HomeMy WebLinkAbout20162791.tiffRESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR MATERNAL AND CHILD HEALTH (MCH)
PROGRAM 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 Maternal
and Child Health (MCH) Program between the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the Department of Public Health
and Environment, and the Colorado Department of Public Health and Environment, commencing
October 1, 2016, and ending September 30, 201 7,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 Maternal and Child Health (MCH) Program
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the 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 Acting Chair Pro-Tem 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 31st day of August, A.D., 2016.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTESTW1v , I ,:a, EXCUSED
Weld County Clerk to the Board
BY:
APP
Deputy Clerk to the Board
ounty Attorney
Date of signature:R ;VIC°
Mike Freeman, Chair
EXCUSED
bara Kirkmeyer
Steve Moreno
CC.: l-lLl OlW/TCC)
IC ! aOt tC
j
em
2016-2791
HL0048
Memorandum
TO: Mike Freeman, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: August 30, 2016
SUBJECT: Continuation Task Order Contract for the
FY16-17 Maternal and Child Health (MCH)
Program
Enclosed for Board approval is a Task Order Contract between the Board of County Commissioners of
Weld County on behalf of the Weld County Department of Public Health and Environment ("WCDPHE")
and the Colorado Department of Public Health and Environment ("CDPHE") for the Maternal and Child
Health (MCH) Program. The task order represents total funding for a one year renewal period and will
not exceed $319,054 for the period October 1, 2016, through September 30, 2017. The MCH program
encompasses two separate and distinct programs as described below.
Early Childhood Obesity Prevention
The Weld County Community Health Improvement Plan identified obesity prevention as a top priority
area to be addressed. The strategies in the Early Childhood Obesity Prevention Action Plan are to focus
closely upon the maternal and child population and be a voice for maternal and early childhood health
in existing partnerships and efforts. Evidenced based strategies to reduce early childhood obesity
include working with childcare centers to increase structured physical activity and breastfeeding
support, working with employers to accommodate breastfeeding employees, and promoting
community wide consistent messaging for preventing obesity. While childhood obesity rates among
low income children age 2-4 in Colorado have been slowly declining since 2012, they have remained
high in Weld County. In 2015, 7.3 percent of children age 2-4 were obese compared to 10.7 % in Weld
County. Childhood obesity increases the risk of developing a variety of health problems in adolescence,
and later in life.
Health Care Program for Children with Special Needs (HCP): Care Coordination
The HCP program provides services to Weld County children and youth with special health care needs
from birth to age 21, who have, or are at risk for, physical, developmental, behavioral or emotional
conditions. There are no financial or diagnostic criteria; services are provided at no cost to the family.
The HCP program provides information and resources, individual care coordination/case management,
access to primary and specialty care, and referral to community resources. This program also facilitates
the development and enhancement of community -based systems of care for children and youth with
special health care needs. Services provided will include interagency collaboration, consultation, and
community involvement.
This contract was approved for placement on the Board's agenda via pass -around dated August 22,
2016. I recommend approval of this contract for Weld's Maternal and Child Health Program.
2016-2791
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 17 FHLA 92905
APPROVED TASK ORDER CONTRACT - WAIVER #154
This task order contract is issued pursuant to master contract made on 01/17/2012, with routing number 13 FAA 00051.
STATE:
State of Colorado for the use & benefit of the
Department of Public Health and Environment
Children Youth and Families
Maternal and Child Health
4300 Cherry Creek Drive South
Denver, CO 80246
CONTRACT MADE DATE: 7/21/2016
CORE ENCUMBRANCE NUMBER:
CT FAAA FHLA 201700001309
TERM:
This contract shall be effective upon approval by
the State Controller, or designee, or on 10/01/2016,
whichever is later. The contract shall end on 09/30/2018.
PROCUREMENT METHOD:
Exempt
BID/RFP/LIST PRICE AGREEMENT NUMBER:
NA
LAW SPECIFIED VENDOR STATUTE:
NA
STATE REPRESENTATIVE:
Heather Baumgartner
Maternal and Child Health Section Manager
Colorado Department of Public Health and
Environment
4300 Cherry Creek Drive South
Denver, CO 80246
CONTRACTOR:
Board of County Commissioners of Weld County (a political
subdivision of the state of Colorado), 915 10`h Street, Greeley,
CO 80632-0758 for the use and benefit of the Weld County
Department of Public Health and Environment
1555 North 17th Avenue
Greeley, CO 80631
CONTRACTOR DUNS: 075757955
CONTRACTOR ENTITY TYPE:
Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
STATUTORY AUTHORITY: NA
CLASSIFICATION: Sub -Recipient
CONTRACT PRICE NOT TO EXCEED: $319,054.00
FEDERAL FUNDING DOLLARS: $135,054.00
STATE FUNDING DOLLARS: $184,000.00
OTHER FUNDING DOLLARS:
Specify "Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY17: $319,054.00
PRICE STRUCTURE: Cost Reimbursement
CONTRACTOR REPRESENTATIVE:
Tanya Geiser
Weld County Department of Public Health
1555 North 17th Avenue
Greeley, CO 80631
PROJECT DESCRIPTION:
Implement population health strategies and provide services that will measurably impact the health and well-being of the MCH population.
