HomeMy WebLinkAbout20170512RESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR CONTROL AND PREVENTION OF
HEALTHCARE -ASSOCIATED INFECTIONS (CLIP INITIATIVE) 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 the Control and
Prevention of Healthcare -Associated Infections (CLIP Initiative) 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 March 1, 2017, and ending July 31, 2017, 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 the Control and Prevention of Healthcare -
Associated Infections (CLIP Initiative) 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.
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3i / I 1
2017-0512
HL0048
TASK ORDER CONTRACT FOR CONTROL AND PREVENTION OF HEALTHCARE -
ASSOCIATED INFECTIONS (CLIP INITIATIVE)
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 15th day of February, A.D., 2017.
BOARD OF COUNTY COMMISSIONERS
WELD COUNT YA COLORADO
ATTESTWat40) Ja;�
Weld County Clerk to the Board
BY
eputy Clerk to the Board
Cfic
APPROAPPRO
oGnty Attorney
Date of signature: 31Co(ll
e9koeue-ter
Steve Moreno, Pro-Tem
Sean P. Conway
Freeman
rbara Kirkme er,
2017-0512
HL0048
/p /e53
Memorandum
TO: Julie A. Cozad, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: February 10, 2017
SUBJECT: Task Order Contract with CDPHE for the
Control and Prevention of Healthcare -
Associated Infections (CLIP Initiative)
For the Board's approval is a Task Order Contract between Colorado Department of Public Health
and Environment ("CDPHE") and the Board of County Commissioners for the County of Weld,
State of Colorado, on behalf of the Weld County Department of Public Health and Environment
("WCDPHE") for the increase of capacity in infection control and prevention (ICP) of healthcare -
associated infections (HAI).
This project serves to build the ICP capacity at WCDPHE in order to reduce the number of HAI
occurring within Weld County. With the increasing number of Weld residents aged 65 or over,
skilled nursing facilities (SNFs) play an important role in our community. SNF services have
expanded to include not only long-term nursing care, but also short-term rehabilitation. There
is often a fluid movement of patients between SNFs and hospitals making ICP critical in both
settings. Weld County has several SNFs that are rated below average in health inspections with
deficiencies in ICP. WCDPHE has partnered with CDPHE to build the ICP capacity in Weld County
through the training and certification of WCDPHE staff; as well as through the development of
partnerships with SNFs to improve their ICP programs and to foster collaborations with the goal
of reducing HAI. The term of this contract is from March 1, 2017, through July 31, 2017, for an
amount not to exceed $12,075, all of which is Federal funding.
This task order contract was approved for placement on the Board's agenda via pass -around
dated February 2, 2017. I recommend approval of this task order for the Control and Prevention
of Healthcare -Associated Infections (CLIP Initiative) contract with CDPHE.
2017-0512
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 17 FHHA 96952
APPROVED TASK ORDER CONTRACT — WAIVER #154
This task order contract is issued pursuant to master contract made on 01/17/2012, with routing number 13 FAA 00051.
STATE:
State of Colorado for the use & benefit of the
Department of Public Health and Environment
Disease Control and Environmental Epidemiology
Communicable Disease-HAI
4300 Cherry Creek Drive South
Denver, Colorado 80246
CONTRACT MADE DATE: 1/24/2017
CORE ENCUMBRANCE NUMBER:
201700003293
TERM:
This contract shall be effective upon approval by
the State Controller, or designee, or on 03/01/2017,
whichever is later. The contract shall end on 07/31/2017.
PROCUREMENT METHOD:
Exempt
BID/RFP/LIST PRICE AGREEMENT NUMBER;
Not Applicable
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE:
Wendy Bamburg
Department of Public Health and Environment
Communicable Disease
4300 Cherry Creek Drive South
DCEED-A3
Denver, CO 80246
CONTRACTOR:
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
915 10th Street
Greeley, CO 80632-0758
for the use and benefit of the
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
CONTRACTOR DUNS: 075757955
CONTRACTOR ENTITY TYPE:
Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
Colorado
STATUTORY AUTHORITY: Not Applicable
CLASSIFICATION_ Subrecipient
CONTRACT PRICE NOT TO EXCEED: $12,075.00
FEDERAL FUNDING DOLLARS: $12,075.00
STATE FUNDING DOLLARS:
OTHER FUNDING DOLLARS:
Specify "Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY 17: $9,660.00
FY18: $2,415.00
PRICE STRUCTURE: Cost Reimbursement
CONTRACTOR REPRESENTATIVE:
Tanya Geiser
Weld County Dept. of Public Health & Env
1555 North 17th Avenue
Greeley, CO 80631
PROJECT DESCRIPTION:
This project serves to increase capacity in infection control and prevention of healthcare -associated infections in Weld County Colorado..
