HomeMy WebLinkAbout20161701.tiff RESOLUTION
RE: APPROVE TASK ORDER CONTRACT AMENDMENT #2 FOR CHILD FATALITY
PREVENTION SYSTEM 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 Task Order Contract Amendment #2 for
the Child Fatality Prevention System 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, 2016, and ending June 30, 2017, with further terms and
conditions being as stated in said task order contract amendment, and
WHEREAS, after review, the Board deems it advisable to approve said task order contract
amendment, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that Task Order Contract Amendment #2 for the Child Fatality Prevention
System 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 for 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 amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 1st day of June, A.D., 2016.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ditic U
Mike Freeman, Chair
Weld County Clerk to the Board
Sean P. Conway, Pro-Te
uty Clerk to the Board r e_
Ju ie A. Cozad
/..
APPROVED AS TO FORM: ! r, ;' ' •
** , 1 j�'yara Kirkmeyer
County Attorney / e,r
1161 2
Date of signature: 1
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(�promo-
1861 ; Memorandum
liTELTO: Mike Freeman, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: May 27, 2016
SUBJECT: Child Fatality Prevention System—Contract
Renewal with CDPHE
Enclosed for the Board's approval is the Child Fatality Prevention System continuation contract
between the Colorado Department of Public Health and Environment (CDPHE) and the Weld
County Department of Public Health and Environment (WCDPHE).
The Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes) established
the Child Fatality Prevention System (CFPS), a statewide, multidisciplinary, multi-agency effort to
prevent child deaths. Under this professional agreement, the WCDPHE will continue to
coordinate the local, multidisciplinary child fatality prevention review team. The purpose of the
review team is to review all preventable Weld County child deaths ages birth-17, identify trends,
and implement strategies to prevent future deaths from occurring.
The contract period is from July 1, 2016,through June 30, 2017. No new staff will be required to
meet the deliverables specified in the Statement of Work. CDPHE agrees to pay WCDPHE
$12,500.00 for services provided in this continuation contract.
This contract was approved for placement of the Board's agenda via pass-around dated April 28,
2016. I recommend approval of this renewal contract with CDPHE for the Child Fatality
Preventions System program.
2016-1701
' r
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
FHLA VIP-3111P
DEPARTMENT OR AGENCY NUMBER
FAAA
[ASK ORDER AMENDMENT ROUTING NUMBER
17 FHLA 90051
To Original Task Order Routing Number
15 FLA 68349
TASK ORDER AMENDMENT#2
This [ask Order Amendment is made this 20th day of April, 2016, by and between the State of Colorado, acting by
and through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal
place of business is 4300 Cherry Creek Drive South,Denver,Colorado 80246, hereinafter referred to as the
-State";and, Board of County Commissioners of Weld County,(a political subdivision of the state of
Colorado),915 10'—" Street,Greeley,Colorado,80632-0758, for the use and benefit of the Weld County
Department of Public Health And Environment, whose address or principal place of business is 1555 North
Avenue,Greeley,Colorado,80631,hereinafter referred to as the -Contractor".
FACTUAL RECITALS
[he parties entered into a Master Contract dated January 17,2012, with contract routing number 13 FAA 00051.
Pursuant to the terms and conditions of the Master Contract the parties entered into a [ask Order Contract dated
April 21,2014, with encumbrance number CT FHLA 2015000000000027, and task order contract routing number
15 FLA 68349, hereafter referred to as the"Original Task Order Contract", whereby the Contractor was to
provide to the State the following:
Establish and coordinate local child fatality review teams to conduct systematic, comprehensive.
multidisciplinary reviews of all preventable child deaths to better understand how and why
children die,to identify trends,to improve systems and to implement strategies that may prevent
future deaths.
The State promises to increase the amount of funds to be paid to the Contractor by Twelve Thousand Five
Hundred Dollars,($12,500.00) for the renewal term of one(I)year,ending on June 30,2017, in exchange for the
promise of the Contractor to perform the increased specifications to the work described herein.
