. The Contractor shall build or maintain a sustainable, strong and broad local coalition
of tobacco control advocates.
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 all updates.
2. The Contractor shall ensure that all work follows best practices using the following as
required resources. This information is incorporated and made part of this document by
reference and are located at the following websites
a. CDC's Best Practices for Comprehensive Tobacco Control Programs -2014
available at the following website:
http://www.cdc.gov/tobacco/stateandcommunity/best j,ractices/pdfs/201.4/compr
ehensive.pdf
b. Best Practices for Comprehensive Tobacco Control Programs at the Local Level
(NACHHO), available at the following website:
https://www.naccho.org/uploads/downloadable-resources/B est-Practi ces-
Tobacco-Programs-Local-Level-2015. pdf
c. US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and
Dependence - 2008 Update, available at the following website:
http://www.ncbi.nlm.nih.gov/books/NBK63952/
3. The Contractor shall comply with and ensure that all work follows the requirements in
the LPHA Core Framework and Foundational Activities. This document is incorporated
and made part of this contract by reference and is available on the following website:
http://www.tobaccofreeco.org
4. The Contractor shall use the following sources and approaches to assess the tobacco
problem as appropriate. This information is incorporated and made part of this contract
by reference and are located at the following websites:
a. The Attitudes and Behaviors Survey (TABS) 2015, or most recent, available on
the following website:
http: //www. ucdenver.edu/academics/colleges/Pub l icHealth/community/CEPEG/
TABS/Pages/TABS.aspx
S. aspx
b. Healthy Kids Colorado Survey available on the following website:
http://www.ucdenver.edu/academics/colleges/Pub licHealth/community/CEPEG/
Youth/Pages/HealthyKidsSurvey.aspx
UnifYouth/Pages/HealthyKidsSurvey.aspx
c. CDPHE Tobacco Retail Scan Link available on the following website:
http://www.tobaccofreeco.org
version: Contract Statement of Work — Exhibit B
December 2015
Page 3 of 7
19 FHLA 108542 Ex B
EXHIBIT B
d. FDA Store Audits available on the following website:
http://www.fda.gov/TobaccoProducts/GuidanceCompl ianceRegulatorylnformati
on/ucm232109.htm
e. Colorado QuitLine information is available on the following website:
https://www.coquitline.org/
f. Colorado QuitLine reports are available on the following website:
http://www.tobaccofreeco.org
g. STEPP Implementation Plan Template is available on the following website:
http://www.tobaccofreeco.org
h. STEPP Tobacco Focused Community Profile guidance is available on the
following website: http://www.tobaccofreeco.org/
i. Focus Group studies approach.
j. Observational studies approach, including PhotoVoice.
k. Key Informant interviews approach.
5. The Contractor shall provide metrics, measures and progress reporting via a reporting
tool through CDPHE's evaluation contractor. These data will be aggregated as part of
the macro -evaluation of the grants program.
6. The Contractor shall use all standardized survey tools available from CDPHE to
conduct the knowledge assessment, follow up assessments with Health Care Agencies,
5As, AAR, and Workflow Assessment. This information is incorporated and made part
of this contract by reference and is available on the following website:
http://www.tobaccofreeco.org
7. The Contractor shall inform the STEPP Tobacco Program point of contact within 15
days if updating the Evaluation Plan.
8. The Contractor shall develop an Evaluation Plan that includes:
a. the participation of the Contractor in evaluation -related TTA as recommended by
CDPHE program staff;
b. coordination with the external evaluation Contractor by providing access to
program information and data as needed by CDPHE's evaluation Contractor;
c. attendance at quarterly meetings (or more often as needed) with CDPHE's
evaluation contractor to provide program updates and to review evaluation
progress, successes and barriers;
d. compliance with data reporting requirements established by CDPHE's evaluation
Contractor.
9. The Contractor shall develop and implement a media plan with guidance from the
CDPHE Tobacco Communications Specialist prior to placement of any media buys or
implementation of any community education plan through media mechanisms.
CDPHE will approve all media plans or placement of media buys a minimum of 15
business days prior to plan implementation or media buys placement.