OC 17 96952 docx
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06/7— 0o5,()
EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A -
Exhibit B -
Exhibit C -
Exhibit D -
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.)
Grant Fund 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.
1. 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(1), 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
OC 17 96952.docx Page 2 of 6
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
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 1, 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
OC 17 96952docx
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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 §24-105-102(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.
OC 17 96952.docx Page 4 of 6
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
for the use and benefit of the
Weld County Department of Public Health and
Environment
Legal Name of Contracting Entity
Julie A. Cozad
Print Name of Authorized Officer
Signature of Authorizydd q)fl'icer
FEB 15 7017
Date
Chair
Print Title of Authorized Officer
By:
By:
STATE OF COLORADO:
JOHN W. HICKENLOOPER, GOVERNOR
arn
For Executive Director
Department of Public Health and Environment
Department Program Approval:
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until
signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until
such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor
for such performance or for any goods and/or services provided hereunder.
By:
Date
OC 17 96952.docx
STATE CONTROLLER:
Rgbert Jaros, CPJMBA, JD
410,
ola 01
Page 5 of 6
020/ 7,405/
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EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 01/24/2017 CMS Task Order Routing Number 17 FHHA 96952
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 federal funds (see Catalog of Federal Domestic Assistance (CFDA)
number 9.3230).
2. The United States Department of Health and Human Services ("USHHS"), through the Centers for Disease
Control and Prevention ("CDC") has awarded as of 08/01/2016 anticipated federal funds of $4,467,929.00
under Notice of Cooperative Agreement Award, hereinafter "NCAA", number 5NUS0CKI000408-03-00,
to perform the following — epidemiology and laboratory capacity.
If the underlying Award authorizes the State to pay all allowable and allocable expenses of a Contractor as
of the Effective Date of that Award, then the State shall reimburse the Contractor for any allowable and
allocable expenses of the Contractor that have been incurred by the Contractor since the proposed Effective
Date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable
and allocable expenses of a Contractor as of the Effective Date of that Award, then the State shall only
reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by
the Contractor on or after the Effective Date of this Task Order Contract, with such effective date being the
later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the
State Controller or delegee.
3. To receive compensation under the 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 CDPHE 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. The Contractor shall submit
the invoice using one of the following two methods.
Mail to:
Lynda Saignaphone
DCEED-Communicable Disease
Colorado Department of Public Health and Environment
DCEED-A3-DSI
4300 Cherry Creek Drive South
Denver, Colorado 80246
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: Lynda
Saignaphone, Lynda.Saignaphone@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.
Page 1 of 2
Contract_l 4:xhibit-A_ldditionalProvigions_'I'askOrdcr040715
EXHIBIT A
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 federal funds to satisfy federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
4. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty (30) calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable, or is otherwise deficient, then the State shall notify
the Contractor of the failure or deficiencies, in writing, within thirty (30) calendar days of: I ) the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable, the Contractor shall have a reasonable period of time, not to exceed thirty (30)
calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within thirty (30) 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.
5. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship under
HIPAA.
6. This award does not include funds for Research and Development.
Page 2 of 2
Contract_I .xhibit;1_AdditionalProvisions_1'askOrdcr 040715
EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 17 FHHA 96952
These provisions are to be read and interpreted in conjunction with the provisions of the contract
specified above.
I. Entity Name: Weld County Department of Public Health and Environment
H. Project Description:
This project serves to increase capacity in infection control and prevention of healthcare -associated
infections in Weld County Colorado.
III. Definitions:
1. APIC - Association for Professionals in Infection Control and Epidemiology
2. CPDHE - Colorado Department of Public Health and Environment
3. EPI - Epidemiology
4. HAI - Healthcare -associated infections
5. CDC - The Centers for Disease Control and Prevention
6. HICPAC - Healthcare Infection Control Practices Advisory Committee
IV. Work Plan:
Goal #1: Improve infection control in healthcare facilities within the Contractor's jurisdiction.
