HomeMy WebLinkAbout20161786.tiffRESOLUTION
RE: APPROVE TASK ORDER CONTRACT AMENDMENT #1 FOR AMENDMENT 35 FOR
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 Task Order Contract Amendment #1 for
Amendment 35 for the Tobacco Use 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, 2016, and ending June 30, 2018, 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 the Task Order Contract Amendment #1 for Amendment 35 for 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 Pro-Tem 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 13th day of June, A.D., 2016.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: W.G. Jelde;ok
Weld County Clerk to the Board
BY(4t �,e^Q, C\--
puty Clerk to the Board
APPROVED AS TO FORM:
1c -K
J
County Attorney
Date of signature: -7/Co
EXCUSED
Mike Freeman, Chair
Sean P. Con ay, Pro-Tem
f, OCr
Julie A. Cozad
cc NLCST)
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2016-1786
HL0048
Memorandum
TO: Mike Freeman, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: June 6, 2016
SUBJECT: CDPHE Amendment 35 Continuation Contract
- Tobacco Use Prevention and Cessation
Education
For the Board's approval is a 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 contract amount is $318,903. The renewal term is for two
(2) years effective July 1, 2016, and ends June 30, 2018. Activities will be conducted by current
staff; no additional FTE is being requested.
This continuation contract was approved for placement on the Board's agenda via pass -around
dated May 23, 2016. I recommend approval of this Tobacco Use Prevention and Cessation
Education continuation contract with CDPHE.
2016-1786
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
FHLA-TOB
B
DEPARTMENT OR AGENCY NUMBER
FAAA
TASK ORDER AMENDMENT ROUTING NUMBER
17-90127
To Original Task Order Routing Number
16-76437
TASK ORDER AMENDMENT #1
This Task Order Amendment is made this 21st 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), whose address or principal place of business is 915 10"' Street, Greeley, Colorado 80632-0758, for the
use and benefit of Weld County Department of Public Health and Environment, whose address or principal
place of business is 1555 North 17`x' Avenue, Greeley, Colorado 80631, hereinafter referred to as the "Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract dated January 17, 2012, with contract routing number 13 FAA 00037.
Pursuant to the terms and conditions of the Master Contract the parties entered into a Task Order Contract dated
January 17, 2012, with encumbrance number CT FAAA FHLA 2016000000000139, and task order contract
routing number 16 FHLA 76437, hereafter referred to as the "Original Task Order Contract", whereby the
Contractor was to provide to the State the following:
This project serves to increase tobacco cessation, reduce initiation of tobacco use, decrease tobacco
prevalence among youth and decrease exposure to secondhand smoke by working toward goals identified
in the Statement of Work.
The State promises to increase the amount of funds to be paid to the Contractor by Three Hundred Eighteen
Thousand Nine Hundred and Three Dollars, ($318,903.00) for the renewal term of two (2) years, ending on
June 30, 2018, 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:
1. 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 16 FHLA 76437, 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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Weld TO Amdl.docx
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, 2018. The maximum amount payable by the State for the work to be
performed by the Contractor during this renewal term is Three Hundred Eighteen Thousand
Nine Hundred and Three Dollars, ($318,903.00) for an amended total contract financial
obligation of the State of Six Hundred Thirty Seven Thousand Eight Hundred and Six
Dollars, ($637,806.00).
This is an increase of Three Hundred Eighteen Thousand Nine Hundred and Three Dollars,
($318,903.00) 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 D" and
"Exhibit E".
B. Changes were required due to 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
Weld TO Amdl.docx
IN WITNESS WHEREOF, the parties hereto have executed this 1 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:
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)
Dale
Signature of Authorized Office
JUN 13 2016
Sean P. Conway
Print Name of Authorized Officer
Pro —Tern
Print Title of Authorized Officer
By:
B',:
STATE:
STATE OF COLORADO
John W. Hickenlooper, Governor
For the Executive Director
DEPARTMENT OF PUBLIC' HEALTH
AND ENVIRONMENT
PRO(: AVI. OROVAL:
l i' r'
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 helm, 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.
Bv:
Date:
Wcld _ It) dn,d l Joe
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
d� fral 1- .(?', '
1i/y/,
Pagel of d
02x7 - / 7e6(t)
This page left intentionally blank.
Page 4 of 4
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EXHIBIT D
STATEMENT OF WORK
To Original Contract Routing Number 16 FHLA 76437
Contract Amendment #1 Routing Number 17 FHLA 90127
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
Term: July 01, 2016 — June 30, 2018
I1. Project Description:
This project serves to increase tobacco cessation and reduce initiation of tobacco use by promoting evidence -based
cessation programs to health care providers and social service programs that work with low socioeconomic (SES)
populations, promoting evidence -based policies and regulations that reduce youth and adult use and access to
tobacco, promoting evidence -based programs and policies for young adult straight to work, ages 18-24,
populations, promoting evidence -based cessation programs to school districts and social service programs that
work with low socioeconomic (SES) populations in the City and County of Weld.
III. Definitions:
I AAR — Ask, Advise, Refer
2. CDC - Centers for Disease Control and Prevention
3. CDPHE — Colorado Department of Public Health and Environment
4. ITTP — Individualized Training and Technical Assistance Plan
5. Quarters:
Quarter 1: July 1 -Sept 30
Quarter 2: Oct 1- Dec 31
Quarter 3: Jan 1 -March 31
Quarter 4: April 1- June 30
6. SES — Socio-economic status
7. STEPP — State Tobacco Education and Prevention Partnership
8. TTA — Training and Technical Assistance
9. TFS - Tobacco -free Schools
IV. Work Plan:
Goal #1: The cessation success gap affecting low socio-economic status (SES) youth and adult smokers will decrease by
fifty percent (50%) and tobacco dependence will be treated as a chronic condition by health systems in Colorado. (STEPP
Goals 1&2).
Objective #1: No later than the expiration date of this Contract, the Contractor shall assist Health Care Agencies in
integrating evidence -based tobacco clinical practice guidelines into routine health care practice.