17 FHLA 92905 OC.docx
Page 1 of 6
020/6-0e79/6)
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.)
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or
made more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of
this Task Order Contract provide more specificity than these general clauses, the more specific provision shall
control.
1. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including any
renewals or extensions, may not exceed five (5) years. The parties intend and agree that all work shall be
performed according to the standards, terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(1), C.R.S., as amended, this Task Order Contract is not valid until it
has been approved by the State Controller, or an authorized delegee thereof. The Contractor is not
authorized to, and shall not; commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date, then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date, then the Contractor shall only commence performance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract, unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its exhibits
17 FHLA 92905 OC.docx Page 2 of 6
and/or attachments), or between this Task Order Contract and its exhibits and/or attachments, such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: I) the
Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its
exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the
Additional Provisions - Exhibit A, and its attachments if included, to this Task Order Contract; 5) the
Scope/Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner, all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B" and "Exhibit C".
5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this
Task Order Contract's Statement of Work through a contract amendment. To be effective, the amendment
must be signed by the State and the Contractor, and be approved by the State Controller or an authorized
delegate thereof. This contract is subject to such modifications as may be required by changes in Federal or
State law, or their implementing regulations. Any such required modification shall automatically be
incorporated into and be part of this Task Order Contract on the effective date of such change as if fully set
forth herein.
6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope/Statement of Work -
Exhibit B, establishes or creates standards of performance greater than those set forth in the RFP, then the
Contractor shall also meet those standards of performance under this Task Order Contract.
7. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective
Date is on or after July I, 2009 and the maximum amount payable to Contractor hereunder is $100,000 or
higher]
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the
provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning
the monitoring of vendor performance on state contracts and inclusion of contract performance information
in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24-103.5-10I, 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
17 FHLA 92905 OC.docx
Page 3 of 6
prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result
by: (i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS
§24-105-102(6)), or (ii) under CRS §24-105-102(6), exercising the debarment protest and appeal rights
provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and
reinstatement of Contractor, by the Executive Director, upon showing of good cause.
8. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and
its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws,
state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be
amended. Without limitation, these federal laws and regulations include the Federal Funding
Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law
110-252, including without limitation all data reporting requirements required there under. This Act is also
referred to as FFATA.
17 FHLA 92905 OC.docx
Page 4 of 6
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
Board of County Commissioners of Weld County (a
political subdivision of the state of Colorado) for the use and
benefit of Weld County Department of Public Health and
Environment
Legal Name of Contracting Entity
B
Julie A. Cozad
STATE OF COLORADO:
JOHN W. HICKENLOOPER, GOVERNOR
For Executive Director
Print Name of Autho• ed Officer Department of Public Health and Environment
Signature of Authorized O leer
08131/2016
Date
Department Program Approval:
Acting Chair Pro—Tem By:
Print Title of Authorized Officer
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until
signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until
such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor
for such performance or for any goods and/or services provided hereunder.
By:
Date
17 Fl ILA 92905 DC.docx
STATE CONTROLLER:
,Robert Jaros, , PA, MBA, JD
/(( t4kia
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Page 5 of 6
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17 FHLA 92905 OC.docx Page 6 of 6
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 07/21/2016 CMS Task Order Routing Number 17 FHLA 92905
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
I. This Task Order Contract contains State and Federal funds (see Catalog of Federal Domestic Assistance
(CFDA) number 93.994).
2. The United States Department of Health and Human Services ("USDHHS"), through the Health Resources
and Services Administration ("HRSA") has awarded as of 04/18/2016 anticipated federal funds of
$7,450,860.00 under Notice of Cooperative Agreement Award, hereinafter "NCAA", number 6
B04MC29309-01-03 to perform the following — Maternal and Child Health Services.
If the underlying Award authorizes the State to pay all allowable and allocable expenses of a Contractor as
of the Effective Date of that Award, then the State shall reimburse the Contractor for any allowable and
allocable expenses of the Contractor that have been incurred by the Contractor since the proposed Effective
Date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable
and allocable expenses of a Contractor as of the Effective Date of that Award, then the State shall only
reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by
the Contractor on or after the Effective Date of this Task Order Contract, with such effective date being the
later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the
State Controller or delegee.