NOW THEREFORE, in consideration of their mutual promises to each other,stated below,the parties hereto agree
as follows:
Consideration for this Task Order Amendment to the Original Task Order Contract consists of the
payments and services that shall be made pursuant to this Task Order Amendment, and promises and
agreements herein set forth.
2. It is expressly agreed to by the parties that this Task Order Amendment is supplemental to the Original
Task Order Contract, contract routing number 15 FLA 68349, as amended by [ask Order Amendment
number I.contract routing number 16 FHLA 80344 collectively referred to herein as the Original Task
Order Contract, which is by this reference incorporated herein. All terms, conditions, and provisions
thereof, unless specifically modified herein, are to apply to this Task Order Amendment as though they
were expressly rewritten, incorporated,and included herein.
3. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified,
altered,and changed in the following respects only:
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17I III A 90051 Amendment 2.docx
9O(O)- 11O1
A. This Task Order Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract.
This Task Order Amendment is for the renewal term of July 1,2016 through and including June 30,
2017.The maximum amount payable by the State for the work to be performed by the Contractor
during this renewal term is Twelve Thousand Five Hundred Dollars,($12,500.00) for an amended
total contract financial obligation of the State of Thirty Nine Thousand Five Hundred Dollars,
($39,500.00).
This is an increase of Twelve Thousand Five Hundred Dollars ($12,500.00)of the amount
payable from the previous term.
The revised specifications to the original Statement of Work and revised Budget, if any, for this
renewal term are incorporated herein by this reference and identified as"Exhibit F"and
"Exhibit G".
B. Changes were required for Renewal.
The Original Task Order Contract is modified accordingly.All other terms and conditions of the Original
Task Order Contract are reaffirmed.
4. The Effective Date of this Task Order Amendment is July 1,2016 or upon approval of the State
Controller,or an authorized delegate thereof,whichever is later.
5. Except for the General Provisions and Special Provisions of the Original Task Order Contract,in the event
of any conflict, inconsistency,variance,or contradiction between the terms and provisions of this Task
Order Amendment and any of the terms and provisions of the Original Task Order Contract,the terms and
provisions of this Task Order Amendment shall in all respects supersede,govern,and control.The Special
Provisions shall always control over other provisions of the Original Task Order Contract or any
subsequent Task Order Amendments thereto.The representations in the Special Provisions to the Original
Task Order Contract concerning the absence of personal interest of state of Colorado employees are
presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR
ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED,
AND OTHERWISE MADE AVAILABLE.
Page 2 of 4
17 FHLA 90051 Amendment 2.docx
IN WITNESS WIIERF;OF, the parties hereto have executed this Fask Order Amendment on the day first above
written.
* 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: STATE:
Board of County Commissioners of Weld County STATE OF COLORADO
(a political subdivision of the state of Colorado) John W. Ilickenlooper,Governor
for the use and benefit of the Weld County Department
of Public Health and Environment / 1
TASic3-lie. B,: n t �-7, km _ 1 7,,. {,,,,___
Signature of Authorized Officer For the Executive Director
JUN 1 2��6 DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Date
Mike Freeman
Print Name of Authorized Officer
Chair, Weld County Commissioners
Print Title of Authorized Officer
PROGRAMj APPROVAL:
PIL
By: CV, IA SLCila •-�en�
AL.L.CONTRACTS MUST BE APPROVED BY TILE STATE CONTROLLER
CRS §21-311-2112 requires the State( ontroller to approve all State Contracts. This Contract is not valid until signed and
dated helm. h. the State Controller or delegate.Contractor is not authorized to begin performance until such time. If
Contractor begins performing prior thereto,the State of Colorado is not obligated to pay Contractor for such
performance or for any goods and/or services provided hereunder.