Primary Activity #1
The Contractor shall educate 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.
Sub -Activities #1
1. The Contractor shall identify and recruit at least two Health Care Agency(s).
2. The Contractor shall assess the knowledge in each Health Care Agency using a standardized
survey tool provided by CDPHE.
3. The Contractor shall assess results of standardized survey tool and identify educational needs
and training recommendations.
4. The Contractor shall disseminate training recommendation report to each Health Care
Agency(s).
&UM It
Dcccmbc, 2015
Weld_S0W Contract Amend.docx
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EXHIBIT D
5. The Contractor shall meet with each Health Care Agency to review results of assessment and
training recommendations.
6. The Contractor shall provide recommended training to each Health Care Agency to increase
staff knowledge.
7. The Contractor shall conduct follow up assessments with each Health Care Agency using
standardized survey tool provided by CDPHE .
Primary Activity #2
The Contractor shall provide technical assistance to each Health Care Agency that supports the
implementation of health systems changes that institutionalize tobacco use screening,
intervention and documentation for every patient.
Sub -Activities #2
I. The Contractor shall identify and recruit at least two Health Care Agency(s).
2. The Contractor shall assess current workflow using standardized survey tool provided by
CDPHE.
3. The Contractor shall, based on survey findings, provide evidence -based strategy
recommendations such as 5A's and Ask, Advise Refer (AAR), for integrating tobacco
treatment into routine clinical practice in each Health Care Agency using a tailored consultation
and technical assistance plan.
4. The Contractor shall implement suggested changes by linking each Health Care Agency to
cessation resources and implementing the consultation and technical assistance plan.
5. The Contractor shall reassess with each Health Care Agency using a standardized survey
tool provided by CDPHE.
Primary Activity #3
The Contractor shall provide technical assistance to each health care agency to integrate
tobacco dependence treatment into electronic health records and workflows to increase the
number and quality of referrals to the Colorado QuitLine or other evidence -based cessation
resources.
Sub -Activities #3
1. The Contractor shall identify and recruit at least two Health Care Agency(s).
2. The Contractor shall assess current workflow using standardized survey tool provided by
CDPHE.
3. The Contractor shall based on survey findings provide recommended strategies for
appropriately and effectively recommending evidence -based services to tobacco users,
documenting referral status and following up on completed referrals in each Health Care
Agency using a tailored consultation and technical assistance plan.
4. The Contractor shall implement suggested changes by linking each Health Care Agency to
cessation resources and implementing the consultation and technical assistance plan.
5. The Contractor shall reassess with each Health Care Agency using a standardized survey
tool provided by CDPHE
Primary Activity #4
The Contractor shall provide technical assistance to each Health Care Agency to assess the
impact of health system change efforts on patient outcomes.
Sub -Activities #4
I. The Contractor shall assist Health Care Agency(s) in defining a patient outcomes tracking
plan.
2. The Contractor shall assist Health Care Agency(s) in implementing the evaluation plan and
reporting processes.
3. The Contractor shall submit report with feedback and suggestions for further action to each
Health Care Agency.
December 2015
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EXHIBIT D
4. The Contractor shall create a report on the impact of health systems changes.
Primary Activity #5
The Contractor shall develop and implement a media plan prior to placement of any media
buys.
Primary Activity #6
The Contractor shall update, at a minimum, annually an individualized training and technical
assistance plan (1TTP) in collaboration with the CDPHE approved Technical Assistance
provider(s).
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 obtain guidance from the CDPHE Tobacco Communications Specialist
at a minimum, fifteen (15) days before the development and implementation of the media plan.
The media plan shall be approved by CDPHE before placement of media buys.
3. The Contractor shall use existing, customizable media materials. This information is located
on the CDPHE website http://cohealthresources.org/ and is incorporated and made part of this
contract by reference. Should these existing materials not meet Contractor needs a proposal for
the development of additional resources must be submitted by the Contractor for approval from
the CDPHE Tobacco Program Point of Contact and STEPP Communications Specialist.
4. The Contractor shall participate in, at a minimum, one (1) consultation meeting with the
CDPHE approved Technical Assistance Provider, as appropriate, to update an individualized
training and technical assistance plan, annually, for each required A35 strategy in the work
plan.
5. The Contractor shall use all standardized survey tools available from CDPHE to conduct the
knowledge assessment, 5A's, AAR, and Workflow Assessment found at
https://sites.google.com/a/state.co.us/tobaccograntees/goals-1-2, incorporated and made part of
this Contract by reference.
6. The Contractor shall ensure that all work follows best practices using the following as
required resources: CDC's Best Practices for Comprehensive Tobacco Control Programs -
2014, US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and
Dependence - 2008 Update. All work must align with the Patient Protection and Affordable
Care Act (ACA), and The Health Information Technology for Economic and Clinical Health
Act (HITECH). These documents are incorporated and made part of this contract by reference
and are available on the following websites:
http://www.cdc.gov/tobacco/stateandcommunity/best practices/pdfs/2014/comprehensive.pdf
http://www.ncbi.nlm.nih.gov/books/NBK63952/
7. The patient outcome tracking plan includes collected baseline data and post -intervention data
from Electronic Health Records or other practice records.
8. The Contractor shall prioritize work to promote health systems change with health care
systems, social service settings and other applicable interagency programs serving low-SES
and other priority populations.
9. The Contractor shall comply with and ensure that all work, including the work performed by
subcontractors, follows the requirements in the A35 Tobacco Goals Required and Optional
Strategies for Community and Cessation Initiatives. This document is incorporated and made
part of this contract by reference and is available on the following website:
https://www.https://www.colorado.gov/pacific/sites/default/files/PW A35 Tobacco -2016-
2018 -strategies Apr2016.pdf
December 2015
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EXHIBIT D
10. The Contractor shall immediately inform STEPP of any tobacco control municipal
ordinance and/or organizational policy issues that are aligned with the A35 Tobacco Goals
Required and Optional Strategies for Community and Cessation Initiatives 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.