3. To receive compensation under the Contract, the Contractor shall submit a signed Monthly CDPHE
Reimbursement Invoice Form. This form is accessible from the CDPHE Internet website
https://www.colorado.gov/pacific/cdohe/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:
cdphe.psmchreports@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 costsharing and matching requirements unless
approved in writing by the appropriate federal agency.
4. Time Limit for Acceptance of Deliverables.
a. Evaluation Period. The State shall have Forty Five (45) 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.
Page 1 of 4
Cimtract_Exhibit-A_AdditionalProviaions_ CaskOrdcr 040715
EXHIBIT A
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable, or is otherwise deficient, then the State shall notify
the Contractor of the failure or deficiencies, in writing, within Fifteen (15) calendar days of: 1) the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable, the Contractor shall have a reasonable period of time, not to exceed Thirty (30)
calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within Thirty (30) calendar days, the Contractor shall be in default of its obligations under this
Task Order Contract and the State, at its option, may elect to terminate this Task Order Contract or
the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract.
5. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship under
HIPAA.
6. This award does not include funds for Research and Development.
7. If Contractor indicates full expenditure of funds under this Contract by June 30 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 June 30 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 June 30, CDPHE will reallocate unspent funds
without any penalties to the Contractor.
8. 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.
9. 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. Contractor shall submit a Budget Revision Request Form incorporated and
made part of this Task Order Contract by reference and located at www.mchcolorado.org. Any request for
modifications to the Budget in excess of twenty-five percent (25%) of the total budget for direct costs shall
be submitted to the State at least 90 days prior to the end of the contract period and may require an
amendment in accordance with General Provisions, Section 5, of this Task Order Contract.
10. The Contractor shall adhere to the same guidance as the State when considering food and beverage
purchases. Food or beverages may be purchased for events related to the MCH action plan such as training,
community meetings or events that engage external stakeholders, and/or multi -county regional meetings.
Title V and State General funds may not be used to purchase food or beverages while conducting routine
staff meetings and specialty clinics. Contact the MCH Generalist Consultant if guidance is necessary
11. Contractor shall retain and use all revenues generated by MCH Program for services in those programs.
The revenue cannot be used for other programs or purposes.
12. Title V, Section 504 (b) (6). Title V funds may not be used to pay for any item or service (other than an
Page 2 of 4
Contract_Exhibit-r\_r\dditionaWrovisions_TaskOrdcr_040715
EXHIBIT A
emergency item or service) furnished by an individual or entity convicted of a criminal offense under the
Medicare or any State health care program (i.e., Medicaid, Maternal and Child Health, or Social Services
Block Grant Programs).
13. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in
Data, Documents and Computer Software or Other Intellectual Property, unless otherwise provided for, all
data collected or produced or derived exclusively from the Contractor's or subcontractor's work under this
Task Order Contract shall remain the sole property of the State, whether in individual, aggregate, identified
or de -identified form or any other form required by the State. To facilitate follow-up, research, surveillance
and evaluation, any such data collected, used or acquired shall be made available in any form required by
the State, to the State and any other entity designated by the State.
Any such data collected, used or acquired shall be used solely for the purposes of this Task Order Contract.
The Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell, or otherwise
make known any such data to unauthorized persons without the express prior written consent of the State or
as otherwise required by law. This includes a prior written request by the Contractor to the State for
submission of abstracts or reports to conferences, which utilize data collected under this Task Order
Contract.
Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or
work papers necessary to perform its duties under this Task Order Contract and in accordance with
professional standards.
14. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in
Data, Documents and Computer Software or Other Intellectual Property, or Section 23.i, General
Provisions, Media or Public Announcements, the State of Colorado, specifically the Department of Public
Health and Environment, shall be the owner of all printed materials, graphic representations, educational
materials, audio-visual products, or any other media, in whatever form, created under this Task Order
Contract. This requirement applies, but is not limited to, any brochure, flyer, presentation, billboard, radio
spot, website, banner advertisement. The State reserves the right to require logos, or other wording on any
material, representation, product or other media form created under this Task Order Contract.
Any material, representation, product or other media form that will use the State's or logo or information
must be approved by the State prior to production and distribution. A minimum of ten (10) business days is
required for the review and approval process.
15. Contractor agrees to provide services to all Program participants and employees in a smoke free
environment in accordance with Public Law 103-227, also known as "the Pro -Children Act of 1994", (Act).
Public Law 103-227 requires that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or regularly for the provision of health, day care,
early childhood development services, education or library services to children under the age of 18, if the
services are funded by Federal programs either directly or through State or local governments, by Federal
grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in
indoor facilities that are constructed, operated, or maintained with such Federal funds. The law does not
apply to children's services provided in private residences; portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or
Medicaid; or facilities where Women, Infants and Children (WIC) coupons are redeemed. Failure to
comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty
of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the
responsible entity. By signing this Task Order Contract, Contractor certifies that Contractor shall comply
with the requirements of the Act and shall not allow smoking within any portion of any indoor facility used
for the provision of services for children as defined by the Act. Contractor agrees that it shall require the
language of the Act be included in any subcontracts which contain provisions for children's services and
that all subcontractors shall sign and agree accordingly.