Objective #1: No later than the expiration date of the Contract, the Contractor shall provide staff selected by the
Contractor at the Contractor's agency with improved knowledge of healthcare -associated infections, antimicrobial
resistance, and infection control, and provide outreach to healthcare facilities within the Contractor's jurisdiction on
the topics of healthcare -associated infections, antimicrobial resistance, and infection control.
Primary Activity #1
The Contractor shall attend and participate in CDPHE-led calls and webinar trainings,
and infection prevention trainings and conferences.
Sub -Activities #1
1. The Contractor shall attend webinar trainings on infection control, antimicrobial
resistance, and healthcare -associated infection outbreaks offered by CDPHE.
CDPHE will notify the Contractor in advance of the trainings and will record and
monitor attendance.
2. The Contractor shall attend conference calls coordinated by CDPHE. CDPHE will
notify the Contractor in advance of the trainings and will record and monitor
attendance.
3. The Contractor shall select and ensure one (1) staff member attends the APIC EPI
Intensive infection control training course. Information about this course can be
found online on the following website http://www.apic.org/Education-and-
Events/EPI-Intensive. This information is incorporated and made part of this
contract by reference.
4. The Contractor shall support one (1) staff member to obtain certification in
infection control from APIC.
Primary Activity #2
The Contractor shall assist with the investigation of outbreaks of healthcare -associated
infections and/or antimicrobial resistant organisms within the Contractor's jurisdiction.
version: Contract Statement of Work — Exhibit B
December 2015
to Exhibit B SOW.doc
Page 1 of 3
EXHIBIT B
Sub -Activities #2
1. The Contractor shall assist CDPHE with investigations of outbreaks of healthcare -
associated infections and/or antimicrobial resistant organisms, including
participation in conference calls and site visits as directed by the CDPHE
Healthcare -Associated Infections Program Manager.
2. The Contractor shall accompany CDPHE disease control staff during infection
prevention assessments of facilities. The CDPHE Healthcare Associated
Infections Administrator will notify the Contractor via phone call or email in
advance of the assessment.
Primary Activity #3
The Contractor shall use healthcare -associated infection and antimicrobial resistant
organism data, as well as infection prevention assessments, to inform infection
prevention efforts.
Sub -Activities #3
1. The Contractor shall identify healthcare -associated infections and antimicrobial
resistant pathogen data needed from CDPHE and shall request data from CDPHE.
The Contractor shall contact the CDPHE Healthcare Associated Infections
Administrator via email for this request. If data from specific healthcare facilities
within the Contractor's jurisdiction is needed and CDPHE is unable to provide this
data, the Contractor shall work with the healthcare facility directly to obtain this
data.
2. The Contractor shall request and review infection prevention assessments
performed by CDPHE within the Contractor's jurisdiction during the contract
period. The Contractor shall contact the CDPHE Healthcare Associated Infections
Administrator via email for this request.
Primary Activity #4
The Contractor shall provide trainings on infection control, healthcare -associated
infections, and antimicrobial resistance to healthcare facilities in the Contractor's
jurisdiction.
Sub -Activities #4
1. The Contractor shall hold quarterly meetings with long-term care facilities with the
purpose of fostering relationships and discussing topics related to healthcare -
associated infections, antimicrobial resistance, and infection control.
2. The Contractor shall develop and deliver at least one (I) training targeting at least
three (3) long-term care facilities on healthcare -associated infections,
antimicrobial resistance, and/or infection control.
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 utilize the following when providing infection prevention
guidance or education to healthcare facilities:
a. CDC Carbapenem-Resistant Enterobacteriaceae Toolkit located on the
following website https://www.cdc.gov/hai/organisms/cre/cre-toolkit/
and is incorporated and made part of this contract by reference.
b. HICPAC Guideline for Sterilization and Disinfection in Healthcare
Settings, HICPAC Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings, HICPAC
Guidelines for Environmental Infection Control in Healthcare
Facilities, and HICPAC Guidelines for Hand Hygiene in Healthcare
Settings. All HICPAC guidance documents can be found on the
following website https://www.cdc.gov/hicpac/ and are incorporated
and made part of this contract by reference.
version: Contract Statement of Work — Exhibit B
December 2015
to Exhibit B SOW.doc
Page 2 of 3
EXHIBIT B
1. Provide guidance to healthcare facilities regarding healthcare -associated
infections, antimicrobial resistance, and infection control.