1 I . If the Evaluation Plan is updated, the Contractor shall inform the STEPP Tobacco Program
Point of Contact within fifteen (15) days.
12. The Colorado QuitLine information is found at https://www.coquitline.org/, incorporated
and made part of this Contract by reference.
Expected Results of
Activity(s)
All Heath Care Agencies involved in this project have integrated tobacco cessation into routine
clinical practice.
Measurement of
Expected Results
1. Increase the number of referrals and enrollment conversion rate to the Colorado Quitline
from each Health Care Agency.
2. Health Care Agency staff will demonstrate increased knowledge of the burden of tobacco
and importance of treating tobacco as a chronic condition.
3. 5A's/AAR Framework for Smoking Cessation implementation into EHR and clinical
practice is completed, strengthened or expanded for each Health Care Agency
Completion
Date
Deliverables
The Contractor shall submit progress reports to the STEPP Tobacco
Program Generalist via mechanism provided by CDPHE, prior to the
report deadline.
No later than
October 15, January
15, April 15 and
July 15 of each
fiscal year.
Goal #2: A majority of Coloradans live, learn, work and play in communities that have effective policies and regulations that
reduce youth and adult use and access to tobacco. (STEPP Goal 3)
Objective #1: No later than expiration date of the Contract, the Contractor shall engage in a tobacco policy change process
that reduces prevalence and initiation of tobacco and exposure to secondhand smoke.
Primary Activity #1
The Contractor shall complete a community assessment and/or retail assessment that identifies
opportunities for a tobacco policy change process.
Sub -Activities #1
1. The Contractor shall develop an assessment plan.
2. The Contractor shall assess the tobacco and secondhand smoke problems in a targeted Weld
County municipality.
3. The Contractor shall research, review and analyze existing tobacco policies to identify
strengths, gaps, and areas for improvement in a targeted Weld County municipality.
4. The Contractor shall identify at least one non -cigarette tobacco retail licensing policy for
improvement through a tobacco policy change process.
December 2015
Weld SOW Contract Amend.docx
Page 4 of 15
EXHIBIT D
5. The Contractor shall create decision maker profiles to identify key decision -makers.
6. The Contractor shall meet with key decision -makers to discuss the local burden of tobacco,
proven tobacco and environmental policy change strategies and best practices, and the policy
change process.
Primary Activity #2
The Contractor shall utilize a youth/adult taskforce and engagement model of community
mobilization to make identified tobacco policy change.
Sub -Activities #2
1. The Contractor shall involve a youth/adult taskforce to assist with appropriate activities, such
as conducting assessments and educating the community.
2. The Contractor shall educate task force in the design of the specific tobacco policy change
campaign.
Primary Activity #3
The Contractor shall develop and implement a tobacco education and policy promotion
campaign.
Sub -Activities #3
1. The Contractor shall conduct an analysis of stakeholders.
2. The Contractor shall identify and work with key community influencers to determine policy
priorities, key messages, timelines and roles and responsibilities.
3. The Contractor shall conduct research to gauge support, determine barriers inform the
development of key talking points and future messaging for the successful implementation of
the proposed tobacco policy.
4. The Contractor shall collaborate with Technical Assistance to ensure clarity, impact, and
P
focus of the proposed policy.
5. The Contractor shall create a tobacco education and policy change campaign.
6. The Contractor shall create a burden report presentation for decision-makers/stakeholders.
7. The Contractor shall create and present a burden report presentation for decision-
makers/stakeholders/community groups and leaders impacted most directly by the proposed
policy.
Primary Activity #4
The Contractor shall advocate for environmental tobacco policy changes.
Sub -Activities #4
V,i NITTII I.\HT last ,llalMIMIl Iii WTT, I..I,T(,I
1. The Contractor shall conduct meetings with key decision makers to assess support for
tobacco policy change.
2. The Contractor shall adopt or modify model tobacco policy language that is in alignment
with STEPP model policy standards.
3. The Contractor shall identify, schedule, and confirm dates of presentations to council/board.
4. The Contractor shall develop a plan to monitor and assist with implementation of the tobacco
policy changes.
5. The Contractor shall educate and inform key decision makers and taskforce leadership
regarding the policy issue, enforcement and implementation of the environmental tobacco
policy changes.
6. The Contractor shall organize and facilitate a community event to increase awareness and
gain support of the tobacco policy change campaign.
7. The Contractor shall present the policy proposal to formal key decision -making authority.
II
December 2015
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EXHIBIT D
Primary Activity #5
The Contractor shall support the implementation and enforcement of the tobacco policy change
campaign.
Sub -Activities #5
1. The Contractor shall promote implementation of and compliance with the policy.
2. The Contractor shall execute the implementation plan.
3. The Contractor shall evaluate the compliance and enforcement of the selected policy.
4. The Contractor shall present results of compliance and enforcement evaluation to youth/adult
taskforce members, key stakeholders, decision -makers and the public and determine if
adjustments need to be made.
Primary Activity #6
The Contractor shall review, update, and implement activities documented in a project
Evaluation Plan, at a minimum, annually.
Primary Activity #7
The Contractor shall develop and implement a media plan prior to placement of any media
buys.
Primary Activity #8
The Contractor shall update, at a minimum, annually an individualized training and technical
assistance plan (ITTP) in collaboration with the CDPHE approved Technical Assistance
provider(s).
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 evaluation plan shall include:
a. the participation of the Contractor in evaluation -related trainings and technical assistance
(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 in bi- monthly (every two months) meetings (or 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.
3. The Contractor shall obtain guidance from the CDPHE Tobacco Communications Specialist
at a minimum, fifteen (15) days before the development and implementation of the media plan.
The media plan shall be approved by CDPHE before placement of media buys.
4. The Contractor shall use existing, customizable media materials. This information is located
on the CDPHE website http://cohealthresources.org/ and is incorporated and made part of this
contract by reference. Should these existing materials not meet Contractor needs, a proposal
for the development of additional resources must be submitted by the Contractor, for approval
from the CDPHE Tobacco Program Point of Contact and STEPP Communications Specialist.