Page 3 of 4
Contract]xhibit-A_AdditionalProvisions_ I'askOrdcr_040715
EXHIBIT A
16. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 10,
Confidential or Proprietary Information, the Contractor shall protect the confidentiality of all applicant or
recipient records and other materials that are maintained in accordance with this Task Order Contract.
Except for purposes directly connected with the administration of this Task Order Contract, no information
about or obtained from any applicant or recipient shall be disclosed in a form identifiable with the applicant
or recipient without the prior written consent of the applicant or recipient, or the parent or legal guardian of
a minor applicant or recipient with the exception of information protected by Colorado Statute as it applies
to confidentiality for adolescent services in which case the adolescent minor and not the parent or legal
guardian must provide consent or as otherwise properly ordered by a court of competent jurisdiction.
Contractor shall have written policies governing access, duplication, and dissemination of all such
information. Contractor shall advise its employees, agents, servants, and any subcontractors that they are
subject to these confidentiality requirements.
17. The State may require continued performance for a period of up to 4 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
Attachment A -I. 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 5 years. (Note: 5 years is the
maximum allowable.)
18. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding
Letter substantially equivalent to Attachment A-2. The Grant Funding Change Letter is not valid until it
has been approved by the State Controller or designee.
19. The Contractor shall not charge for services those individuals of families at or below the official poverty
guidelines, updated periodically in the Federal Register by the U.S. Department of Health and Human
Services under the authority of 42 U.S.C. 9902(2), in accordance with Title V, Section 501 (I) (B) and
Section 505 (5) (D). The most current version of this document is available on the MCH website:
www.mchcolorado.org and is incorporated and made part of this Task Order Contract by this reference and
the Health Care Program for Children with Special Health Care Needs (HCP) website
www.hcpcolorado.org and is incorporated and made part of this Task Order Contract by this reference. If
the State receives new poverty guidelines from the DHHS during the term of this Task Order Contract, the
State shall immediately update the guidelines on the MCH and RCP websites. The Contractor shall use
these new poverty guidelines, if any, when posted to the websites.
If any charges are imposed for services to clients who are above the one hundred percent (100%) of poverty
level, such charges must be on a sliding scale which takes into account the client's family size, income and
resources. These charges and the sliding fee scale must be made available to the general public and to all
clients and must be based on the agency's usual and customary cost for the service. Clients must
understand they shall not be denied services for inability to pay any of the sliding fee charges.
Page 4 01.4
Contract_1;xhibit-A_AddidonalProvisons_TaskOrdcr_040715
Attachment A-1
OPTION LETTER
Date:
State Fiscal Year:
Option Letter No.
CMS Routing #
CORE Encumbrance #
1) OPTIONS: Choose all applicable options listed
a. Option to renew only (for an additional term)
b. Change in the amount of goods within current
c. Change in amount of goods in conjunction
d. Level of service change within current term
e. Level of service change in conjunction with
f. Option to initiate next phase of a contract
2) REQUIRED PROVISIONS. All Option Letters
a. For use with Options 1(a -e): In accordance
in §1 and in §2 and delete the
term
with renewal for additional term
renewal for additional term
shall contain the appropriate provisions
with Section(s) of the
Name of Department or Higher
for an additional term beginning
in Section , AND/OR an
in Identify the Section, Schedule,
following: In accordance with
rest.
set forth below:
Original Contract routing number
Ed Institution , and Contractor's
Insert start date and ending on
increase/decrease in the amount of
Attachment, Exhibit etc.
Section(s) of the Original
of Department or Higher Ed
to initiate Phase indicate which
ending date at the cost/price
contract value is
New $ Amt to as consideration
Fiscal Year. The first
value including all previous
State Controller or
between the State of Colorado, Insert
Name, the State hereby exercises its option
Insert ending date at a cost/price specified
goods/services at the same rate(s) as specified
b. For use with Option 1(f), please use the
Contract routing number between the
Institution , and Contractor's Name, the State
Phase: 2, 3, 4, etc for the term beginning Insert
specified in Section
c. For use with all Options 1(a -f): The amount
State of Colorado, Insert Name
hereby exercises its option
start date and ending on Insert
of the current Fiscal Year
to a new contract value of Insert
for the current fiscal year indicate
accordingly. The total contract
$ Amt.