STATE CONTROLLER
Robert Jaros,/ Y A,
By:
Date: (4/Mee
•
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17 Fl LA 90051 Amendment 2.docx
EXHIBIT F
STATEMENT OF WORK
To Original Contract Routing Number 15 FHLA 68349
Contract Amendment#2 Routing Number 17 FHLA 90051
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
Entity Name: Weld County Department of Public Health and Environment
II. Project Description:
This project serves to support the Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised
Statutes), which is a statewide, multi-agency effort to prevent child deaths. Pursuant to C.R.S. § 25-20.5-404-405,
local public health agencies, or agencies designated by local public health agencies, are required to establish and
coordinate local, multidisciplinary child fatality prevention review teams. The purpose of local child fatality
prevention review teams to conduct systematic, comprehensive, multidisciplinary reviews of child deaths to better
understand how and why children die. The child fatality review process uses a public health approach to identify
trends and patterns, to take action, to improve systems,and to implement strategies that may prevent future deaths
from occurring.
III. Definitions:
I. CDPHE—Colorado Department of Public Health and Environment
2. CFPS—Child Fatality Prevention System
3. FTP—File Transfer Protocol
4. SUID—Sudden Unexpected Infant Death
IV. Work Plan:
Goal#1: Reduce the number of child deaths in Colorado due to the following causes: undetermined,
unintentional injury,violence,motor vehicle incidents,child abuse and neglect,sudden unexpected infant deaths,
and suicide.
Objective#1: No later than the expiration date of this Contract,the Contractor shall conduct individual,case-
specific, multidisciplinary reviews of child fatalities assigned to the local child fatality prevention review team.
Primary Activity The Contractor shall conduct individual,case-specific,multidisciplinary reviews of child
#1 fatalities assigned to the local child fatality prevention review team based on coroner's
jurisdiction.
I. The Contractor shall access the Death Certificate File Transfer Protocol(FTP) Website
on a monthly basis to obtain death certificates for each child fatality assigned to the
local child fatality review team.
•
2. The Contractor shall gather case records from the coroner's office, law enforcement
•
agencies,county department of human services,hospitals,and other agencies for each
child fatality assigned to the local child fatality review team.
3. The Contractor shall abstract critical data from case records and enter the data into the
National Center Data Collection Website for each child fatality assigned to the local
Sub-Activities#1 child fatality review team.
4. The Contractor shall develop case summaries for the'purpose of completing the
"Narrative"section(Section M)of the National Center Data Collection Website for
each child fatality assigned to the local child fatality review team.
5. The Contractor shall coordinate and facilitate local child fatality review team meetings
with multidisciplinary local child fatality review team members to conduct individual,
case-specific reviews of child fatalities for the purpose of discussing and identifying
prevention recommendations in the"Review Meeting Process"section(Section L)of
the National Center Data Collection Website.
Page 1 of 5
Contract Statement of Work—Exhibit B
Colorado Child Fatality Prevention System-03/15/16
EXHIBIT F
6. No later two(2)months after reviewing a child fatality,the Contractor shall complete
-' - data entry for Sections A-N and click"Data entry completed"of the National Center
• ': Data Collection Website for each child fatality assigned to the local child fatality
•
• review team.
Objective#2: No later than the expiration date of this Contract,the Contractor shall participate in statewide
efforts to implement the Colorado Child Fatality Prevention System(CFPS).
-Primary Activity The Contractor shall promote evidence-based injury and violence prevention strategies.
#1
- 1. The Contractor shall provide input and vote on state-level prevention
recommendations to be prioritized by the CFPS State Review Team for the CFPS
annual legislative report.
• ' 2. The Contractor shall apply a public health approach to identify trends and patterns of
child fatalities using local child fatality prevention review team data reports.
"Sub-Activities#1 3. The Contractor shall apply a public health approach to identify prevention strategies
and systems improvements to implement at the local level.
, 4. The Contractor shall implement evidence-based child fatality prevention strategies and
- system improvements at the local level.
. - _ 5. The Contractor shall complete the Prevention Strategies Tracking Form for any
prevention strategies and system improvements that are promoted and implemented at
the local level.
