HomeMy WebLinkAbout20161703.tiff RESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR YOUTH SUBSTANCE ABUSE
PREVENTION INITIATIVE AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Task Order Contract for the Youth
Substance Abuse Prevention Initiative between the County of Weld , State of Colorado, by and
through the Board of County Commissioners of Weld County, on behalf of the Weld County
Department of Public Health and Environment, and the Colorado Department of Public Health
and Environment, commencing July 1 , 2016, and ending June 30, 2018, with further terms and
conditions being as stated in said task order contract, and
WHEREAS, after review, the Board deems it advisable to approve said task order
contract, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Task Order Contract for the Youth Substance Abuse Prevention
Initiative between the County of Weld , State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and the Colorado Department of Public Health and Environment, be and hereby is,
approved .
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said task order contract.
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: Wait/Li _1CaLle
Mike Freeman , Chair
Weld County Clerk to the Board •
fr
Sean P. Conway, Pro-Tem
ut Clerk to the Board ti� (?
-
P Y l
Julie A. Cozad %
APPROVED AS TO FORM :
-gei • ara Kirkmeye
f T •� /
County Attorney f`,; �1 •
r. . 432 a oreno
Date of signature: 1 ( 1 / 1G e. , s'o 1]
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"- L- 5T r . 2016- 1703
`� �� 1 - , I (2 HL0048
DecA-iNck- q
Aar Memorandum
• TO: Mike Freeman, Chair
�.___ N T Y Board of County Commissioners
ur
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: May 27, 2016
SUBJECT: Youth Substance Abuse Prevention Initiative
Task Order Contract
Enclosed for the Board's review and approval is a new Youth Substance Abuse Prevention
Initiative task order contract between the Colorado Department of Public Health and
Environment (CDPHE) and the Weld County Board of County Commissioners for the benefit and
use of the Weld County Department of Public Health and Environment (WCDPHE) .
CDPHE released a one-time non-competitive grant, funded from Colorado's marijuana tax, to
support local public health agencies. The funding will be used to support staff and efforts to
address youth substance abuse prevention, including marijuana, opioids (including heroin or
prescription drugs), and alcohol . This funding opportunity also aligns with our new strategic plan
priority areas and our Community Health Improvement Plan (CHIP) .
In early March, the Health Communications division of WCDPHE received approval from the
Board of County Commissioners to apply for this grant to support drug abuse prevention
including hiring a new 1.0 FTE Health Educator. This task order contract period is July 1, 2016,
through June 30, 2018. The first term of the contract will be from July 1, 2016, through June 30,
2017, and the funding for this term will be $ 199,527.00.
This contract was approved for placement of the Board's agenda via pass-around dated May 12,
2016. I recommend approval of this task order contract with CDPHE for the Youth Substance
Abuse Prevention Initiative.
2016- 1703
DEPARTMENT OF PUBLIC HEALTH AND
EN VIRON MIENT
CMS ROUTING NO. 17 FHLA 89340
APPROVED TASK ORDER CONTRACT - WAIVER # 154
This task order contract is issued pursuant to master contract made on 01/17/12, with routing number 13 FAA 00051.
STATE: CONTRACTOR:
State of Colorado for the use & benefit of the Board of County Commissioners of Weld County
Department of Public Health and Environment (a political subdivision of the state of Colorado)
Prevention Services Division 915 10th Street, Greeley, Colorado 80632-0758
Injury and Violence Prevention - Mental Health Promotion for the use and benefit of the Weld County Department of
4300 Cherry Creek Drive South Public Health and Environment
Denver, Colorado 80246 1555 North 17th Avenue, Greeley, Colorado 80631
CONTRACTOR DUNS 075757955
CONTRACTOR ENTITY TYPE
CONTRACT MADE DATE 4/ 10/2016 Political Subdivision Colorado
BILLING STATEMENTS RECEIVED:
CORE ENCUMBRANCE NUMBER
CT FAAAFHLA20 1 700000 1 42 Monthly
TERM STATUTORY AUTHORITY C.R.S. § 25-3 .5- 1001 through
1007 et al . (October 15, 2009)
This contract shall be effective upon approval by
the State Controller, or designee, or on 07/01/2016, CLASSIFICATION Sub-Recipient
whichever is later. The contract shall end on 06/30/2018.
CONTRACT PRICE NOT TO EXCEED $ 199,527.00
PROCUREMENT METHOD: FEDERAL FUNDING DOLLARS $0.00
Exempt STATE FUNDING DOLLARS $ 199,527.00
BID/RFP/LIST PRICE AGREEMENT NUMBER: OTHER FUNDING DOLLARS.
Not Applicable Specify "Other"
MAXIMUM AMO( NT AVAILABLE PER FISCAL YEAR:
LAW SPECIFIED VENDOR STATUTE: FY 17: $ 199,527.00
Not Applicable
STATE REPRESENTATIVE:
Ali Maffey, MSW
Policy and Communication Unit Supervisor
VIP - MI-LP Branch PRICE STRUCTt;RE: Cost Reimbursement
Prevention Services Division, A-4 CONTRACTOR REPRESENTATIVE:
4300 Cherry Creek Drive South Tanya Geiser
Denver, Colorado 80246 Administrative Services Director
1555 North 17th Avenue
Greeley, Colorado 80631
PROJECT DESCRIPTION .
Implement the "Communities that Care" model to identify evidence-based or evidence-informed youth substance abuse prevention strategies
and identify sustainable local or regional strategies for ongoing implementation of youth substance abuse prevention strategies
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EXHIBITS
The following exhibits are hereby incorporated:
Exhibit A - Additional Provisions (and any of its Attachments; e.g., A- 1 , A-2, etc.)
Exhibit B - Statement of Work (and any of its Attachments; e.g., B- 1 , B-2, etc.)