Letter is upon approval of the
increased/decreased by $ amount of change
for services/goods ordered under the contract
sentence in Section is hereby modified
amendments, option letters, etc. is Insert New
3) Effective Date. The effective date of this Option
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
PROGRAM APPROVAL:
By:
By: Lisa McGovern, Purchasing & Contracts Section
Director
Date:
ALL CONTRACTS REQUIRE APPROVAL 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, CPA, MBA, JD
By:
Date:
I Contract_OptionLetter 101915 Page 1 if 1
Attachment A-2
GRANT FUNDING CHANGE LETTER
Date:
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.
SUMMARY OF CHANGES
Document Type
CMS Routing
#
Funding Source
(federal, state, other)
Period
Dollar Amount
Period
Total
Original Contract
$
$
$
$
$
$
$
$
$
$
Contract Cumulative Grand Total
$
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or <insert projected effective date>,
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
PROGRAM APPROVAL:
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:
Date:
GFCL Attachment A-2.docx Page I of I
EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 17 FHLA 92905
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
1. Entity Name: Weld County Health Department
II. Project Description:
This project serves to develop, implement and evaluate evidence -based MCH Action Plans and HCP Care
Coordination services that contribute to the improvement of MCH performance measures and outcomes.
III. Definitions:
A. CDPHE — Colorado Department of Public Health and Environment
B. CDS — the state HCP-developed data system for documentation of clinic coordination, care coordination
and information only services for children and youth with special health care needs.
C. CYSHCN - children and youth with special health care needs
D. HCP — a program for children and youth with special health care needs
E. HCP Care Coordination — the state HCP-developed intervention model for providing care coordination
for families of children and youth with special health care needs.
F. HCP Consultants — the program staff for HCP who provide technical assistance, consultation and
training on HCP program components.
G. LPHAs - local public health agencies
H. MCH - maternal and child health
I. MCH Action Plans — action plans are work plans that Contractors select or develop to describe the goals,
objectives, key activities, persons responsible, and timelines of the MCH effort. Action plans may be
state -developed and related to the MCH priorities or may be developed by the Contractor.
J. MCH Generalist Consultants — the primary MCH Program staff who monitor MCH contracts and who
provide technical assistance and consultation to Contractors on program development and
implementation.
IV. Work Plan:
Goal #1: Optimize the health and well-being of mothers and children by employing primary prevention and early intervention
public health strategies.
Objective #1: No later than the expiration of the contract, identify and address maternal and child health needs within their
county jurisdiction to improve the health and well-being of mothers and children.
Primary Activity #1
The Contractor shall implement evidence -based strategies to improve maternal and child
health.
Sub -Activities #1
I. The Contractor shall implement each activity specified within the agency's CDPHE-
approved, customized action plan(s).
2. The Contractor shall engage in a minimum of one (1) training or technical assistance
opportunity to support community engagement strategies specific to MCH initiatives.
3. The Contractor shall participate in a minimum of three (3) check -in calls with their MCH
Generalist Consultant.
Primary Activity #2
The Contractor shall implement the HCP Model of Care Coordination for CYSHCN residing
within the Contractor's jurisdiction.
Page 1 of4
Contract Statement of Work— Exhibit B
May 2016
EXHIBIT B
Sub -Activities #2
1. The Contractor shall provide information and resources for community partners and families
of children and/or youth with special health care needs.
2. The Contractor shall participate in HCP statewide meetings via webinar every other month
as scheduled.
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 be guided by the MCH priority local action plans that correspond
with their selected priorities. This information is located on the MCH website
www.mchcolorado.org and incorporated and made part of this contract by reference.
3. The Contractor shall comply with MCH policies and guidelines. This information is
located on the MCH website www.mchcolorado.org and incorporated and made part of
this contract by reference.
4. The Contractor shall participate in consultation, technical assistance, oversight and
training by state HCP staff on HCP care coordination, including HCP documentation.
5. The Contractor shall use a medical home approach for CYSHCN.
6. The Contractor shall be guided by the by the Medical Home Policy Resource Document
available on the MCH website, incorporated and made part hereof by reference, and
located at www.mchcolorado.org.
7. The Contractor shall engage families with CYSHCN and community family leaders to
solicit consumer feedback when serving the CYSHCN population by referencing the
Reducing Barriers to a Medical Home Approach resource document available online on
the HCP website, incorporated and made part hereof by reference, and located at
www.hcpcolorado.org.
8. The Contractor shall perform work in accordance with the HCP Policy & Guidelines and
shall follow the policies, procedures, and program expectations set forth therein. Also
included in this document is the HCP model of care coordination. The HCP Policy &
Guidelines are located on the HCP web site at www.mchcolorado.org. These forms are
incorporated and made part of this Contract by reference.
9. The Contractor shall complete all required data documentation in CDS, the state HCP-
developed data system for documentation of Clinic Coordination, Care Coordination and
Information services, for HCP services in accordance with the HCP Policy & Guidelines.
The HCP Policy & Guidelines are located on the HCP web site at www.hcpcolorado.org.