Primary Activity The Contractor shall participate in training opportunities facilitated by CFPS support staff at
CDPHE.
I. The Contractor shall attend the annual local coordinator training hosted by CFPS
support staff at CDPHE.
Sub-Activities#2 . 2. The Contractor shall participate in web-based trainings facilitated by CFPS support
staff at CDPHE.
Primary Activity The Contractor shall participate in statewide evaluation of the Colorado CFPS and complete
#3 • state-level data collection tools and surveys.
I. The Contractor shall complete and submit the Local CFPS Annual Survey by August
Sub-Activities#3 31.
I. The content of electronic documents locatedon CDPHE and non CDPHE websites and
information contained on CDPHE and non-CDPHE websites may be updated
periodically during the Contract term. The Contractor shall monitor documents and
• - website content for updates and comply with all updates.
• =- - 2. The Contractor shall comply with the Child Fatality Prevention Act C.R.S.25-20.5-
• •Standards and 404-409.This document is incorporated and made part of this contract by reference and
Requirements I is available on the following website httn://www,sos.state.co.us/CCR/Welcome.do.
. 3. The Contractor shall adhere to processes and policies outlined in the Colorado Child
Fatality Prevention System (CFPS) Operations Manual to conduct individual,case-
_ - specific review of fatalities; identify prevention recommendations;and enter
information regarding the child fatality into the National Center Data Collection
.. - Website.This document is incorporated and made part of this contract by reference
Page 2 of 5
Contract Statement of Work—Exhibit B
Colorado Child Fatality Prevention System—03115/16
EXHIBIT F
and is available on the following website
https//www.cochildfatalityprevention.com/p/cfps-operations-manual.htm 1.
4. Reviewable child fatalities include one or more of the following causes:undetermined
causes, unintentional injury,violence,motor vehicle incidents,child abuse/neglect,
sudden unexpected infant death(SUID),and suicide.
• 5. The Contractor shall maintain access and ensure the Local Child Fatality Prevention
Review Team Coordinator has login credentials to the Death Certificate File Transfer
Protocol(FTP) Website and the National Center Data Collection Website. This
website content is incorporated and made part of this contract by reference and is
accessible at,https://www.cdrdata.org/auth/login.
6. CDPHE will assign child fatalities for review to the Contractor based on the coroner's
jurisdiction using the Death Certificate File Transfer Protocol(FTP)Website on a
monthly basis.This website content is incorporated and made part of this contract by
reference and is accessible at https://secft2.dphesfate.co.us/thinclient/Login.aspx.
7. The Contractor shall complete individual,case-specific,multidisciplinary reviews and
data entry of child fatalities in the National Center Data Collection Website.
S. CDPHE will conduct quality assurance checks as defined on the Colorado Child
Fatality Prevention website on the data entered into the National Center Data
Collection Website for child fatalities reviewed by the Contractor.This information is
incorporated and made part of this contract by reference and is available on the
• following website https//www.cochildfatalityprevention.com/.
9. The Contractor shall request technical assistance and training from the CFPS support
staff at CDPHE by completing and submitting an online form.This form is
incorporated and made part of this contract by reference and is available on the
following website https//www.cochildfatalityprevention.com/p/contact-cfps-staffhtml.
10. CDPHE will analyze and aggregate child fatality data and disseminate this data to the
Contractor in local child fatality prevention review team data reports. In addition,
CDPHE will provide information and resources for evidence-based injury and violence
prevention strategies and will make this information available on the Colorado Child
Fatality Prevention website. This information is incorporated and made part of this
contract by reference and is accessible at
https//www.cochildfatal ityprevention.com/p/prevention-efforts.htm 1.
II. The Contractor shall incorporate information from the Colorado Child Fatality
Prevention website on acceptable and approved uses of finding for child fatality,
injury,and violence prevention strategies when implementing local prevention
strategies.