5. The Contractor shall use the following sources and approaches to assess the tobacco problem
as appropriate e.g. burden reports, all are incorporated and made part of this Contract by
reference:
a. The Attitudes and Behaviors Survey (TABS) 2012, or most recent, found at
http://www.ucdenver.edu/academics/colleges/PublicHealth/community/CEPEG/TABS/Pag
es/TABS.aspx
b. Healthy Kids Colorado Survey found at
http://www. ucdenver.edu/academics/colleges/PublicHealth/community/CEPEG/UnifYouth
/Pages/HealthyKidsSurvey.aspx
ds Survey.aspx
c. Counter Tools and Synar Compliance Data found at http://audit.countertobacco.org/ and
December 2015
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EXHIBIT D
http://www.mapsportal.org/unc/tobaccomap/cotob/
d. FDA Store Audits found at
http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryl nformation/ucm232
109.htm
e. Focus Groups studies
f. Observational studies, including Photo Voice
g. Key Informant interviews
6. The Contractor shall participate in at a minimum, one (1) consultation meeting with the
CDPHE approved Technical Assistance Provider, as appropriate, to update an individualized
training and technical assistance plan, annually, for each required A35 strategy in the work
plan.
7. The Contractor shall engage with a community youth/adult taskforce or group that is made
up of: Youth leaders, strategic community leaders, those impacted by proposed environmental
tobacco change, and Power brokers from community.
8. The Contractor shall ensure that the environmental tobacco change campaign includes
community members, decision -maker and a media outreach and education component to
support the proposed environmental tobacco change.
9. The Contractor shall ensure that promotion of implementation and enforcement at a
minimum includes: letters of thanks to decision makers and media for the passage of the policy
and implementation plans to the community
10. The Contractor shall comply with and ensure that all work, including the work performed
by subcontractors, follows the requirements in the A35 Tobacco Goals Required and Optional
Strategies for Community and Cessation Initiatives. This document is incorporated and made
part of this Contract by reference and is available on the following website:
https://www.https://www.colorado.gov/pacific/sites/default/files/PW A35 Tobacco -2016-
2018 -strategies Apr2016.pdf
11. The Contractor shall ensure that all work follows best practices using the following as
required resources: CDC's Best Practices for Comprehensive Tobacco Control Programs -
2014, US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and
Dependence - 2008 Update. All work must align with the Patient Protection and Affordable
Care Act (ACA), and The Health Information Technology for Economic and Clinical Health
Act (HITECH). These documents are incorporated and made part of this Contract by reference
and are available on the following websites:
http://www.cdc.gov/tobacco/stateandcommunity/best practices/pdfs/2014/comprehensive.pdf
http://www.ahrq.gov/professional s/c l in is fans-providers/guidelines-
recommendations/tobacco/clinicians/update/treating tobacco use08.pdf
12. The Contractor shall prioritize work to promote tobacco policy change with health care
systems, social service settings, municipal settings and other applicable programs serving low-
SES and other priority populations.
13. The Contractor shall immediately inform STEPP of any tobacco control municipal
ordinance and/or organizational policy issues that are aligned with the A35 Tobacco Goals
Required and Optional Strategies for Community and Cessation Initiatives which arise in the
Contractor's county and are not already covered under deliverables in this Statement of Work.
14. 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.
December 2015
Weld SOW_ Contract Amend.docx
Page 7 of 15
EXHIBIT D
15. The Contractor will be provided metrics, measures and a reporting tool through CDPHE's
evaluation contractor. These data will be aggregated as part of the macro -evaluation of the
grants program.
16. If the Evaluation Plan is updated, the Contractor shall inform the STEPP Tobacco Program
Point of Contact within fifteen (15) days.
Expected Results of
Activities
A strengthened, expanded or newly developed local policy leading to the reduction of youth
and adult use and access to tobacco.
Measurement of
Expected Results
Demonstrate the progress of primary activities as outlined in the work plan.
Coletion
mpletion
Date
Deliverables
I .The Contractor shall submit progress reports to the STEPP Tobacco
Program Generalist via mechanism provided by CDPHE, prior to the
report deadline.
No later than
October 15, January
15, April 15 and
July 15 of each
fiscal year.
Goal #3: Tobacco prevalence and initiation among young adults straight to work (18-24 years old) will decrease by fifty
percent (50%) in Colorado. (STEPP Goal 4)
Objective #1: No later than expiration date of the Contract, the Contractor shall engage in a tobacco policy change process
that reduces prevalence and initiation of tobacco and exposure to secondhand smoke.
Primary Activity #1
The Contractor shall complete a community assessment and identify opportunities for a
tobacco policy change process.
Sub -Activities #1
1. The Contractor shall develop an assessment plan.
2. The Contractor shall assess the tobacco and secondhand smoke problems particularly areas
in which the young adult, straight to work populations are not already protected by smoking
bans and smoke -free policies in a targeted Weld County municipality.
3. The Contractor shall assess the availability of current, evidence -based cessation resources for
the target population in a targeted Weld County municipality.
4. The Contractor shall research, review and analyze existing tobacco policies to identify
strengths and areas for improvement in a targeted Weld County municipality.
5. The Contractor shall identify at least two Community, Organizational, or Campus policies
for improvement through a tobacco policy change process.
6. The Contractor shall create decision maker profiles.
7. The Contractor shall meet with key decision -makers to discuss the local burden of tobacco,
proven tobacco and environmental policy change strategies and best practices, and the policy
change process.
Primary Activity #2
The Contractor shall utilize a local taskforce focused on making needed Community,
Organizational, or Campus tobacco policy change.
Sub -Activities #2
I The Contractor shall involve a taskforce to assist with appropriate activities such as
conducting assessments and educating the community about the tobacco burden, benefits of the
proposed policy and the change process.
2. The Contractor shall educate task force regarding best practice and evidence -based strategies
for tobacco control.
3. The Contractor shall educate task force in the design of the specific Community,
Organizational, or Campus tobacco policy change campaign.