10. The Contractor shall use existing, customizable media materials. This information is
incorporated and made part of this contract by reference and is located on the CDPHE
website http://cohealthresources.org/. Should these existing materials not meet
Contractor needs, the Contractor shall obtain approval for the development of
additional resources from the CDPHE Tobacco Program POC at a minimum, 15
version: Contract Statement at Work - Exhibit B
December 2015
Page 4 of 7
19 FHLA 108542 Ex B
EXHIBIT B
business days prior to use.
11. The Contractor shall participate annually in a minimum of one (1) consultation meeting
with the CDPHE-approved Technical Assistance Provider(s) to update the Contractor's
implementation plan for each identified and selected A35 strategy in the
implementation plan.
12. The Contractor shall facilitate the development of Tobacco -free Schools Policies that
are consistent with Colorado's Tobacco Free Schools Law (C.R.S. 25.14.103.5) and
the Teen Tobacco Use Prevention Act (C.R.S. 25-14-301). This information is
incorporated and made part of this contract by reference and is available at the
following websites: Tobacco Free Schools Law and
https://www. co lorado. gov/pacific/sites/default/fi les/Possession.pdf
13. The Contractor shall utilize STEPP approved evidence -based tobacco prevention
strategies, including at a minimum Not -On -Tobacco and Second Chance programs and
Technical Assistance for support and assistance on implementing evidence -based
strategies in schools.
14. The Contractor shall prioritize low-SES and other priority populations in any work to
reduce tobacco use in settings such as schools, multi -unit housing, health care systems,
social service settings, municipal settings, and other applicable settings.
15. The Contractor shall, in all efforts to educate the community and policy makers about
tobacco control policies which reduce tobacco use, utilize a youth /adult task force
model of community mobilization. The Contractor shall lead efforts to build a
sustainable, strong and broad local coalition.
16. The Contractor shall inform STEPP, within five (5) business days of passage, of any
tobacco control municipal ordinance, organizational policy issues, or both that are
aligned with the LPHA Core Framework which arise in the Contractor's county and
are not already covered under deliverables in this Statement of Work. The Contractor
shall collaborate with STEPP in determining a local strategy approach in order to
promote environmental change processes to reduce tobacco initiation, use and
exposure to secondhand smoke among the Local Community's most tobacco -
burdened populations.
17. The Contractor shall ensure that food and drinks provided at CDPHE-funded meetings
or events meet nutrition standards consistent with Healthy Meeting and Event
Guidelines. These guidelines are incorporated and made part of this contract by
reference and are available at the following website http://www.tobaccofreeco.org
18. The Contractor shall, unless otherwise stated, submit all deliverables via email to the
STEPP Tobacco Program Generalist at cdphe_stepp_pg@state.co.us.
19. The Contractor shall not begin activities in the implementation plan until approved by
CDPHE.
20. The Contractor shall participate in scheduled STEPP Update calls.
21. The Contractor shall participate in scheduled Learning Community Calls specific to
evidence -based tobacco program interventions in which the Contractor engages.
22. The Contractor shall inform the STEPP POC within 15 business days of the hire of any
new tobacco program staff members and arrange for a time for new employee(s) to be
introduced to the CDPHE STEPP Point of Contact and discuss STEPP roles and
responsibilities.
version, Contract Statement of Work — Exhibit B
December 2015
Page 5of7
19 FHLA 108542 Ex B
EXHIBIT B
23. The Contractor shall ensure that all new tobacco program staff members complete
Foundations of Tobacco Control modules 1-3 within one (1) month of hire and
Modules 4-7 shall be completed within three (3) months of hire based upon LPHA-
selected strategic identified in the TFCP. These modules are incorporated and made
part of this contract by reference and are available at the following website:
https://www.tobaccocontrolco.org/.
24. The Contractor shall ensure that all new tobacco program staff members engaged in
Strategy 1.1 of the FY19-21 LHA Core Framework complete Tobacco Retailer
Education module within six (6) months of hire. This module is incorporated and made
part of this contract by reference and is available at the following website:
http://www.tobaccofreeco.org
25. The Contractor shall ensure that all new tobacco staff members participate within three
(3) months of hire in the STEPP New Employee Orientation training. This training is
incorporated and made part of this contract by reference and is available at the
following website: http://www.tobaccofreeco.org
26. The Contractor shall ensure that all new tobacco staff members participate within three
(3) months of hire in Public Health 101 training. This training is incorporated and
made part of this contract by reference and is available at the following website:
http://www.tobaccofreeco.org
27. The Contractor shall complete the final project report as a non -reimbursable deliverable.
28. The Contractor shall obtain from its subcontractors and maintain, at a minimum, a
Memorandum of Understanding or other binding contractual agreement and provide a
copy, upon request, to CDPHE within 15 calendar days of the execution date of the
contract.