12. The Contractor shall use the electronic Prevention Strategies Tracking Form located on
the Colorado Child Fatality Prevention website when tracking prevention strategies
• and system improvements.
13. The Contractor shall notify CFPS support staff at CDPHE within thirty(30)calendar
days of a change of the Local Child Fatality Prevention Review Team Coordinator
responsible for the performance of services provided under this contract.
14. Travel may be required from time to time by CDPHE.The contractor shall attend
meetings as requested by CDPHE.
Page 3 of 5
Contract Statement of Work—Exhibit B
Colorado Child Fatality Prevention System—03/15/16
i
EXHIBIT F
I. Improved understanding of child fatality data in Colorado including circumstances,
risk and protective factors,trends,and patterns surrounding the child deaths
Expected Results 2. Identification of evidence-based prevention recommendations to prevent future child
of Activity(s) fatalities from occurring in Colorado.
3. Implemented and evaluated child fatality prevention strategies at the state and local
levels.
I. Sections A-N of the National Center Data Collection Website will be completed for
100%of child fatalities that occurred in Colorado and meets CFPS's review criteria
Measurement of • within the local child fatality prevention review team's jurisdiction.
Expected Results 2. Increased number of prevention strategies implemented at the state and local levels as
documented in the CFPS annual report,the Local CFPS Annual Survey,and the
Prevention Strategies Tracking Form.
,ter.-.: .rte s> .,, s - a a / n r .n s o/ Completion
letion
. ,.� .. of<t - Date -
Deliverables I. The Contractor shall complete entry of all child fatality data into No later than
the National Center Data Collection Website for each child fatality January I
case assigned to the local child fatality review team by the CFPS
support staff at CDPHE.
. • t
. .; 2. The Contractor shall complete entry of all child fatality data into No later than
. the National Center Data Collection Website for each child fatality two months after
case assigned to the local child fatality review team by the CFPS conducting the
• support staff at CDPHE. child fatality
- ` ' review meeting.
' 3. The Contractor shall submit,via email to the Child Fatality No later than
Prevention System Technical Assistance and Prevention August 31
•
Coordinator,the web-based Local CFPS Annual Survey provided,
by CDPHE electronically.
4. The Contractor shall provide input and vote on state-level No later than
prevention recommendations via a web-based survey provided by April 15
' CDPHE electronically.
5. The Contractor shall submit the online Prevention Strategies No later than
Tracking Form for any prevention strategies that are promoted and September 30;
implemented at the local level. January 31;and
May 31
'• 6. The contractor shall submit progress reports,via email to the Child No later than
Fatality Prevention System Technical Assistance and Prevention November 30
Coordinator. and April 30
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the Child Fatality Prevention System Technical Assistance and Prevention Coordinator.
Methods used will include a review of documentation determined by CDPHE to be reflective of performance to
include progress reports, invoices,data entered into the National Center Data Collection Website,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:
Page 4 of 5
Contract Statement of Work—Exhibit B
Colorado Child Fatality Prevention System-03/15/16
EXHIBIT F
The Contractor will be notified in writing within fifteen (15) calendar days of discovery of a compliance issue.
Within thirty (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 Child Fatality Prevention System Technical Assistance and Prevention Coordinator 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.
Page 5 of 5
Contract Statement of Work—Exhibit B
Colorado Child Fatality Prevention System-03/15/16
Exhibit G
4 COPHE COLORADO
cA Department of Public
Health & Environment
rimy cm11VIY JCKV1LC3 UfVt3LVIV- DUUVC I vvl i ri JUSTIFICATION FORM
Contract Routing# 17 FHLA 90051
Contractor Name Weld County Department of Public Health&. Program Contact Name, Ericartko.Director,Health Communication,
Environment Title,Phone and Email Education Planning;970-304-6470 e.e
2380;eaakko@weltlgoemm
Budget Period July 1,2016,through June 30,2017 Fiscal Contact Name,Title, Tanya Deiu.,orenor.adminizo-xma
Phone and Email services;970-304-6410 en 2122;
yeiurewelagw.mm
Project Name CFPS Phase Ill
Expenditure Categories
Personal Services - .