December 2015
Page 8 of 15
Weld_ S0W_ Contract Amend.docx
EXHIBIT D
Primary Activity #3
The Contractor shall develop and implement a tobacco education and policy promotion
campaign.
Sub -Activities #3
1. The Contractor shall conduct a stakeholder analysis
2.The Contractor shall work with key community influencers and the task force to determine
policy priorities, key messages, timelines and roles and responsibilities
3. The Contractor shall conduct research to gauge support for, determine barriers to, and inform
the development of key talking points and future messaging for the implementation of the
proposed tobacco policy change
4. The Contractor shall collaborate with Technical Assistance partners to ensure clarity, impact,
and focus of the proposed policy as well as to ensure that policy and cessation plans are
consistent with STEPP best practices
5. The Contractor shall create a tobacco education and policy change campaign
6. The Contractor shall create burden report that highlights the tobacco related disparities for
the straight to work, young adult population presentation for decision-makers/stakeholders
7. The Contractor shall present burden report to community groups and leaders impacted by
tobacco policy change
8. The Contractor shall attend community events to provide education about the community's
tobacco burden and gather support/supporters for proposed tobacco policy change
9. The Contractor shall promote STEPP approved existing, recommended, young adult -facing
cessation resources and new offerings as they become available.
10. The Contractor shall to ensure communication of evidence -based tobacco cessation
programs and resources to community groups impacted by tobacco policy change.
Primary Activity #4
The Contractor shall advocate for environmental tobacco policy changes.
Sub -Activities #4
1. The Contractor shall conduct meetings with key decision makers and taskforce members to
assess support for tobacco policy change.
2. The Contractor shall adopt or modify model tobacco policy language that is in alignment
with STEPP model policy standards.
3. The Contractor shall identify, schedule, and confirm dates of presentations to council/board.
4. The Contractor shall develop a plan to monitor and assist with implementation.
5. The Contractor shall provide ongoing education and information key decision makers and
taskforce leadership on the policy enforcement and implementation concerns.
6. The Contractor shall organize and facilitate a community event to increase awareness and
gain support of the tobacco policy change campaign.
7. The Contractor shall present policy proposal to formal decision -making authority.
Primary Activity #5
The Contractor shall support the implementation and enforcement of the tobacco policy change
campaign.
December 2015
Weld_ SOW_ Contract Amend.docx
Page 9 of 15
EXHIBIT D
Sub -Activities #5
1. The Contractor shall promote and support implementation and compliance of the policy
2. The Contractor shall execute the implementation plan
3. The Contractor shall execute an evaluation of the compliance and enforcement of the
selected policy
4. The Contractor shall present results of compliance and enforcement evaluation to taskforce
members, key stakeholders, decision -makers and the public and determine if adjustments are
needed.
Primary Activity #6
The Contractor shall develop and implement a media plan prior to placement of any media
buys.
Primary Activity #7
The Contractor shall update, at a minimum, annually an individualized training and technical
assistance plan (ITTP) in collaboration with the CDPHE approved Technical Assistance
provider(s).
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 obtain guidance from the CDPHE Tobacco Communications Specialist
at a minimum, fifteen (15) days before the development and implementation of the media plan.
The media plan shall be approved by CDPHE before placement of media buys.
3. The Contractor shall use existing, customizable media materials. This information is located
on the CDPHE website http://cohealthresources.org/ and is incorporated and made part of this
Contract by reference. Should these existing materials not meet Contractor needs, a proposal
for the development of additional resources must be submitted by the Contractor, for approval
from the CDPHE Tobacco Program Point of Contact and STEPP Communications Specialist.
4. The Contractor shall use the following sources and approaches to assess the tobacco problem
as appropriate, all are incorporated and made part of this Contract by reference:
a. The Attitudes and Behaviors Survey (TABS) 2012, or most recent, found at
http://www.ucdenver.edu/academics/colleges/PublicHealth/community/CEPEG/TAB S/Page
s/TABS.aspx
b. Healthy Kids Colorado Survey found at
http://www. ucdenver.edu/academics/colleges/Pub licHealth/community/CEPEG/Uni fYouth/
Pages/HealthyKidsSurvey.aspx
c. Counter Tools and Synar Compliance Data found at http://audit.countertobacco.org/ and
http://www.mapsportal.org/unc/tobaccomap/cotob/
d. FDA Store Audits found at
http://www. fda.gov/TobaccoProducts/GuidanceComp I ianceRegulatoryI nformation/ucm23 2
109.htm
e. Focus Groups studies
f. Observational studies, including Photo Voice
g. Key Informant interviews
5. The Contractor shall participate in at a minimum, one (1) consultation meeting with the
CDPHE approved Technical Assistance Provider, as appropriate, to update an individualized
training and technical assistance plan, annually, for each required A35 strategy in the work
plan.
6. The Contractor shall engage a community taskforce or group that is made up of strategic
community leaders and those impacted by the proposed environmental tobacco change process,
which may include youth leaders, and power brokers from the community.
December 2015
Weld_ SOW Contract Amend.docx
Page 10 of 15
EXHIBIT D
7. The Contractor shall ensure that the environmental tobacco change campaign will include
community members, decision -maker and a media outreach and education component to
support the proposed environmental tobacco change.
8. The Contractor shall ensure that promotion of implementation and enforcement at a
minimum includes letters of thanks to decision makers and media for the passage of the policy
and implementation plans to the community.
9. The Contractor shall comply with and ensure that all work, including the work performed by
subcontractors, follows the requirements in the A35 Tobacco Goals Required and Optional
Strategies for Community and Cessation Initiatives. This document is incorporated and made
part of this contract by reference and is available on the following website:
https://www.https://www.colorado.gov/pacific/sites/default/files/PW A35 Tobacco -2016-
2018 -strategies Apr2016.pdf
the following as
Programs
Use and
and Affordable
and Clinical Health
Contract by reference
10. The Contractor shall ensure that all work follows best practices using
required resources: CDC's Best Practices for Comprehensive Tobacco Control
2014, US Public Health Service Clinical Practice Guideline: Treating Tobacco
Dependence - 2008 Update. All work must align with the Patient Protection
Care Act (ACA), and The Health Information Technology for Economic
Act (HITECH). These documents are incorporated and made part of this
and are available on the following websites:
http://www.cdc.gov/tobacco/stateandcommunity/best j,ractices/pdfs/2014/comprehensive.pdf
http://www.ahrq.gov/profess ionals/c l in icians-providers/guidel ines-
with health care
serving low-
municipal
Tobacco Goals
which arise in the
Statement of Work.
approach in order
use and exposure to
populations.