Exhibit C - Budget (and any of its Attachments; e.g., C- 1 , C-2, etc.)
Exhibit D - Grant Funding Change Letter
Exhibit E - Option Letter
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or
made more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of
this Task Order Contract provide more specificity than these general clauses, the more specific provision shall
control.
l . This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including any
renewals or extensions, may not exceed five (5 ) years. The parties intend and agree that all work shall be
performed according to the standards, terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202( I ), C.R.S., as amended, this Task Order Contract is not valid until it
has been approved by the State Controller, or an authorized delegee thereof. The Contractor is not
authorized to, and shall not; commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date, then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date, then the Contractor shall only commence performance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract, unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its exhibits
I7F FILA89440 11) docx Page 2 of 6
and/or attachments), or between this Task Order Contract and its exhibits and/or attachments, such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: l ) the
Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its
exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the
Additional Provisions - Exhibit A, and its attachments if included, to this Task Order Contract; 5) the
Scope/Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner, all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B" and "Exhibit C".
5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this
Task Order Contract's Statement of Work through a contract amendment. To be effective, the amendment
must be signed by the State and the Contractor, and be approved by the State Controller or an authorized
delegate thereof This contract is subject to such modifications as may be required by changes in Federal or
State law, or their implementing regulations. Any such required modification shall automatically be
incorporated into and be part of this Task Order Contract on the effective date of such change as if fully set
forth herein.
6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope/Statement of Work -
Exhibit B, establishes or creates standards of performance greater than those set forth in the RFP, then the
Contractor shall also meet those standards of performance under this Task Order Contract.
7. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective
Date is on or after July /. 2009 and the maximum amount payable to Contractor hereunder is $100, 000 or
higher/
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the
provisions of CRS §24- 102-205, §24- 102-206, §24- 103-601 , §24- 103.5- 101 and §24- 105- 102 concerning
the monitoring of vendor performance on state contracts and inclusion of contract performance information
in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24- 103.5- 101 , and State Fiscal Rules, Policies and Guidance.
Evaluation of Contractor's performance shall be part of the normal contract administration process and
Contractor's performance will be systematically recorded in the statewide Contract Management System.
Areas of review shall include, but shall not be limited to quality, cost and timeliness. Collection of
information relevant to the performance of Contractor's obligations under this Task Order Contract shall be
determined by the specific requirements of such obligations and shall include factors tailored to match the
requirements of the Statement of Project of this Task Order Contract. Such performance information shall
be entered into the statewide Contract Management System at intervals established in the Statement of
Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term. Contractor shall be notified following each performance and shall address or correct any identified
problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project, the Executive Director of the Colorado
Department of Personnel and Administration (Executive Director), upon request by the Colorado
Department of Public Health and Environment and showing of good cause, may debar Contractor and
I7F( li.A89440 To docx Page 3 of 6
I 1
prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result
by: ( i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS
§24- 105- 102(6)), or ( ii) under CRS §24- 105- 102(6), exercising the debarment protest and appeal rights
provided in CRS §§24- 109- l06, 107, 201 or 202, which may result in the reversal of the debarment and
reinstatement of Contractor, by the Executive Director, upon showing of good cause.
8. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and
its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws,
state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be
amended. Without limitation, these federal laws and regulations include the Federal Funding
Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law
110-252, including without limitation all data reporting requirements required there under. This Act is also
referred to as FFATA.
17FFILA8944o_ 'O docx Page 4 of 6
I
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR: STATE OF COLORADO:
JOHN W. HICKENLOOPER, GOVERNOR
BOARD OF COUNTY COMMISSIONERS OF WELD
COUNTY
for the use and benefit of the
Weld County Department of Public Health and
Environment
Legal Name of Contracting Entity
By: /(
Mike Freeman For Executi e Director
Print Name of Authorized Officer Department of Public Health and Environment
lenLkalate
Signature of Authorized Officer
JUN 0 1 2016
Date
Depart ent m Ap val:
Chair , Weld County Commissioners By:
Print Title of Authorized Officer
4
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until
signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until
such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor
for such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER:
Robert Jaros, CP • , BA, JD
By:
Date 6ba
I
I
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17FHLA89440_TO:docx Page 6 of 6
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 04/10/2016 CMS Task Order Routing Number 17 FHLA 89340
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
1 . This Task Order Contract contains state funds.
2. To receive compensation under the Contract, the Contractor shall submit a signed Monthly CDPHE
Reimbursement Invoice Form. This form is accessible from the CDPHE internet website
https://www.colorado.gov/pacific/cdphe/standardized-invoice-form-and-links and is incorporated and made
part of this Contract by reference. CDPHE will provide technical assistance in accessing and completing
the form. The CDPHE Reimbursement Invoice Form and Expenditure Details page must be submitted no
later than forty-five (45) calendar days after the end of the billing period for which services were rendered.
Expenditures shall be in accordance with this Statement of Work and Budget.
Scan the completed and signed CDPHE Reimbursement Invoice Form into an electronic document. Email
the scanned invoice with the Excel workbook containing the Expenditure Details page to: Ali Maffey,
MSW, Policy and Communication Unit Supervisor, ali.maffey@state.co.us
Final billings under the Contract must be received by the State within a reasonable time after the expiration
or termination of the Contract; but in any event no later than forty-five (45) calendar days from the
effective expiration or termination date of the Contract.
Unless otherwise provided for in the Contract, "Local Match", if any, shall be included on all invoices as
required by funding source.
The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless
4 approved in writing by the appropriate federal agency.
3. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty (30) calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable, or is otherwise deficient, then the State shall notify
the Contractor of the failure or deficiencies, in writing, within thirty (30) calendar days of: I ) the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable, the Contractor shall have a reasonable period of time, not to exceed thirty (30)
calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within thirty (30) calendar days, the Contractor shall be in default of its obligations under this
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Page 1 of 3
(:ontract_I •:xhibit-.1_.ldditionall'rovtsions_•Iask( )rdcr_040715
1
EXHIBIT A
Task Order Contract and the State, at its option, may elect to terminate this Task Order Contract or
the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract.
4. Health Insurance Portability and Accountability Act ( HIPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship under
HIPAA.
5. This award does not include funds for Research and Development.
6. If Contractor indicates full expenditure of funds under this Contract by March 3 I of each grant year and the
full expenditure does not occur, CDPHE has the option to reduce current or upcoming Contract by said
amount or a percent deemed reasonable by CDPHE. The State will notify the Contractor of the potential
need to decrease the current or upcoming budget. If the Contractor indicates at a later date than March 31
of each grant year an expectation of surplus of funds or inability to fully expend said funds for unforeseen
circumstances that Contractor had not anticipated by March 31 , CDPHE will reallocate unspent funds
without any penalties to the Contractor.
Upon receipt of timely written notice of an objection by the State for inability to fully expend funds, the
Contractor shall have a reasonable period of time not to exceed ten ( 10) calendar days to respond to the
action. If no dispute is received by the State within ten ( 10) calendar days, the State has the option to
reduce the current budget for the current year and any upcoming budget for future contractual agreements.
7. Contractor shall request prior approval in writing from the State for all modifications to the Statement of
Work/Work Plan or for any modification to the direct costs in excess of twenty-five percent (25%) of the
total budget for direct costs. Any request for modifications to the Budget in excess of twenty-five percent
(25%) of the total budget for direct costs shall be submitted to the State at least ninety (90) days prior to the
end of the contract period and may require an amendment in accordance with General Provisions. Section
16, Contract stdodifications. of this Contract.
8. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be
the owner of all equipment as defined by Federal Accounting Standards Advisory Board (FASAB)
Generally Accepted Accounting Principles (GAAP) purchased under this Contract. At the end of the term
of this Task Order Contract, the State shall approve the disposition of all equipment.
9. Contractor shall not use State funds provided under this Task Order Contract for the purpose of lobbying as
defined in Colorado Revised Statutes (C.R.S.) 24-6-301 (3.5)(a).
10. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding
Letter substantially equivalent to Exhibit D. The Grant Funding Change Letter is not valid until it has been
approved by the State Controller or designee.
11 . The State may require continued performance for a period of up to three (3 ) years at the same rates and
same terms specified in the Task Order Contract. If the State exercises the option, it will provide written
notice to Contractor at least 30 days prior to the end of the current contract term in a form substantially
equivalent to Exhibit E. If exercised, the provisions of the Option Letter shall become part of and be
incorporated into the original Task Order Contract. The total duration of this Task Order Contract,
including the exercise of any options under this clause, shall not exceed five (5 ) years. ( Note: 5 years is the
maximum allowable. )
12. The State may increase or decrease the quantity of goods/services described in Exhibit B based upon the
rates established in the Task Order Contract. If the State exercises the option, it will provide written notice
to Contractor as least 1 day prior to the end of the current contract term in a form substantially equivalent to
Exhibit E. Delivery/performance of the goods/service shall continue at the same rates and terms. If
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Contract_I{xhibir \ .\ddinonal Provisions_ I'ask( )rder_0440715
EXHIBIT A
exercised, the provisions of the Option Letter shall become part of and be incorporated into the original
Task Order Contract.
13. The State may require the contractor to begin performance on the next contact phase as outlined in the
Statement of Work in Exhibit B and at the same terms and same conditions stated in the Task Order
Contract. If the State exercises this option, it will provide written notice to the contractor at least 1 day prior
to the end of the current phase in a form substantially equivalent to Exhibit E. If exercised, the provisions
of the Option Letter shall become part of and be incorporated into the original Task Order Contract.
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(.ontract_I.:xhibit-.1_.\dditionalPrnvtsions_ l'ask( )rdcr_040715
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EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 17 FHLA 89340
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
Project Title: Youth Substance Abuse Prevention Initiative
Term: July 1 , 2016 through June 30, 2018
II. Project Description:
This project serves to implement the Communities That Care model, with fidelity, in order to identify evidence-
based or evidence-informed youth substance abuse prevention strategies in communities across Colorado.
Additionally, this funding supports communities to identify sustainable local or regional strategies and funding for
the ongoing implementation of youth substance abuse prevention strategies within each locality.
III. Definitions:
1 . Behavioral health: a continuum of services for individuals at risk of, or suffering from, mental, behavioral, or
addictive disorders, and behavioral health, and as a discipline, refers to mental health, psychiatric, marriage
and family counseling, and addictions treatment, and includes services provided by social workers,
counselors, psychiatrists, psychologists, neurologists, and physicians, as well as nurse practitioners and
physician assistants.
2. CDE: Colorado Department of Education
3. CDPHE: Colorado Department of Public Health and Environment
4. CTC or Communities That Care: an evidence-based community engagement model identified as a
promising program by the Blueprints for Healthy Youth Development evidence-based registry. Communities
that Care includes 5 Phases of implementation:
Phase 1 : Get Started
Phase 2: Get Involved
Phase 3: Develop Community Profile
Phase 4: Create a Plan
Phase 5: Implement and Evaluate
5. DCJ: Division of Criminal Justice,
6. LPHA: Local Public Health Agency
7. MCH: Maternal Child Health
8. OBH: Office of Behavioral Health at the Colorado Department of Human Services
9. Primary Prevention: As defined by the Centers for Disease Control's Principles of Prevention Guide,
primary prevention takes place BEFORE substance abuse initially occurs. It involves programs and strategies
designed to reduce the factors that put people at risk for substance abuse or exposure. Or, they encourage the
factors that protect or buffer people from substances.