29. If purchasing gift cards, the Contractor shall provide to CDPHE upon request written
procedures related to gift card purchasing and handling. At a minimum, the
procedures shall include the following:
a. How the gift card inventory is tracked and maintained;
b. Gift card storage and safeguards against theft
c. The primary person responsible for securing and distribution of gift cards
d. A gift card distribution log that records each gift card number, dollar amount, and
theprinted name and signature of each gift card recipient.
Expected Results
of Activity(s)
1. Demonstrated progress of primary activities based upon implementation plan.
2. Tobacco prevalence and initiation among youth and young adults (18-24 years old)
with an emphasis on low SES population will both decrease in Colorado.
3. Exposure to secondhand smoke and vapor, with an emphasis on low SES population
will decrease in Colorado.
4. Cessation success gap affecting low SES youth and adult smokers decreases.
5. Tobacco dependence is treated as a chronic condition by all health systems in
Colorado.
Measurement of
Expected Results
1. Any new community policy leading to the progress of overall programmatic goals
identified in objectives above.
2. Creation of the Tobacco -Focused Community Profile.
3. Development of implementation plan to identify strategies in which the Contractor will
engage.
4. Timely completion and submission of quarterly and annual progress reports.
5. Number of place -based or school -based tobacco -free policies.
6. Evidence of engagement of the health neighborhood through the promotion of evidence
based tobacco control practices.
7. Decrease in tobacco -use prevalence, especially among low-SES and priority
populations.
version: Contract Statement of Work — Exhibit B
December 2015
Page 6 of 7
19 FHLA 108542 Ex B
EXHIBIT B
8. Increase in quit attempts especially among low-SES and priority populations.
9. Engagement and maintenance of a community -led task force.
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Completion Date
Deliverables
1. The Contractor shall submit quarterly and annual
CDPHE-approved progress report.
No later than 10/15, 1/15,
4/15 and 7/15, annually.
2. The Contractor shall submit a Tobacco Focused
Community Profile.
No later than 12/31/2018.
3. The Contractor shall submit an implementation plan
for each objective and strategy identified in the TFCP
and this Statement of Work.
No later than 4/30/2019 and
no later than 10/1 annually,
thereafter.
4. The Contractor shall submit a media plan to STEPP
POC for approval.
At minimum, 15 business
days prior to the placement
of any media, as applicable,
throughout the contract term.
5. The Contractor shall submit an updated evaluation
plan.
No later than 4/30/2019,
12/31/2019, and 12/31/2020.
6. The Contractor shall submit as a non -reimbursable
deliverable a final comprehensive report for the three-
year contract term.
No later than 7/15/2021.
V. Monitoring:
CDPI-IE monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the STEPP Tobacco Program Generalist. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include 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 time line, the Contractor must email a request to the STEPP
Tobacco Program Generalist 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.
version: Contract Statement of Work — Exhibit B
December 2015
Page 7 of 7
19 FHLA 108542 Ex B
Exhibit C Budget
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 108542
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact Name, Title,
Phone and Email
Rachel Freeman, Program Supervisor,
970.400.2385, rfreeman@weldgov.com
Budget Period
July 1, 2018 - June 30, 2019
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Director Admin Services,
970.400.2122, tgeiser@weldgov com
Project Name
Weld County Tobacco Control Program
CT FAAA FHLA 201900000095
Contract (CT or PO) Number
Expenditure Categories
Personal Services I
Salaried Employees
Position Title
Description of Work
Gross or Annual
Salary
Fringe
Percent of
Time on
Project
Total Amount
Requested from
CDPHE
Health Education Specialist II
Coordinate and oversee activities related to the tobacco
focused community profile; including working with
municipal government, youth, employers, collaboration
with community based organizations. Will provide staff
supervision of 2.0 FTE tobacco staff.