These forms are incorporated and made part of this Contract by reference.
10. The Contractor shall designate appropriate personnel to attend scheduled HCP statewide
meetings, HCP annual meetings, and quarterly scheduled activities for local HCP staff to
promote learning and increase skills, as organized by the CDPHE HCP Program.
11. The Contractor shall use the HCP Electronic Planning Forms and Budgets located on the
MCH website at www.mchcolorado.org. These forms are incorporated and made part of
this Contract by reference.
Expected Results of
Activity(s)
Increase or maintain the health status and needs of the maternal and child population within the
Contractor's jurisdiction.
Measurement of Expected
Results
1. Quantitative analysis of quarterly and annual reports.
2. The Contractor meets a minimum of ninety percent (90%) of their information and
resource target in their annual HCP Electronic Planning Form.
3. The Contractor meets a minimum of ninety percent (90%) of their care coordination target
Page 2 of 4
Contract Statement of Work— Exhibit B
May 2016
EXHIBIT B
in their annual HCP Electronic Planning Form.
4. Data contained in CDSprovides documentation of the care coordination services provided.
Completion Date
Deliverables
I. The Contractor shall submit via email to the MCH Generalist
Consultant the MCH-HCP Annual Report, using a CDPHE-
provided template.
No later than
October 31,
annually
2. Early Childhood Obesity Prevention Priority: The Contractor shall
submit via email to the MCH Generalist Consultant a plan with
data measurements to execute breastfeeding-friendly resource and
policy adoption training/technical assistance for child care centers.
No later than Sept.
30, 2018
3. Early Childhood Obesity Prevention Priority: The Contractor shall
submit via email to the MCH Generalist Consultant a plan with
data measurements to execute training/technical assistance for
local businesses/employers on workplace accommodation for
nursing mother laws and related policy adoption.
No later than Sept.
30, 2017
4. Early Childhood Obesity Prevention Priority: The Contractor shall
submit via email to the MCH Generalist Consultant
documentation of having a) worked collaboratively with child care
center staff to establish desired and reasonable physical activity -
related goals based on the baseline assessment results, and b)
developed a plan to improve integration of structured physical
activity into lesson plans, curriculum, and policy.
No later than Sept.
30, annually
5. Early Childhood Obesity Prevention Priority: The Contractor shall
submit via email to the MCH Generalist Consultant
documentation of having implemented the early childhood obesity
messaging evaluation plan (using or adapting CDPHE tools) and
reporting findings to partners.
No later than Sept.
30, 2018
6. The Contractor shall submit via email to the MCH Generalist
Consultant three quarterly reports using a CDPHE-provided
template.
No later than the
15th of the month
for Jan., April, and
July for the duration
of the contract
7. The Contractor shall submit via email to the MCH Generalist
CDPHE-provided readiness tools to assess ability to begin or
continue work within individual MCH priorities.
No later than April
I, annually
8. The Contractor shall submit via email to the MCH Generalist
updated MCH action plans and budgets for the next contract
period to the CDPHE MCH Consultant. Action plans and budgets
must be determined acceptable to CDPHE upon review.
No later than June
13, annually
9. The Contractor shall submit via email to the MCH Generalist and
the HCP Consultant the electronic HCP Planning Form and
Budget for care coordination for the upcoming federal fiscal year.
No later than
June 13, annually
IV. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the Program's MCH Generalists and HCP Consultants. Methods used will include review
of documentation reflective of performance to include progress meetings, site visits, invoices, and data reports.
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.
Page 3 of 4
Contract Statement of Work — Exhibit B
May 2016
EXHIBIT B
V. Resolution of Non -Compliance:
The Contractor will be notified in writing within thirty (30) calendar days of discovery of a compliance issue.
Within forty-five (45) days, 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 require an extension to the time line, the Contractor must email a request to the MCH Unit
Manager and receive approval of 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 Remedies
section of the General Provisions of this contract.
Page 4 of 4
Contract Statement of Work— Exhibit B
May 2016
Exnibit C Budget
COLORADO
Department of Pubic
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 92905
Maternal and Child Health Planning Budget
Agency Name
Weld County Dept of Public Health & Environment
Budget Period _
October 1, 2016 -September 30, 2017
Identity the population for
this budget
ca
identify all action plans
related to this budget
Early Childhood Obesity Prevention
. Date Completed:
5.20.16
Program Contact Name, Title.
Phone and Email
Eric 'Sack:, Director, Health
Communication, Education & Planning
570.400.2380
eaakko@co.weld.co.us
Fiscal Contact Name, Title,
Phone and Email -
Tanya Geiser
Director, Administrative Services
(970)400-2122
tgeiser@co.weld.co.us
.,,Expenditure: Categories.''..