Expected Results of
Activity(s)
Measurement of
Expected Results
1. Webinar Training attendance
2. Conference call attendance
3. Data contained in attendance sheets and agendas from each meeting or training
led by the Contractor
f #• P
fi'',P,t/ P/P _I ✓!f fll' /,1 %xsrw _, i'.� /� .!fJ. "r' j .`�! i /j 'r' / '// %/!.'f/'J 1, ' ' + ,f
,fl il�� %'�/ � .�/f �.: `'%✓�/�� � � /.f'�i� � �.J ���� .��� � � �' l',� � •✓ F`'f` /'`f//'%.%/ri r,:1/i `i� :lJ.; f' ,.,�r,"i/ r Y "ilr ,f:J �t r
�/r /�, /, �,�i: ,,�, f��ls>,l,y rf /ir,��.i! �., r���� / �'� /lf: �� .�' /!�,'!,''�f e�' / �%l!f,�%if�//1,��r �✓� %i,./.;/I
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Completion Date
Deliverables
1. The Contractor shall provide a copy of the registration for the
No later than
APIC EPI Intensive infection control training course to the
thirty (30)
CDPHE HAI Administrator via email.
calendar days
after the training
course
2. The Contractor shall provide a copy of documentation of
No later than July
registration for the test for certification in infection control to
the CDPHE HAI Administrator via email.
31, 2017
3. The Contractor shall provide a copy of attendance sheets and
No later than
agendas from each meeting or training led by the Contractor
thirty (30)
to the CDPHE HAI Administrator via email.
calendar days
after the meeting
or training
4. The Contractor shall provide a copy of Contractor-
No later than July
developed training materials to the CDPHE HAI
31, 2017
Administrator via email.
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted
throughout the contract period by the Healthcare -Associated Infections Administrator. Methods used
will include a review of documentation determined by CDPHE to be reflective of performance to
include progress reports and other fiscal and programmatic documentation as applicable. The
Contractor's performance will be evaluated at set intervals and communicated to the contractor. A Final
Contractor Performance Evaluation will be conducted at the end of the life of the contract.
VI. Resolution of Non -Compliance:
The Contractor will be notified in writing within 14 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 Healthcare -Associated Infections Administrator 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
to Exhibit B SOW.doc
Page 3 of 3
Exhibit C Budget
Agency Name
Budget Period
COLORADO
Department of Public
Health & Environment
BUDGET WITH JUSTIFICATION FORM
OC 17 FHHA 96952
Weld County Dept of Public Health & Environment
January 1, 2017 - July 31, 2017
Program Contact Name, Title,
Phone and Email
Carrie Hanley, PhD, MPH
Community Health Services Mgr
(970) 400-2316
chanley@weldgov.com
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser Director,
Administrative Services
(970) 400-2122
tgeiser@co.weld.co.us
Expenditure Categories
liall__..
_ _ IIIIP Personal Services
Salaried Employees
Position Title
Description of Work
Budget item
supports SOW
(Yes/No)
Gross or
Annual Salary
Fringe
Percent of Time
on Project
Total Amount
Requested from
CDPHE
Community Health Services
Manager
Office Technician
Infection control expert at the WCDPHE will provide
training to skilled nursing facilities, facilitate
meetings, and build collaboration with facilities in
the county. This salary is prorated for the relevant
grant period of 7 months; not 12 months.
Yes
$50,431.77
$19,633.09
6.0%
$4,203.89
The office technician will assist with ordering
supplies, scheduling trainings and meetings, and
coordinating with facilities. This salary is prorated
for the relevant grant period of 7 months; not 12
months.
Yes
$22,677.94
$8,828.52
2.0%
$630.13
Total Personal Services
(including fringe benefits)
$4,834.02
Supplies & Operating Expenses
item
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Miscellaneous Office
Supplies & Printing Costs
Miscellaneous office supplies and printing costs including allocated costs
for in-house printing and office supplies (estimated at $10/month for 7
months)
Yes
$10.00
7
$70.00
Educational Infection
Control Pamphlets
Educational pamphlets to be available in the skilled nursing facilities to
promote infection control and prevention
Yes
$1.50
200
$300.00
Educational Infection
Control Posters
Educational posters to be hung in the skilled nursing facilities to promote
infection control and prevention
Yes
$15.00
20
5300.00
Light Refreshments for
Meetings with Nursing
Homes
Light refreshments will be provided to nursing facilites staff during
meetings and trainings
Yes
$20.00
7
$140.00
Infection Control and
Prevention Training
APIC Epi-Intensive Course Registration for 1 person
Yes
$975.00
1
$975.00
APIC Study Guide for CBIC
Examination
APIC study guide for preparation for the CBIC exam for 1
P p person
Yes
$120.00
1
$120.00
APIC Text of Infection
Control & Epidemiology
APIC Text of Infection Control & Epidemiology is the recommended text
for infection control certification This text will assist in
preparation.
learning infection control and prevention.