10. PLC-WC: Weld County Prevention Partners Leadership Council
11 . PYD: Positive Youth Development is an approach that guides communities and organizations in the way that
they organize services, opportunities and supports. In practice, this approach incorporates the development of
skills, opportunities and authentic relationships into programs, practices and policies, so that young people
reach their full potential.
12. Socioecological model: CDC uses a four-level social-ecological model to better understand violence and the
effect of potential prevention strategies. This model considers the complex interplay between individual,
relationship, community, and societal factors.
13. State-funded prevention programs: Examples of state-funded prevention programs include the Tony
Grampsas Youth Services projects, sexual violence prevention programs, communities funded by the Office
of Suicide Prevention, LPHA Maternal Child Health, CDE grantees, collaborative management programs,
community substance abuse treatment programs funded by OBH, Senate Bill 94 programs, and other Division
of Criminal Justice programs.
14. Substance abuse: substance abuse among youth includes underage use of marijuana and alcohol and the
misuse of prescription drugs/opioids. Additional substances may be included in the definition of substance
version Contract Statement of Work Exhibit Page I of 8
A
EXHIBIT B
abuse by a community if they have documented data of misuse or abuse among youth in their community,
excluding tobacco.
15. TGYS: Tony Grampsas Youth Services grants for primary prevention programs in communities.
IV. Work Plan:
Goal #1 : Prevent substance abuse among youth within two (2) Weld County communities by addressing
common risk factors and improving protective factors across the socioecological model within Colorado.
Objective #1 : No later than December 31 , 2016, the Contractor shall negotiate and receive formal agreement
from key leaders and stakeholder groups within each community to implement the Communities That Care
(CTC) model to identify youth substance abuse prevention evidence-based strategies that address identified
risk or protective factors within the community.
The Contractor shall mobilize and build capacity among a coalition of stakeholders
Primary Activity through steps of the Communities That Care model, using data and priorities tailored by
#1 each individual community.
1 . The Contractor shall provide a full time Communities That Care facilitator for
each of the two (2) new Weld County communities.
2. The Contractor will utilize the existing Weld County Prevention Partners
Leadership Council (PLC-WC) as the Key Leader Board under this CTC grant.
3. The Contractor shall recruit key leaders from each new community (x2) to
participate in the existing PLC-WC, using guidance outline in the CTC model.
4. The Contractor shall recruit potential community board members to participate in
the each CTC coalition and provided with meals and snacks as appropriate, using
guidance outlined in the CTC model.
5. The Contractor shall recruit leaders of state-funded prevention and treatment
projects to participate in each community coalition, as available within the
communities.
6. The Contactor shall recruit a minimum of one ( I ) youth advisor and one ( 1 )
family leader to participate on one of the workgroups within each community
coalitions and incentivize their participation. Family leaders may include
graduates ofCDPHE's Family Leadership Training Institute.
Sub-Activities #1 7. The Contractor shall use group facilitation skills and tools provided by CTC to
help guide each coalition through the CTC process.
8. The Contractor shall prepare for and lead the CTC workshops for each
community for Phase I , in appropriate order and timing, for effective community
progress.
9. The Contractor shall hold regular meetings of each coalition, a minimum of one
( I ) meeting of each coalition or workgroup per month.
10. The Contractor shall complete the CTC Milestones & Benchmarks evaluation
tool for each community for Phase 1 , with the support of the coalitions.
1 l . The Contractor shall ensure each community coalition meeting preparation and
follow-up is completed.
12. The Contractor shall facilitate delegation of community prevention coalition
tasks, including but not limited to collecting, organizing, and analyzing data;
community outreach and public relations; and coalition meetings.
13. The Contractor shall train each community coalition to expand community
outreach.
T r _ ,7-,-;„•' -. -
Objective #2: No later than March 30, 2017, the Contractor shall complete an assessment and gap analysis of
youth substance abuse prevention concerns within each community.
Primary Activity The Contractor shall analyze local and regional data to identify gaps in prevention for
#1 youth substance use or abuse.
version Contract Statement of Work Exhibit Page 2 of 8
EXHIBIT B
1 . The Contractor shall review data about substance abuse and mental health risk and
protective factors in the community using a list provided by CDPHE of recommended
indicators. This shall include school-, district-, or regional-level data from the
Healthy Kids Colorado Survey.
2. The Contractor shall review and update information, as needed, to be included in the
existing local community health assessment as required in the Public Health Act of
2008, regarding youth substance abuse and mental health with members of each
coalition.
3. The Contractor shall prepare for and lead the CTC workshops for Phases 2-3 with
appropriate timing for effective community progress,
4. The Contractor shall complete additional assessments/data analysis to develop a clear
picture of gaps in youth substance abuse prevention within each community,
specifically related to shared risk and protective factors that prevent substance use.
5. The Contractor shall request data from members of each coalition to further analyze
gaps in local youth substance abuse prevention.
6. The Contractor shall request local or regional data from CDPHE released after the
completion of the existing community health assessment to further identify gaps or
Sub-Activities #1 concerns related to youth substance use, abuse, and prevention.
7. The Contractor shall engage community members to assess risk and protective factors
driving prioritized problems based on selected prevention priorities.
8. The Contractor shall map existing resources already in place within each community
to address the gaps identified in the data.
9. The Contractor shall analyze and summarize these assessment results in an updated
community health assessment brief using a CDPHE-approved template for the
substance abuse-related risk, protective and outcome data.
10. The Contractor shall present the results of the updated community health assessment
brief, a minimum of once during the first twelve ( 12) months of this Contract,
including members of each coalition and community.
11 . The Contractor shall facilitate the identification of a shared mission and vision of
coalition members, based on information from the updated needs assessment.
12. The Contractor shall complete the Phase 5 Trainings on Funding and Systems Change
with each coalition.