Personal Services
- Salaried: Employees
Total Amount
Requested from
CDPHE
Position Title
HC Supervisor
Description of Work
Supervises day-to-day activities of the ECOP grant
and workplan
Budget item
supports SOW
(Yes/No)
Yes
Gross or
Annual Salary
$68,828.80
Fringe
$26,795.05
Percent of Time
on Project
5.00%
$4,781.19
Health Communication
Spec
Plans, Coordinates, and Implements Weld ECOP
Action Plan
Yes
560,241.71
$23,452.10
70.75%
559.21337
Data Analyst
Coordinates ECOP workplan grant evaluation and
related data analysis
Yes
592,89L94
$36,162.23
5.00%
56,452.74
50.00
Personal Services - .
Hourly Employees
Position Title
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
$0.00
Total_PersonaiServices
(lnciuding fringe benefits)
70,447311Bat
Operating. Expenses -
Item
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Supplies & Materials
Miscellaneous office and other operating supplies and marketing mater
Yes
55.00
12
$60.00
Refreshments
Light refreshments for trainings to outside agencies
Yes
$5.00
12
$60.00
$0.00
TTotal Supplies
& Operatino Expenses
Page 1 of 2
V. 1.lan 2013
120110'
Exhibit C Budget
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 92905
Maternal and Child Health Planning Budget
Agency Name
Weld County Dept of Public Health & Environment
Budget Period
October 1, 2016 - September 30, 2017
Identify the population far
this budget
CA
Identify all action plans
related to this budget
Early Childhood Obesity Prevention
- `. --Date Completed:
5.20.16
. . --'
Program Contact Name..Title,
Phoneand Email._
Eric Aakko, Director, Health
Communication, Ecucation & Planning
970.40.2380
eaakko@co.weld.co.us
...
Fiscal Contact Name; Title;
Phone and Email- -
Tanya Geiser
Director, Administrative Services
(970) 400-2122
tgeiser@coweld.co.us
Travel
Item
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Mileage
Travel to meetings ar various sites, and particpace in various outreach
opportunities. Mileage is reimbursed at $.52/mile.
Yes
$0.52
258
$134.16
$0.00
tai Travel
Contractual.
Subcontractor Name
UNE NOT OPEN
Description of Item
Budget item
supports SOW
(Yes/No)
Rate I Quantity
Total Amount
Requested from
CDPHE
$0.00
$0.00
Tctal Contractual
SUB -TOTAL BEFORE'INDIREC7
470,7011. -
Indirect• f'
Item
Description of Item
Total Amount
Requested from
[DIME
Federally -negotiated
indirect cost rate
CDPHE-approved indirect
cart rate agreement CY16 CDPHE negotiated rate of 36.49% TOC - Health Ed Fixed
De minimis indirect cost
rate
$25,798.96
325',998.96'
TOTAL AMOUNT REQUESTED'FROM CDPHE.
$96,500
Page 2 of 2
V. '_Jan 2013
Exhibit C Budget
COLORADO
Department of Public
Health 8 Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 92905
Maternal and Child Health Planning Budget
Agency; Name. .
Web County Dept of Public Health & Environment
Budget Period _
October 1, 2016 - September 30, 2017
Identify the population for
this budget
CYSHCN - HCP Care Coordination (CC)
Identify all action plans
related tothis budget .
Date Completed: -' - 5/18/2016
Program PhContact Name, Ttland EmaR -.
onei
•
Amy Antuna RN, BSN, HCP
Supervisor 970-400-2322
aantuna@coweld.co.us
Fiscal Contact Name, Title ,
Phone and. Email.
Tanya Geiser Director, Administrative
Services (970) 400-2122
tgeiser@co.weld.co.us
- - Expenditure Categories — - - "
' .Personal Services
_ Salaried Employees _.
Position Title
Description of Work
Budget item
supports SOW
(Yes/No)
Gross or
Annual Salary
Fringe
Percent of Time
on Project
Total Amount
Requested from
CDPHE
PH Nurse Supervisor
PH Nurse
Social Worker
Office Techidan
Provides direct oversight and supervision of HCP
care coodination program and staff, directs care
coordination activities. oversees HCP support
group activities, participates in HCP program
outreach and represents HCP on several
community groups/coalitions, responsible for
reporting and evaluation of NC? program.
WCDPHE FTE is 1.0. Actual HCP program FTE is .95.
yes
570,897.14
$27,600.26
45.0%
$44,323.83
Provides are coordination services to HCP clients,
assists with HCP program outreach and attends
HCP community meetings. WCDPHE FTE is 1.0.
Actual HCP program FTE is 1.0.
Yes
$61,755.60
524,041.46
55.0%
547,188.38
Provides psychosocial are coordination services to
HCP clients, coordinates and facilitates monthly
HCP support group, HCP program outreach and
represents HCP on several community
groups/coalitions. WCDPHE FTE is L0. Actual HCP
program FTE is .8.