570,047 31
527,269.42
70°n
568,121.71
Health Education Specialist II
Coordinate activities related to the tobacco focused
community profile; including working with municipal
government, youth, employers, collaboration with
community based organizations.
S58,788.34
$22,886.30
100%
581.674 64
Health Educator I
Coordinate activities related to the tobacco focused
community profile; including working with municipal
government, youth, employers, collaboration with
community based organizations.
S56,934 11
$22,164.45
100%
$79,098.56
Bilingual Health Education
Specialist
Bilingual health educator will conduct outreach to
Spanish speaking populations.
$68,972.34
$26,850.93
1%
$958.23
Division Director
Provide overall program administration, budget
management, and staff supervision of 1.0 FTE tobacco
staff.
$106,402.69
$41,422.57
1
51,478 25
Data and Evaluation Specialist
Provide evaluation assistance on all workplan activities
and evaluation coordination with the Weld County
Community Health Improvement Plan (CHIP).
$97,350.34
i
$37,898.49
5%
$6,762.44
Fringe
Fringe benefits are 38.93%. Components included are: 1.45% SSI, .09% unemployment, .08%
worker's compensation, 13.7% PERA, .33% life insurance, 12.13% health insurance,4.6%
vacation, 4.23% for holidays and 2.3% for sick leave.
Personal Services
Position Title
Description of Work
Hourly Wage
Hourly Fringe
Total # of
Hours on
Project
Total Amount
Requested from
CDPHE
Office Technician III
Provide desktop publishing, design, and other duties as
required in fulfilling activities.
518 11
51 1 /
/5
51 918.28
Total Personal Services (including fringe benefits)
$240,012.11
Supplies & Operating Expenses
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Printing/Copies
Printing and photocopying @ (black and white 0.02 cents per copy x
20,000 = $400; color @ 0.06 cents per copy x 3000 = $180).
$580.00
1
$580.00
Page 1 of 3
January 2018
Exhibit C Budget
PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 108542
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact Name, Title,
Phone and Email
Rachel Freeman, Program Supervisor,
970.400.2385, rfreeman@weidgovcom
Budget Period
July 1, 2018 June 30, 2019
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Director Admin Services,
970.400.2122, tgeiser@weldgov.com
Project Name
Weld County Tobacco Control Program
.
CT FAAA FHLA 201900000095
Contract (CT or PO) Number
General Office Supplies
Paper, pens, lamination supplies, and general office supplies.
$20.00
12
$240.00
ToP Facilitation Methods
Training Registration
Training registration cost for 2 staff to attend ToP Facilitation Methods
training in the Denver Metro Area. At the training, staff will learn 3 proven
ways to activate group participation. Fee for 2 days of training is $700.
$700.00
2
$1,400.00
Tobacco Treatment Specialist
Training Registration
Training registration cost for 2 staff to attend the Rocky Mountain Tobacco
Treatment Specialist training in the Denver Metro Area. Fee for 4 days of
p Y
training is $1200.
51,200.00
2
$2,400.00
Food - Focus Groups
Food and beverages for focus group meetings related to the community
profile work. Food is needed because focus groups may be conducted close
to meal times so in order to achieve adequate group participation, meals
must be served. ($8 per person x 10 people per focus group x 9 groups =
$720). Additionally, $45 for flatware and cups ($5 per focus group x 9
groups = $45)
]85.00
9
5765.00
Gift Cards - Focus Groups
Gift Card incentives to assist in the recruitment of focus group participants.
Focus groups will be conducted to assist with the Tobacco Community
Profile process. (80 at $15.00 each = $1200). The total cost for the time
and expertise of an individual with the experience and knowledge needed
for the Tobacco Community Profile is less than the cost of the gift cards
STEPP approves the use of gift cards for the purpose.
$15.00
30
$1,200.00
Community Meeting Food
Food and beverages for youth and community meetings related to
objectives. Food is needed for community meetings in order to incentivize
meeting participation. Additionally, meetings may be held close to meal
times (i.e. over the lunch hour) so in order to achieve adequate meeting
participation, meals must be served. ($9 per person x 10 people per
meeting per month x 12 months = $1080). Additionally, $60 for flatware
and cups ($5 per meeting per month x 12 months = $60). Community
meetings differ from focus groups in that the community meeting has a
broader reach of participants in order to gain a more global perspective.