13. The Contractor shall complete the CTC Milestones & Benchmarks evaluation tool for
Phases 2-3 and related tasks in Phase 5, with the support of the coalitions.
Objective #3: No later than June 30, 2017, the Contractor shall develop a prevention action plan for each
community to implement primary prevention strategies to reduce risk and promote protective factors
addressing gaps in youth substance abuse prevention identified in the assessment.
The Contractor shall develop a prevention action plan for each community to address gaps
Primary Activity in youth substance abuse prevention identified in the assessment, to be implemented in
#1 years two through five of this Contract, using evidence-based or informed strategies from a
list approved by CDPHE.
version Contract Statement of Work Exhibit Page 3 of 8
EXHIBIT B
I . The Contractor shall build capacity of each community coalition members to
address alcohol, prescription drug, and marijuana use/abuse among youth by
providing a minimum of two (2) trainings designed for coalition members:
substances and impacts of their use on young people and positive youth
development principles and practices.
2. The Contractor shall determine ( in consultation with coalitions) the communities
appropriate for intervention within the prevention action plans.
3. The Contractor shall prepare for and lead the CTC workshops for Phases 4-5
with appropriate timing for effective community progress, with support from
CDPHE.
4. The Contractor shall develop a process for setting prevention priorities based on
updated assessment data from each community and the county health assessment
survey.
5. The Contractor shall identify existing prevention programs that can be leveraged
to address the strategies selected at each of the socioecological model levels,
including programs funded by CDE, MCH, TGYS, OBH or DCJ.
6. The Contractor shall identify (in consultation with each coalition) a minimum of
one ( 1 ) prevention strategy from both the societal and community levels of the
socioecological model to implement thus improving social norms, life skills and
Sub-Activities #1 resilience, and community connectedness. Strategies shall be selected from a
menu of prevention strategies to be provided by CDPHE.
7. The Contractor shall identify (in consultation with coalitions) action steps to
improve implementation of evidence-based prevention strategies from the menu
of prevention strategies at the individual and relationship levels of the
socioecological model for each participating community.
8. The Contractor shall develop a logic model that illustrates and connects the
problems each coalition will address, evidence-based strategies to address those
problems, and anticipated outcomes.
9. The Contractor shall work with community prevention coalition members,
members of the larger community and CDPHE to develop a comprehensive
community prevention action plan, using evidence-based or evidence-informed
strategies from the menu of prevention strategies to be provided by CDPHE.
10. The Contractor shall develop implementation budgets for the prevention strategies
identified by each coalition.
1 I . The Contractor shall identify process and outcome evaluation measures for each
action step and strategy to be implemented within the prevention action plans.
12. The Contractor shall complete the relevant sections of the CTC Milestones &
Benchmarks evaluation tool for each community for Phases 4-5, with the support
of the coalitions.
I • ..c' j{� 1. Rp-i}r rt t` il' iR 1 iitSn4.L{� ,•. .1 11.2'1
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K' ��F f P� rc•F i3\ -�i . Wx�e f,�. '.•.\ • 1.. 'ti' \ G I ;,
Objective #4: No later than June 30, 2018, the Contractor shall begin implementation of the substance abuse
prevention strategies within each community.
The Contractor shall document the implementation of a minimum of twelve ( 12) months of
Primary Activity completion of specific action steps and related evaluation measures from the prevention
#1 action plan, including successes and challenges each CTC coalition encountered while
implementing substance abuse prevention strategies within the community.
1
version Contract Statement of Work Exhibit Page 4 of R
EXHIBIT B
l . The Contractor shall be aware of and involved in the implementation of any
substance abuse prevention strategies within both communities to avoid
duplication.
2. The Contractor shall document successes or challenges encountered by each
communities' coalition members while implementing strategies.
3. The Contractor shall track progress toward implementation of the steps outlined
Sub-Activities #1 in each community prevention action plan.
4. The Contractor shall discuss edits and updates to the community prevention
action plan with the CDPHE contract monitor.
5. The Contractor shall complete the relevant sections of the CTC Milestones &
Benchmarks evaluation tool for each community for Phases 4 and 5, with the
support of each coalition.
t -.fR.:7i +i. • ,�YA.i} �,rgf ]t x l• r' a r < .41.E �ejr +f�-JeF- ♦ t r �`_``3. y .�i .ls. -.,fj �,•..-. t - .
1 3 41 f Cy 3 r r � a ? �;r d to i.e .,. �`�`.nr
__ •Y. .'.i •° s Jr -]ilr !1 �°"'.i,.'^.r� � 5Ge: T. ,. ; .• tY o
l . 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 participate in required technical assistance meetings conducted
by the CDPHE CTC team.
3. The Contractor shall facilitate and document the implementation of the five phases of
the Communities That Care model with fidelity, providing justification for necessary
adaptations. The five phases are described on the CTC website:
http://www.communitiesthatcare.net/how-ctc-works/, incorporated and made part of
this Contract by reference.
4. The Contractor shall ensure that the CTC Facilitator demonstrates the skills identified
in the CTC Facilitator job description provided by the University of Washington.
5. CDPHE will provide a list of recommended youth substance abuse and mental health
risk and protective factor indicators for each community to review for inclusion in the
updated community health assessment.
6. CDPHE will provide a menu of approved primary prevention strategies across the
socioecological model for implementation by communities. These strategies will be
based on the best available research and evidence for the prevention of substance
abuse.
Standards and 7. The Contractor shall select strategies for implementation in each community
Requirements prevention action plan from the menu of primary prevention strategies to be provided
by CDPHE with selection input from each community coalition and board members.
The Contractor shall employ, in each community, a minimum of one ( 1 ) strategy at
the community and one ( I ) strategy at the societal levels of the socioecological model.
8. The Contractor shall use the CDPHE-approved template for each community
prevention action plan.