Tobacco Program
recommendations/tobacco/clinicians/update/treating tobacco use08.pdf
II. The Contractor shall prioritize work to promote tobacco change policies
systems, social service settings, municipal settings, and other applicable programs
SES and other priority populations.
12. The Contractor shall immediately inform STEPP of any tobacco control
ordinance and/or organizational policy issues that are aligned with the A35
Required and Optional Strategies for Community and Cessation Initiatives
Contractor's county and are not already covered under deliverables in this
The Contractor shall collaborate with STEPP in determining a local strategy
to promote environmental change processes to reduce tobacco initiation,
secondhand smoke among the Local Community's most tobacco- burdened
13. If the Evaluation Plan is updated, the Contractor shall inform the STEPP
Point of Contact within fifteen (15) days.
Expected Results of
Activity(s)
A strengthened, expanded or newly develop local policy leading to the reduction in prevalence
and incident of tobacco use among young adults (18-24).
Measurement of
Expected Results
Demonstrate the progress of primary activities as outlined in the work plan.
....... ....... .. � � »,.� � � .....:; ..._. ; �x.r r.... , ,_ _.... _............. .... __
Completion
Date t
Deliverables
1.The Contractor shall submit progress reports to the STEPP Tobacco
Program Generalist via mechanism provided by CDPHE, prior to the
report deadline.
No later than
October 15, January
15, April 15 and
July 15 of each
fiscal year.
Goal #4: Tobacco initiation among youth, especially high burden and low SES populations, decreases by fifty percent (50%)
in Colorado. (STEPP Goal 5)
Objective #1: No later than the expiration date of this Contract, the Contractor shall facilitate the adoption of a
Dccembcr 2015
Page 11 of 15
Weld_ S0W_ Contract Amend.docx
EXHIBIT D
comprehensive Tobacco -free Schools Policy utilizing the Essential Components of Effective Tobacco Prevention for Schools.
Primary Activity #1
The Contractor shall review communication and enforcement of school district tobacco free
schools policies.
Sub -Activities #1
1.The Contractor shall utilize a youth /adult task force model of community mobilization to
make needed Tobacco Free Schools tobacco policy change.
2. The Contractor shall educate the task force on best practices and evidence -based strategies
for supporting tobacco free environments in schools.
3. The Contractor shall identify at least four schools to implement comprehensive Tobacco
Free Schools Policy.
4. The Contractor shall involve the youth /adult task force, to assist with appropriate activities
such as conducting assessments, and educating the school district leadership on the TFS policy,
and the importance of adopting enhanced policy language.
5. The Contractor shall identify a team to complete the Tobacco Free Schools Policy Checklist.
6. The Contractor shall complete appropriate sections of the Tobacco Free Schools Policy
Checklist with the identified team.
7. The Contractor shall develop recommendations on communication and enforcement
implementation strategies for each school based on results from sections 2 and 3.
8. The Contractor shall evaluate the effectiveness of communication and enforcement strategies
for each school.
Primary Activity #2
The Contractor shall develop a revised and/or enhanced comprehensive Tobacco -free Schools
Policy for identified schools.
Sub -Activities #2
I. The Contractor shall utilize a local youth /adult task force model of community mobilization
to make needed TFS policy change.
2 The Contractor shall complete appropriate sections of the Tobacco Free Schools Policy
Checklist with the identified team.
3. The Contractor shall identify areas of strength and areas that require improvement in
comprehensive tobacco free schools policy.
4. The Contractor shall draft policy language to address areas for improvement in a
comprehensive tobacco free schools policy.
5. The Contractor shall build school district and community support for adoption of enhanced
policy language.
6. The Contractor shall encourage school district to take enhance policy language to the Board
of Education for adoption.
Primary Activity #3
The Contractor shall collaborate with community organizations, parents and school staff to
review, modify and implement existing classroom instruction health curricula to promote
tobacco cessation and prevention resources, utilizing STEPP approved evidence based tobacco
prevention strategies, including Not -On -Tobacco and Second Chance programs.
Sub -Activities #3
1. The Contractor shall complete appropriate sections of the Tobacco Free Schools Policy
Checklist with the identified team.
2. The Contractor shall identify areas of strength and improvement in current tobacco
prevention curricula implementation.
3. The Contractor shall identify and review research based health education curricula to address
VC MI
December 2015
Weld_ SOW_ Contract Amend.docx
Page 12 (74.15
EXHIBIT D
areas of improvement.
4. The Contractor shall build school district, school administration and community support to
implement identified research based health education curricula.
Primary Activity #4
The Contractor shall implement Not -On -Tobacco, the Second Chance Programs and/or other
STEPP approved research based health education curricula in existing health education
curricula.
Primary Activity #5
The Contractor shall review, update, and implement activities documented in a project
Evaluation Plan, at a minimum, annually.
Primary Activity #6
The Contractor shall develop and implement a media plan prior to placement of any media
buys.
Primary Activity #7
The Contractor shall participate in a minimum of two (2) STEPP approved trainings or capacity
building opportunities each State fiscal year.
Primary Activity #8
The Contractor shall update, at a minimum, annually an individualized training and technical
assistance plan (ITTP) in collaboration with the CDPHE approved Technical Assistance
provider(s).
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 evaluation plan shall include:
a. the participation of the Contractor in evaluation -related trainings and technical
assistance (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 in bi- monthly (every two months) meetings (or 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.