$95.00
12
$1,140.00
Incentives - Tobacco
Treatment Meetings
Incentive items to use as rewards for individuals who successfully complete
tobacco treatment meetings. Items may include stress balls, stickers, and
pens. ($5 per person x 150 people = $750)
SS.00
30
$750.00
Total Supplies & Operating_ $8,475.00
Travel
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Mileage
Project -related mileage for tobacco staff for within Weld County and
required travel to CDPHE state meetings and other trainings.
$0.53
5440.77
$2,856.40
Page 2 of 3
January 2018
Exhibit C Budget
PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 108542
Contractor Name
Weld County Department of Public Health and
Environment
Program Contact Name, Title,
Phone and Email
Rachel Freeman, Program Supervisor,
970.400.2385, rfreeman@weldgov corn
Budget Period
July 1, 2018 - June 30, 2019
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Director Admin Services,
970.400.2122, tgeiser@weldgov.com
Project Name
Weld County Tobacco Control Program
CT FAAA FHLA 201900000095
Contract (CT or PO) Number
Training and Conference
Lodging
Hotel cost for program staff to attend the STEPP conference ($175/night x
2 people x 1 day = $350) Hotel cost for program staff to attend ToP
Facilitation Methods Training in Denver Metro area ($175/night x 1 person
x 1 day = $175) Hotel cost for program staff to attend the Rocky Mountain
Tobacco Treatment Specialist Training in Denver Metro Area ($175/night x
2 person x 3 days = $1050) Hotel rates were determined based on the
quarterly average daily rate of hotels in Denver in 2017 (gathered from
Statista). Total hotel stay = $1,575
S 175.00
9
$1,375.00
Training and Conference Meals
Following county travel policy, the actual cost of meals are reimbursed.
Using historical data, an estimate of $40/day is used for budgeting
purposes. Off -site meal cost for program staff to attend the STEPP
Conference ($40/day x 3 people x 1 days = $120) Meal cost for program
staff to attend the ToP Facilitation Methods Training ($40/day x 2 people x
2 days = $160) Meal cost for program staff to attend the Tobacco
Treatment Specialist Training ($40/day x 2 person x 4 days = $320) Total
training meals = $600.
$40.00
15
5600.00
Total Travel
$5,031.40
Contractual
Subcontractor Name
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
ME dla
Purchase of paid media using outdoor advertising (i.e. billboards, bus
benches) and digital and social media platforms @ ($850 x 2 media
platforms (outdoor and digital) = $1700). Tobacco prevention ads will be
utilized from CDPHE when available.
$850.00
2
$1,700.00
Tobacco Treatment Specialist
A contractor (TBD) will be hired to provide tobacco treatment services
throughout Weld County. Hiring a contractor is necessary as Weld County
has identified a need for expanded cessation resources within the medical
neighborhood. Contractor will provide in -person, one-on-one and group
tobacco cessation counseling services to assist Weld residents who want to
quit tobacco. (1 person x 18/hr x 600 hours = $10,800)
$18.00
600
$10,800.00
Total Contractual
$12,500.00
SUB -TOTAL OF DIRECT COSTS
$266,018.52
Indirect
Item
Description of Item
Total Amount
Requested from
CDPHE
Federally -Negotiated Indirect
Cost Rate
CDPHE-Negotiated Indirect
Cost Rate
CDPHE negotiated indirect rate for 2018 = 19.88% of total direct costs; would like to use our 2019 indirect rate
for direct costs in 2019 once that rate has been determined.
$52,884.48
De minimis Indirect Cost Rate
Total Indirect
$52,884.48
$318,903.001
TOTAL
Page 3 of 3
January 2018
EXHIBIT D
OPTION LETTER
Date:
State
Fiscal
Year:
Option
Letter
No.
Original
Contract CMS#
Option
Letter
CMS
Routing #
CORE
Encumbrance
#
DELETE all BLUE text, CUSTOMIZE Red text and CHANGE Red text to Black after customization.