9. CDPHE will review the following submitted items within five (5) business days of
receipt and provide feedback:
a. updated chapter for the community health assessment with recent data on risk
and protective factors related to youth substance use.
b. community prevention action plans and related evaluation activities.
10. The Contractor shall receive CDPHE approval for each community prevention action
plan prior to strategy implementation.
11 . The Contractor shall receive CDPHE approval for each community prevention action
plan prior to implementing evaluation strategies.
12. The Contractor shall submit any edits to each community prevention action plan to
CDPHE for approval.
13. The Contractor will adhere to all eCTC license agreement requirements.
14. The Contractor shall ensure all community facilitators using the eCTC system must
successfully complete the Facilitator Training and content mastery assignment in
advance of launching eCTC in their communities.
version Contract Statement of Work Exhibit Page 5 of 8
•
EXHIBIT B
a. To ensure high quality implementation of eCTC, this license assumes that
community facilitators have successfully completed a Facilitator Training
and content mastery assignment, and their communities are working with a
certified CTC coach.
i 5. The Contractor shall comply with the National Standards for Culturally and
Linguistically Appropriate Services in Health Care (CLAS Standards) website
http://www.integration.samhsa.gov/EnhancedCLASStandardsBlueprint.pdf as they
relate to health communications and is incorporated and made part of this Contract by
reference.
16. The Contractor shall utilize current substance abuse social marketing campaign
materials provided by CDPHE.
17. The Contractor shall use only marijuana research or statements on the health effects
outlined by the Retail Marijuana Public Health Advisory Committee.
18. These approved health statements and factsheets are incorporated and made part of
this Contract by reference and are available on the following website
www.colorado.gov/marijuana.
19. The Contractor shall attend identified trainings, including grantee orientation, the
Communities That Care model, effective facilitation strategies, positive youth
development, accessing data resources, prevention-science, and others as identified.
20. The Contractor shall use the CDPHE-approved progress and final report templates for
each community, to be provided by CDPHE, which includes the following
requirements:
a. Updates to the Milestones and Benchmarks process tracking document,
b. Number and description of community partners engaged in the coalition and
workgroups,
c. Evaluations of workshops, workgroups and coalition meetings,
d. Updates, progress, and outcome reporting on any prevention action plan steps
and related evaluation activities within the community prevention action
plans,
e. Opportunities and next steps for the program, and
f. Document a minimum of one ( I ) success story from the project.
2 I . The Contractor shall provide to CDPHE upon request written procedures related to
gift card purchase and handling. At a minimum, the procedures must include the
following:
a. How the gift card inventory is tracked and maintained
b. Gift card storage and safeguards against theft
c. The primary person responsible for securing and distribution gift cards,
d. A gift card distribution log that records each gift card number, dollar
amount, and the printed name and signature of each gift card recipient.
22. The Contractor shall provide CDPHE with an updated staff roster of CTC Facilitators
within two weeks of any staffing change.
23 . CDPHE will provide Healthy Kids Colorado Survey data at the regional level, where
available. www.chd.dphe.state.co.us/topics.aspx?q=Adolescent Health Data. This
information is incorporated and made part of this Contract by reference.
Reduce youth substance use and abuse through the implementation of the Communities
Expected Results That Care model and identified evidence-informed primary prevention strategies in
of Activity(s) communities across Colorado.
Final progress and outcome evaluation results, including:
a. documented CTC Milestones & Benchmarks
Measurement of b. community health assessment with analyzed data on risk and protective factors
Expected Results related to youth substance use
c. implementation of community prevention action plan, including evaluation
activities
version ( ontract Statement of Work Exhibit Page 6 of 8
EXHIBIT B
;Tat q� .: '' : i , . - i i� 4. 1S"= Yt s f C:
_t , . vw �7�4� ;:.fiVVVR� r' -.� 1- :: Completion Date
Deliverables 1 . The Contractor shall provide a monthly update for each No later than the
community via phone to the CTC Coordinator at CDPHE on the fifteenth ( 15th) of
progress of the activities and deliverables in the scope of work. each subsequent
The Contractor will include CTC Facilitators and Program month
Assistant on the monthly call for needed TA and coaching.
2. The Contractor shall provide completed "Milestones & No later than
Benchmarks" spreadsheet for each community via email to the December 31 ,
CTC Coordinator documenting completed activities for Phase I 2016.
of the CTC process.
3. The Contractor shall submit a mid-year progress report, No later than
outlining progress in each community, via email to the CTC December 31 ,
Coordinator following CDPHE guidance that provides an 2016.
overview of all activities implemented in the first six months of
funding.
4. The Contractor shall provide completed "Milestones & No later than
Benchmarks" spreadsheet for each community via email to the March 31 , 2017
CTC Coordinator documenting completed activities for Phases
2-3 of the CTC process.
5. The Contractor shall provide an updated community health No later than
assessment brief for each community via email to the CTC March 31 , 2017
Coordinator with recent data on risk and protective factors
related to youth substance use.
6. The Contractor shall submit community prevention action plans No later than June
for each community via email to the CTC Coordinator for 30, 2017
implementation in years two (2) through five (5) that addresses
the identified gaps found in the community health assessment.
7. The Contractor shall submit a first-year written narrative report No later than July
via email to the CTC Coordinator that provides an overview of 31 , 2017
all activities implemented in each community the first fiscal
year.
8. The Contractor shall submit a quarterly written narrative report No later than
via email to the CTC Coordinator that provides an overview of October 31 , 2017
all activities implemented in the first quarter of the second fiscal
year.
9. The Contractor shall submit an eighteen-month ( 18) written No later than
narrative report via email to the CTC Coordinator that provides January 30, 2018
an overview of all activities implemented in each community in
the first eighteen months of the contract.