3. The Contractor shall obtain guidance from the CDPHE Tobacco Communications Specialist
at a minimum, fifteen (15) days before the development and implementation of the media plan.
The media plan shall be approved by CDPHE before placement of media buys.
4. The Contractor shall use existing, customizable media materials. This information is located
on the CDPHE website http://cohealthresources.org/ and is incorporated and made part of this
contract by reference. Should these existing materials not meet Contractor needs, a proposal
for the development of additional resources must be submitted by the Contractor, for approval
from the CDPHE Tobacco Program Point of Contact and STEPP Communications Specialist.
5. The Contractor shall utilize Technical Assistance from Rocky Mountain Center for Health
(RMC) to assist with providing TA on evidence based tobacco prevention strategies , and TFS
resources and to implement Second Chance.
6. The Contractor shall utilize Technical Assistance from American Lung Association of
Colorado to assist with providing TA on evidence based tobacco prevention strategies to
implement Not On Tobacco.
7. The Contractor shall utilize a diverse local youth /adult task force model of community
mobilization to make needed TFS policy change.
December 2015
Page 13 of 15
Weld SOW Contract Amend.docx
EXHIBIT D
8. The Contractor shall develop Tobacco -free Schools Policies that are consistent with
Colorado's Tobacco Free Schools Law and the Teen Tobacco Use Prevention Act.
9. The Contractor shall participate in at a minimum, one (I) consultation meeting with the
CDPHE approved Technical Assistance Provider, as appropriate, to update an individualized
training and technical assistance plan, annually, for each required A35 strategy in the work
plan.
10. The team to complete the Tobacco Free Schools Policy Checklist must be made up of local
health agency staff, school district staff, community members and parents.
11. The Contractor shall comply with and ensure that all work, including the work performed
by subcontractors, follows the requirements in the A35 Tobacco Goals Required and Optional
Strategies for Community and Cessation Initiatives. This document is incorporated and made
part of this contract by reference and is available on the following website:
https://www.https://www.colorado.gov/pacific/sites/default/files/PW A35 Tobacco -2016-
2018 -strategies Apr20 16.pdf
the following as
Programs
Use and
and Affordable
and Clinical Health
contract by reference
12. The Contractor shall ensure that all work follows best practices using
required resources: CDC's Best Practices for Comprehensive Tobacco Control
2014, US Public Health Service Clinical Practice Guideline: Treating Tobacco
Dependence - 2008 Update. All work must align with the Patient Protection
Care Act (ACA), and The Health Information Technology for Economic
Act (HITECH). These documents are incorporated and made part of this
and are available on the following websites:
http://www.cdc.gov/tobacco/stateandcommunity/best j,ractices/pdfs/2014/comprehensive.pdf
http://www.ahrq.gov/professionals/clinicians-providers/guidel ines-
municipal
Tobacco Goals
which arise in the
Statement of Work.
approach in order
use and exposure to
populations.
through CDPHE's
-evaluation of the
Tobacco Program
recommendations/tobacco/clinicians/update/treating tobacco use08.pdf
13. The Contractor shall immediately inform STEPP of any tobacco control
ordinance and/or organizational policy issues that are aligned with the A35
Required and Optional Strategies for Community and Cessation Initiatives
Contractor's county and are not already covered under deliverables in this
The Contractor shall collaborate with STEPP in determining a local strategy
to promote environmental change processes to reduce tobacco initiation,
secondhand smoke among the Local Community's most tobacco- burdened
14. The Contractor will be provided metrics, measures and a reporting tool
evaluation contractor. These data will be aggregated as part of the macro
grants program.
15. If the Evaluation Plan is updated, the Contractor shall inform the STEPP
Point of Contact within fifteen (15) days.
Expected Results of
Activity(s)
A strengthened, expanded or newly develop Tobacco free Schools Policy leading to a reduction
in tobacco initiation among high burden and low SES youth.
Measurement of
Expected Results
Demonstrate the progress of primary activities as outlined in the work plan.
..., ;
ompleti
Completion
Date
Deliverables
I.The Contractor shall submit progress reports to the STEPP Tobacco
Program Generalist via mechanism provided by CDPHE, prior to the
report deadline.
No later than
October 15, January
15, April 15 and
July 15 of each
fiscal year.
December 2015
Page 14 of 15
Weld_ S0W_ Contract Amend.docx
EXHIBIT D
V. Monitoring:
CDPHE's 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 ten (10) 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 contract monitor 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.
December 2015
Page 15 of 15
Weld_ SOW Contract Amend.docx
Exhibit E Budget
CDPHE
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 90127
Contractor Name
Weld County Department of Public Health and
Environment
Budget Period
July 1, 2016 - June 30, 2017
Project Name
Weld County Tobacco Control Program
Program Contact Name,
Title, Phone and Email
Rachel Freema, Program Supervisor, Hlth
Comm. Ping 970.304.6470 X 2385,
rtreeman@weidgov.com
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Director, Administrative Servi es 970.304.6410 X
2122, tgeiser@weidgovcon,
Expenditure Categories
Personal Services
Salaried Employees
Position Title/Employee
Name
Description of Work
Budget Item
Supports SOW
(Yes/No)
Gross or
Annual Salary
Fringe
Percent of
Time on
Project
Total Amount
Requested from
CDPHE
Health Education Specialist
II
0.80 FTE Health educator (12 mos) will coordinate
activities related to cessation, and tobacco free coalition;
including working with colleges, employers,
collaboration with community based organizations, and
the Weld County tobacco free coalition. Additional
duties are related to the paid and earned media.
Yes
$64,388.40
$25,066.40
80%
$71,563.84
Health Education Specialist
II
1.0 FTE Health educator (12 mos) will coordinate youth
prevention activities; including at risk young adults,
collaboration with community based organizations,
youth organizations, school administrators and
coordination of school based trainings and retailer
audits.
Yes
$54,937.43
$21,387.14
100%
$76,324.57
Health Educator I
0.75 FTE Health educator (12 mos) will coordinate youth
prevention activities; including at risk young adults,
collaboration with community based organizations,
youth organizations, school administrators and
coordination of school based trainings and retailer
audits.