1) OPTIONS: Choose all applicable options listed below
a. Option to extend for a renewal or additional term
b. Option to change amount of goods
c. Option to change amount of services
d. Option to change contract rates
e. Option to initiate next phase of contract
2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options a: In accordance with Section(s) enter section the Original Contract referenced above between the
State of Colorado, Colorado Department of Public Health and Environment, and enter Contractor's name the State hereby
exercises its option for an additional term beginning insert start date and ending on insert end date at the rates stated in the
Original Contract, as amended.
b. For use with Option b and c. In accordance with Section(s) enter Section of the Original Contract routing number
referenced above, between the State of Colorado, Colorado Department of Public Health and Environment, and enter
Contractor's name the State hereby exercises its option to Increase/Decrease the quantity of Goods/Services or both at the
same cost/price as specified in enter Exhibit/Attachment name.
c. For use with Option d. In accordance with Section(s) enter section of the Original Contract routing number referenced
above, the State hereby exercise its option to modify the Contract rates specified in Exhibit/Section Number. The Contract
rates attached to this Option letter in Exhibit/Attachment Name replace the rates in the original Contract as of the Option
Effective Date of this Option Letter.
d. For use with Option e: In accordance with Section(s) enter section of the Original Contract routing number referenced
above, the State hereby exercise its option to initiate Phase indicate which Phase: 2, 3, 4 etc. which shall begin on insert start
date and ending on insert end date at the cost/price specified in Section enter section the Original Contract referenced above.
e. For use with Options a, b, c that modify the contract value: The amount of the current Fiscal Year contract value is
increased/decreased by $ enter amount of change to a new contract value of insert new $ amount as consideration for
services/goods ordered under the contract for the current fiscal year Indicate Fiscal Year. The first sentence in Section enter
section of the original contract is hereby modified accordingly. The amended total contract financial obligation including all
previous amendments, option letters, etc. is insert new $ amount.
3) Effective Date: The effective date of this Option Letter is upon approval of the State Controller if exact date is required
complete the following: enter date, and include the following: whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
By: Lisa McGovern, Purchasing & Contracts Section Director
Date:
By:
PROGRAM APPROVAL:
Date:
.ALL. CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §2-t-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.
(ontract_Samplc ( )ptionLetter_ 17 9 1
EXHIBIT D
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By
Date
J
Contract_Sample OptionLetter_ 17 9 18
Exhibit E
GRANT FUNDING CrIANGE LETTER
StateChange
CMS
Routing
TO: <Insert Grantee's name>
In accordance with Section of the Original Contract routing number , [insert the following, language here if
previous . renewal(s) . been • as amendedby[includeall previous amendment(s), renewal(s) and
their routing •'following words here if previous amendment(s),been processed] between - / •
of Colorado, Department of Public Health and Environment and <insert contractor name> beginning
start date ot original/ • ending on . 1 . ,undersigned commits
the ffillowing funds to the Grant:
• amount of (federal, state, other) grant funds available and • 1 in Section of<insertprevious
contract modification number and routing number is increased or decreased by S
amountf • • to new • I
l
funds for period <date to date> of $<insert new period cumulative1 f• - following I •
Section is hereby modified accordingly. The revised Budget is incorporated herein by this reterence and
identified as Revised Exhibitbudget att. / / budget inclu1 1
Compdete the tablebelow; insert/delete 1ws as needed
- table below original budget and I modifications to the total since " effective date of Original
SUMMARY
,
CHANGES
DocumentI.
CMS
•
(federal,
Funding
Source
state. other)
PeriodDollar
Period
Total
Original
! •
►
,
1
1
1
1
1Contract
Cumulative
Grand
Total
1
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The • • date of hereof upon approval of " State Controller or <insertprojected 1 .
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, Governor
Department of Public Health and Environment
Lisa Maim, ern
PROGRAM
• , • APPROVAL
Colorado Department of Public Health and
Environment
INSERT -Name Authorized Individual
Purchasing and Contracting Section Director, CDP111: INSERT -Official Title of Authorized Individual
Date
Date
In accordance♦Contract.lid until signed. 1 authorized
STATE CONTROLLER
RobertJaros,CPA, MBA, /
Effective Date:
of
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