Salaried Employees -
Budget Item Percent of Total Amount
Position Title/Employee
Supports SOW Gross or Time on Requested from
Name Description of Work (Yes/No) Annual Salary Fringe Project j CDPHE
Coordinator will facilitate local child fatality
prevention review team in examining preventable
child deaths to gain understanding of issue and
develop prevention methods.Coordinator will
coordinate and facilitate local CFR meetings,gather
case records,develop case summaries,enter data
into National Center Data Collection Website,
attend state CFPS trainings,provide input on state-
level prevention recommendations,and assist with
Public Health Nurse local prevention campaigns. Yes $ 68,972.34 $ 26,850.93 8.75% $8,384.54
•
• Personal Services
_ - . _ Hourly-Employees -•
- '
•
Budget Item Total#of Total Amount
Position Title/Employee Supports SOW Hours on Requested from
Name Description of Work (Yes/No) Hourly Wage Hourly Fringe Project CDPHE '
" $0.00
Total.Personal Services .
(including fringe benefits) $8,384,54
Supplies&Operating Expenses
Budget Item Total Amount
Supports SOW Requested from
Item Description of Item (Yes/No) Rate Quantity CDPHE
Meeting Supplies Supplies for quaterly team meetings. Yes $ 110.00 4 $440.00
TntalSupplies -
&Operating Expenses $440.00
- Travel .
Page 1 of 3
V.1 Jan 2013
1
Exhibit G
aka.`v rrtty I I KM t �
Health & Environment WI i intJUST►FICATION FORM
Contract Routing # 17 FHLA 90051
Weld CountyProgram Department of Public Health& Contact Name, Ericnakko,Director,Health Communication,
Contractor NameEducation and Planning;Wa3Dv6Mo ext
Environment Title,Phone and Email
2380;eaaYko@weldgwtom
Budget Period Fiscal Contact Name,Title, Tanya Geiser,Director,Administrative
9 July 1,2016,through June 30,2017 Services;970-3044410 ext 2122;
Phone and Email igeise,@weldgov.,om
Project Name CEPS Phase Ill
Budget Item Total Amount
Supports SOW Requested from
Item Description of Item (Yes/No) Rate Quantity CDPHE
Mileage Mileage support for travel to/from trainings or meetings. Yes $ 0.52 65 $33.80
Total Travel-'
' $33.80
Contractual
Budget Item Total Amount
Supports SOW Requested from
Subcontractor Name Description of Item (Yes/No) Rate Quantity CDPHE
TBD Putting aside small amount of funding to allow for prevention campaign. Yes S 300.00 1 $300.00
. - .. - Total Contractual
. $300.00
•
SUB-TOTAL BEFORE INDIRECT $9,158.34
Page 2 of 3
V.1Jan 2013
Exhibit G
rlwvt I any Health Et Environment
WTlfH JUSTIFICATION FORM
Contract Routing # 17 FHLA 90051
Contractor Name Weld County Department of Public Health& Program Contact Name, Eric Aakko,Director,Health Communication,
Environment Education and Planning;910-3044470 nut
Title,Phone and Email 13g0;eaakko@weidgov.com
Fiscal Contact Name,Title, Tanta Geiser,Director,Administrative
Budget Period July 1,2016,through June 30,2017
Phone and Email services;970-304{410 eaa 2122
rgeiaer@werdgw.com
Project Name CFPS Phase III
Indirect
Total Amount
Requested from
Item Description of Item CDPHE
Negotiated Indirect cost
rate(Federal,State,or 2016 CDPHE contracted indirect rate=36.49%.Weld will use this as the provisional rate for 2017 until a new indirect
CDPHE) rate agreement is finalized. $3,342
Indirect rate(other):
Indirect(modified or
additional base)
Total Indirect 53,341.88
TOTAL
$12,500
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V.1 Jan 2013
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