Yes
$53,927.37
$20,993.93
75%
$56,190.97
Bilingual Health Education
Specialist
0.10 FTE Bilingual health educator (12 mos) will provide
cessation and other media campaign related resources in
Spanish and will conduct outreach to Spanish speaking
populations.
Yes
$64,127.43
$24,964.81
10%
$8,909.22
Division Director
0.01 FTE Division director (12 mos) will provide overall
program administration, budget management, and staff
supervision of 3.0 FTE tobacco staff.
Yes
$88,673.43
$34,520.57
1%
$1,231.94
Data and Evaluation
Specialist
0.01 FTE Data and evaluation specialist (12 mos and in -
kind) will provide evaluation assistance on all workplan
activities and evaluation coordination with the Weld
County Community Health Improvement Plan (CHIP).
Yes
$91,872.06
$35,765.79
1%
$1,276.38
Office Technician III
0.03 FTE will provide desktop publishing, design, and
other duties as required in fulfilling activitities.
Yes
$44,027.89
$17,140.06
3%
$1,835.04
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.
_
$0.00
Personal Services
Hourly Employees
Position Title/Employee
Name
Description of Work
Budget Item
Supports SOW
(Yes/No)
Hourly Wage
Hourly
Fringe
Total # of
Hours on
Project
Total Amount
Requested from
CDPHE
$0.00
Total Personal Services
$217,331.9T
Page 1 of 3
V. 1Jan 2013
Exhibit E Budget
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 90127
Contractor Name
Weld County Department of Public Health and
Environment
Budget Period
July 1, 2016 -June 30, 2017
Project Name
Weld County Tobacco Control Program
Program Contact Name,
Title, Phone and Email
Fiscal Contact Name, Title,
Phone and Email
Rachel Freema, Program Supervisor, Huth
Comm. Ping 970.304.6470 x 2385,
rfreeman@wemgov.com
Tanya Geiser, Director, Administrative Servi es 970.304.6410
2122, tgeiser@weldgov.com
Supplies & Operating Expenses
Item
Description of Item
Budget Item
Supports
SOW (Yes/No)
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; replacement
ink toners 1 @ $300). Printing supports all deliverables from 1 thru 8 in
the workplan.
Yes
$880.00
1
$880.00
Meeting Supplies
Food and beverages for youth and community meetings related to
objectives 1 thru 8 @ ($10 per person x 20 people per meeting per
month x 12 months = $2,400). Additionally, $120 for flatware and cups
and beverages ($10 per meeting per month x 12 months)
Yes
$210.00
12
$2,520.00
General Office Supplies
Paper, pens, lamination supplies, etc. Rate is calculated @ ($20 per
month x 12 months = $240) to support deliverables 1 thru 8 and 4
health educators.
Yes
$20.00
12
$240.00
Youth Coalition Gift Card
Incentives
Gift Card incentives to assist in the recruitment of youth coalition
members. (30 at $15.00 each = $450). Gift cards will be stored in a
secure location, checked out prior to use, and will be signed for by the
gift card recipient.
Yes
$15.00
30
$450.00
Signage
Tobacco -free school signage for 2 Weld County K-12 schools @ ($450
per school = $900).
Yes
$450.00
2
$900.00
Event Supplies
Visual displays, T -Shirts (to promote campaign messaging and make
volunteers easily accessible and identifiable), and printed materials will
be used to provide education to community members and K-12
students by illustrating the effectiveness of tobacco control policies on
reducing tobacco use. (Displays: $93.75 x 4 displays = $375; T-shirts:
$10.00 per person x 25 people = $250; Printed materials: 0.25 x 3,500 =
$875).
Yes
$1,500.00
1
$1,500.00
$0.00
Total Supplies
S6,490.00
Travel
Item
Description of Item
Budget Item
Supports
SOW (Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Mileage
4 health educators @ (120 miles per month x 0.52 cents per mile) for
within Weld County and required travel to CDPHE state meetings and
other trainings.
Yes
$0.52
5760
$2,995.20
$0.00
Page 2 of 3
V. 1 Jan 2013
Exhibit E Budget
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 90127
Contractor Name
Weld County Department of Public Health and
Environment
Budget Period
July 1, 2016 -June 30, 2017
Project Name
Weld County Tobacco Control Program
Program Contact Name,
Title, Phone and Email
Rachel Freema, Program Supervisor, Hlth
Comm. Ping 970.304.6470 x 2385,
rf reem a n@weldgov.com
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser, Director, Administrative Servi es 970.304.6410 x
2122, tgeiser@weldgov.com
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Travel
$2,995.20
Contractual
Subcontractor Name
Description of Item
Budget Item
Supports
SOW (Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Media- TBD
Purchase of paid media using radio, billboards, digital and social media
platforms that support activites related to objectives 1 thru 7 @
($1,076.25 x 3 media platforms (radio, outdoor, and digital) =
$3,228.75). Tobacco prevention ads will be utilized from CDPHE where
applicable.
Yes
$1,076.25
3
$3,228.75
Tobacco Free Weld County
Coalition
Supports monthly coalition meeting meals, purchase of paid media to
support coalition education activities and policy initiatives, and maintain
a coalition website in educating the public about the various strategies
around youth tobacco prevention. ($10pp x 15 participants at 12
meetings = $1,800, $900 x 2 media platforms (outdoor and digital(=
$1,800)
Yes
$3,600.00
1
$3,600.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Contractual
$6,828.75
SUB -TOTAL BEFORE INDIRECT
$233,645.92
Indirect
Item
Description of Item
Total Amount
Requested from
CDPHE
Negotiated Indirect cost
rate (Federal, State, or
CDPHE)
CDPHE negotiated indirect rate for 2016 = 36.49%; we would like to use our 2017 indirect rate for direct costs in
2017 once that rate has been determined.
$85,257.00
Indirect rate (other):
Indirect (modified or
additional base)
Total Indirect
$85,257.00
T(CITAL w
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V. 1 Jan 2013
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