10. The Contractor shall submit a quarterly written narrative report No later than
via email to the CTC Coordinator that provides an overview of April 30, 2018
all activities implemented in each community in the third
quarter of the second fiscal year.
11 . The Contractor shall submit a final written narrative report via No later than July
email to the CTC Coordinator that provides an overview of all 31 , 2018
activities implemented in each community in the second fiscal
year.
version Contract Statement of Work Exhibit Page 7 of 8
EXHIBIT B
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the CTC Coordinator. Methods used will include a review of documentation determined by
CDPHE to be reflective of performance to include progress reports and other fiscal and programmatic
documentation as applicable. The Contractor's performance will be evaluated at set intervals and communicated
to the contractor. A Final Contractor Performance Evaluation will be conducted at the end of the life of the
contract.
VI. Resolution of Non-Compliance:
The Contractor will be notified in writing within 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 CTC 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.
version Contract Statement of Work - Exhibit Page 8 of 8
r
EXHIBIT C
* CDPHE ' COLORADO
CO i Department of Public
• Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 89340
Contractor Name Weld County Department of Public Health and Program Contact Name, Leslie Beckstrom, HEAL Coordinator, (970) 304
Environment Title, Phone and Email 6470, Ext 2387; lbeckstrom@welgovcom
Fiscal Contact Name, Title, Tanya Geiser, Director of Administrative
Budget Period 7/01/2016 to 6/30/2017 Services, (970) 304-6420, Ext 2122;
Phone and Email tgeiser@weldgov.com
Project Name Weld County Youth Substance Abuse Prevention
Initiative
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 CDPHE
Health Ed Specialist II/LB CTC Community Facilitator Yes $58,707.00 $22,854.00 50% $40,780.50
TBD CTC Community Facilitator Yes $57,052.00 $22,210.00 100% $79,262.00
Tobacco Control Program Supervisor for the TBD 1.0 FTE CTC Community
Supervisor/RF Facilitator Yes $64,388.00 $25,066.00 20% $17,890.80
Administrative tasks, meeting agendas & minutes,
Program Assistant/ARC Yes $44,843.00 $17,457.00 20% $12,460.00
meeting logistics
Personal Services
Hourly Employees
Budget Item Total # of Total Amount
li Position Title/Employee Supports SOW Hourly Hours on Requested from
Name Description of Work (Yes/No) Hourly Wage Fringe Project CDPHE
$0.00
Total Personal Services
(including fringe benefits) $1CO,f,00
Supplies & Operating Expenses
Budget Item Total Amount
Supports SOW Requested from
Item Description of Item (Yes/No) Rate Quantity CDPHE
Community Coalition meats for up to 18 meetings during the year with
• Community Coalition 30 participants each meeting @ $390 per meeting. Meeting/training
Meeting Food schedule per CTC Implementation model. (18 meetings per year X 30 Yes $390.00 18 $7,020.00
members X $13.00 per person)
Community Coalition Community Coalition and workgroup snacks for 20 participants Yes $60.00 12
Workgroup Food attending 12 meetings during the year at $60 per session. $720.00
gi
Page 1 of 3
il
I
EXHIBIT C
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 89340
Contractor Name Weld County Department of Public Health and Program Contact Name, Leslie Beckstrom, HEAL Coordinator, (970) 304-
Environment Title, Phone and Email 6470, Ext 2387; lbeckstrom@welgov.com
Fiscal Contact Name, Title, ranya Geiser, Director of Administrative
Budget Period 7/01/2016 to 6/30/2017 Services, (9701 304-6420, Ext 2122;
Phone and Email tgeiser@weidgov.com
Project Name Weld County Youth Substance Abuse Prevention
Initiative
Community Board gift cards incentivizing 40 community members to
Community Member Gift participate in board and workgroup meetings. Broad-based coalition
Cards required under CTC Implementation model. (40 gift cards X $75.00 per Yes $75.00 40 $3,000.00
card)
Community Board gift cards to reimburse 8 community coalition
Community Coalition Gift members for costs related transportation, meal costs and parking for
p g Yes $25.00 8 $200.00
Cards required CDPHE-CTC required Key Leader Orientation training per CTC
Implementation model. (8 gift cards X 525 per card)
Youth coalition member gift cards incentivizing 8 youth to partipicate in
Youth Coalition Gift Cards the community coalitions. Youth participation required per CTC Yes $50.00 8 $400.00
Implementation model. (8 gift cards X $50 per card)
Office supplies and misc materials (such as, note pads, pencils, ink pens,
name tags, paper, dry erase markers, regular markers, and chart paper
Meeting Supplies Yes $51.00 12 5612.00
pads) for 12-18 community coalition and workgroup meetings. (12
months X $51 per month)
Total Supplies
& Operating_Exuens�es f .00
Travel
Budget Item Total Amount
Supports SOW Requested from
Item Description of Item (Yes/No) Rate Quantity CDPHE
Round-trip mileage for CTC Facilitators and Program Assistant to work
with specified community coalitions and workgroups; and to attend
Mileage Reimbursement required CDPHE-CTC trainings per CTC Implementation model. (4,500 Yes $0.52 4500 $2,340.00
miles X $0.52 per mile)
Hotel cost for CTC Facilitators to attend required training session in
CTC Facilitator Training Hotel Denver ($172/night X 2 facilitators X 3 days) per CTC Implementation Yes $172.00 6 $1,032.00
model.
Per Diem cost for CTC Facilitators to attend required training session in
CTC Facilitator Training Per Denver ($69/day X 2 facilitators X 3 days) per CTC Implementation
Diem pementation Yes $69.00 6 $414.00
model.
Hotel cost for CTC Facilitators and Program Assistant to attend required
Annual CTC Meeting Hotel training session in mountain resort area (TBD) ($150/night X 3 people X Yes $150.00 6 $900.00
2 days) per CTC grant staff.