Yes
5475.00
1
$475.00
APIC Membership
Association for Professionals in Infection Control and Epidemiology
(APIC) Membership Fee for 1 person
Yes
$200.00
1
$200.00
CBIC Exam
Certification Board of Infection Control & Epidemiology examination for
certification in infection control for 1 person
Yes
$350.00
1
$350.00
Total Supplies
& Operating Expenses
$2,930.00
- Travel
Exhibit C Budget
Agency Name
II
Budget Period
COLORADO
Department of Public
Health & Environment
BUDGET WITH JUSTIFICATION FORM
OC 17 FHHA 96952
Weld County Dept of Public Health & Environment
January 1, 2017 July 31, 2017
Program Contact Name, Title,
Phone and Email
Carrie Hanley, PhD, MPH
Community Health Services Mgr
(970) 400-2316
chanley@weldgov.com
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser Director,
Administrative Services
(970) 400-2122
tgeiser@co.weld.co.us
Item
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Visit Outreach Mileage
Travel to skilled nursing facilities for outreach and training
Yes
$0.52
300
$156.00
Taxi
Taxi to and from the airport for the APIC Epi-Intensive course in
Albuquerque, NM for 1 person
Yes
$50.00
2
S100.00
Airfare
Airfare to and from the APIC Epi-Intensive course in Albuquerque, NM for
1 person
Yes
$650.00
1
$650.00
Lodging
Hotel room for 5 nights in Albuquerque, NM for 1 person
Yes
$250.00
5
$1,250.00
Meals
Meals for 6 days during the APIC Epi-Intensive course in Albuquerque,
NM (rate based on GSA per diem rates) for I person
Yes
$51.00
6
$306.00
Total Travel
$2,462.00
SUB -TOTAL BEFORE INDIRECT
$10,226.02
Indirect
Item
Description of Item
Total Amount
Requested from
CDPHE
CDPHE-approved indirect
cost rate agreement
18.08% of TDC - CY17 CDPHE Negotiated Indirect Rate for Weld County Dept of Public Health & Environment
S1,848.86
Total Indirect
$1,848.86
TOTAL AMOUNT REQUESTED FROM CDPHE
$12,075
Page 1
•
EXHIBIT D
GRANT FUNDING CHANGE LETTER
Date:
State Fiscal Year:
Grant Funding Change
Letter (GFCL) #
CMS Routing #
CORE Encumbrance #
TO: <Insert Grantee's name>
In accordance with Section of the Original Contract routing number , [insert the following language here if
previous amendment(s), renewal(s) have been processed] as amended by [include all previous amendment(s), renewal(s) and
their routing numbers], [insert the following words here if previous amendment(s), renewal(s) have been processed] between the State
of Colorado, Department of Public Health and Environment and <insert contractor name> beginning <insert
start date of original contract> and ending on <insert ending date of current contract amendment>, the undersigned commits
the following funds to the Grant:
The amount of (federal, state, other) grant funds available and specified in Section of <insert previous
contract modification number and routing number> iS ❑ increased or ❑ decreased by $ amount of change to new total
funds for the period <date to date> of $ <insert new period cumulative total> for the following reason:
Section is hereby modified accordingly. The revised Budget is incorporated herein by this reference and
identified as Revised Exhibit *. (if budget attached; delete sentence if no budget included.)
Complete the table below; insert/delete rows as needed.
The table below reflects the original budget and all modifications to the total since the effective date of the Original
Contract.
SUMMARY OF CHANGES
Document Type
CMS Routing
#
Funding Source
(federal, state, other)
Period
Dollar Amount
Period
Total
Original Contract
$
$
$
$
$
$
$
$
$
$
• Contract Cumulative Grand Total
$•
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or <insert projected effective date>,
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:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Grants. This Grant is not valid until signed and dated below by the
State Controller or delegate. Grantee is not authorized to begin performance until such time. If Grantee begins performing prior
thereto, the State of Colorado is not obligated to pay Grantee for such performance or for any goods and/or services provided
hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
Ex_D.docx
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