•
Per Diem cost for CTC Facilitators and Program Assistant to attend
Annual CTC Meeting Per
required training session in mountain resort area (TBD) ($74/day Yes 574.00 6 $444.00
Diem
(average) X 3 people X 2 days) per CTC grant staff.
Page 2 of 3
,
EXHIBIT C
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 89340
Contractor Name Weld County Department of Public Health and Program Contact Name, Leslie Beckstrom, HEAL Coordinator, (970) 304
Environment Title, Phone and Email 6470, Ext 2387; Ibeckstrom@welgov.com
Fiscal Contact Name, Title, Tanya Geiser, Director of Administrative
Budget Period 7/01/2016 to 6/30/2017 Services, (970) 304-6420, Ext 2122;
Phone and Email tgeiser@weldgov.com
Project Name Weld County Youth Substance Abuse Prevention
Initiative
Key Leader Orientation Per Per Diem cost for CTC Facilitators to attend required training session in
Diem Denver ($17/day X 2 people) per CTC Implementation model. Yes $17.00 2 $34.00
Positive Youth Development Per Diem cost for CTC Facilitators to attend required training session in
Training Per Diem Denver ($17/day X 2 people) per CTC Implementation model. Yes $17.00 2 $34.00
Miscellaneous parking costs for CTC Facilitators and Program Assistant
Parking to attend required training sessions in Denver or TBD mountain resort Yes $12.00 7 $84.00
area (some are multiple days).
Total Travel
$5,282.0O
Contractual
Budget Item Total Amount
Supports SOW Requested from
Subcontractor Name Description of Item (Yes/No) Rate Quantity CDPHE
$0.00
Total Contractual
SOSO
SUB-TOTAL BEFORE INDIRECT $167,627.30
Indirect
Total Amount
Requested from
Item Description of Item CDPHE
Negotiated Indirect cost rate 19.03% indirect rate, per negotiated agreement with WCDPHE
(Federal, State, or CDPHE) $31,899.48
Indirect rate (other):
Indirect (modified or
additional base)
Total Indirect $31,899.48
TOTAL
•
$199,521
Page 3 of 3
•
. • /
EXHIBIT D
GRANT FUNDING CHANGE LETTER
Da
te: State Fiscal Year: Grant Funding Change CMS Routing #
Letter (GFCL) # CORE Encumbrance #
TO: <Insert Grantee's name>
In accordance with Section of the Original Contract routing number , [insert the following language here if
previous amendment(s), renewal(s) have been processed] as amended by [include all previous amendment(s). renewal(s) and
their routing numbers], [insert the following words here if previous amendment(s), renewal(s) have been processed] between the State
of Colorado, Department of Public Health and Environment and <insert contractor name> beginning <insert
start date of original contract> and ending on <insert ending date of current contract amendment>, the undersigned commits
the following funds to the Grant:
The amount of (federal, state, other) grant funds available and specified in Section of <insert previous
contract modification number and routing number> is ❑ increased or ❑ decreased by $ amount of change to new total
funds for the period <date to date> of $ <insert new period cumulative total> for the following reason:
Section is hereby modified accordingly. The revised Budget is incorporated herein by this reference and
identified as Revised Exhibit *. (if budget attached; delete sentence if no budget included.)
Complete the table below; insert/delete rows as needed.
The table below reflects the original budget and all modifications to the total since the effective date of the Original
Contract.
SUNIMARY OF CHANGES
Document Type CMS Routing Funding Source Period Dollar Amount Period
# ( federal. state. other) Total
Original Contract $ $
$ $
$ $
$ $
$ $
Contract Cumulative Grand Total $
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or <insert projected effective date>,
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR PROGRAM APPROVAL:
Department of Public Health and Environment
By:
By: Lisa McGovern, Purchasing & Contracts Section Director
Date:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Grants. This Grant is not valid until signed and dated below by the
State Controller or delegate. Grantee is not authorized to begin performance until such time. If Grantee begins performing prior
thereto, the State of Colorado is not obligated to pay Grantee for such performance or for any goods and/or services provided
hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By :
L)ate:
i o N
EXHIBIT E
OPTION LETTER
Date: State Fiscal Year: Option Letter No. CMS Routing #
CORE Encumbrance #
1 ) OPTIONS: Choose all applicable options listed in § 1 and in §2 and delete the rest.
a. Option to renew only (for an additional term)
b. Change in the amount of goods within current term
c. Change in amount of goods in conjunction with renewal for additional term
d. Level of service change within current term
e. Level of service change in conjunction with renewal for additional term
f. Option to initiate next phase of a contract
2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options 1 (a-e) : In accordance with Section(s) of the Original Contract routing number
between the State of Colorado, Insert Name of Department or Higher Ed Institution , and Contractor's
Name. the State hereby exercises its option for an additional term beginning Insert start date and ending on
Insert ending date at a cost/price specified in Section . AND/OR an increase/decrease in the amount of
goods/services at the same rate(s) as specified in Identify the Section, Schedule, Attachment. Exhibit etc.
b. For use with Option 1 (f), please use the following : In accordance with Section(s) of the Original
Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed
Institution , and Contractor's Name. the State hereby exercises its option to initiate Phase indicate which
Phase: 2, 3. 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price
specified in Section
c. For use with all Options 1 (a-f): The amount of the current Fiscal Year contract value is
increased/decreased by $ amount of change to a new contract value of Insert New $ Amt to as consideration
for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first
sentence in Section is hereby modified accordingly. The total contract value including all previous
amendments, option letters, etc. is Insert New $ Amt.
3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR PROGRAM APPROVAL:
Department of Public Health and Environment
By:
By: Lisa McGovern , Purchasing & Contracts Section
Director
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
( RS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below
by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins
performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or
services provided hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By
Date.
Hello