Yes
564,845.94
$25,244.52
50.0%
$45,045.23
Administrative support to HCP team.
Responsibilities include interpretation and
translation, CDS data entry, EMR data entry,
materials preparation, assists HCP staff with are
coordination activities,etc. WCDPHE FIE is 1.0.
Actual HCP program FTE is .8.
Yes
$36,595.09
$14,246.47
47.0%
$23,89553
PH Nurse - vacant
Provides care coordination services to HCP diems,
assists with HCP program outreach and attends
HCP community meetings. WCDPHE FIE 15.75.
Actual HCP program FTE is .5.
Yes
$54,751.31
$21,314.68
40.0%
530,426.40
50.00
Personal Services. `
Hourly Employees
Position Title
Description of Work
Budget item
supports SOW
(Yes/No)
Hourly Wage
Hourly Fringe
Total # of Hours
on Project
Total Amount
Requested from
CDPHE
Page 1 of 3
V. 11an 2013
Exhibit C Budget
COLORADO
Department of Public
Health 8- Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 92905
Maternal and Child Health Planning Budget
Y Agency Name
Weld County Dept of Public Health & Environment
Budget Period
October 1, 2016 - September 30, 2017
Identify the population for
_; this budget
CYSHCN - HCP Care Coordination (CC)
identify all action plans;
related to this budget `
- Date Completed:
5/18/2016
Program Contact Name, Tit14
Phone and Email -
Tr -
Amy Antuna RN, ESN, HCP
Supervisor 970-400-2322
aantwna@co.weld.co.us
Fiscal Contact Name, Title,
Phone Viand Email
Tanya Geiser Oirettor, Administrative
Services (970)400.2122
tgeiser@coweld.co.us
$0.00
So.00
1
-2TotalE(P.ersonafiSerViCeS
Cmduding fringe benefits)
$190,8)937 _.-
Supplies .& Operating Expenses
Budget item
supports SOW
(Yes/No)
Item
Description of Item
Rate
Quantity
Total Amount
Requested from
CDPHE
Supplies & Operating
Expenses
HCP program outreach, marketing, and systems building activities,
printing, postage, office supplies, computer services (network fees,
software, and printers), phone services, fadlity fees for official HCP
functions.
Yes
$22.00
12
$264.00
$o.00
Total Supplies
& Operation, Expenses
Travel
Item
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Mileage
MCH - HCP staff will travel to MCH/HCP meetings at various sites, and
participate in various outreach opportunities and client home visits
related to the HCP program. Annual HO' team travel is reimbursed at
$52/mile.
Yes
$052
199
$103.48
$0.00
Total Travel
Contractual
Subcontractor Name
Description of Item
Budget item
support SOW
(Yes/No)
Rate
Total Amount
Requested from
Quantity CDPHE
$0.00
Total Conirabtuaf
Page 2 of 3
V. 1 Jan 2013
$0.00
Exhibit C Budget
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 17 FHLA 92905
Maternal and Child Health Planning Budget
I .Agency Name
Weld County Dept of Public Health & Environment
Budget Period.
October 1, 2016 - September 30, 2017
Identify the: population for
- this budget
CYSHCN - HCP Care Coordination (CC)
Identify all action plans.
relatedrto this budget
DateCompletedt
5/18/2016
Program Contact Name, Title,
:'.
Phone and Email: -
Amy Antuna RN, BSN, HCP
Supervisor 970-400-2322
aantuna@co.wela.co.us
Fiscal Contact Name, TKIe,
Phone and Email
Tanya Geiser 0tractor. Administrative
Serv900-2122
(970) 900-2
tgeiser@m.weldco.us
SUB -TOTAL. BEFORE INDIRECT
$191,246.85-.
Indirect
Item
Description of Item
Total Amount
Requested from
CDPHE
Federally -negotiated
indirect cost rate
CDPHE-approved indirect 16.37% of TDC - CY16 CDPHE Negotiated Indirect Rate for Public Health Services aka Nursing
cost rate agreement
De minimis indirect cost
rate
531,307.11
Total In direct
TOTAL -AMOUNT REQUESTED FROM CDPHE
5222,554-.
Page 3 of 3
V. 1 Jan 2013
Esther Gesick
From: Tanya Geiser
Sent: Friday, September 23, 2016 1:05 PM
To: Hood - CDPHE, David
Cc: Heather Baumgartner - CDPHE; Sara Almon - CDPHE; Joel Pavelis - CDPHE; Skye
Turchado; Esther Gesick
Subject: RE: CDPHE-Weld County Department of Public Health -17 FHLA 92905 -Notification
Attachments: 17 FHLA 92905 Corrected Cover.pdf
Thank you for the revised cover page; we will substitute on our end.
From: Hood - CDPHE, David [mailto:david.hood@state.co.us]
Sent: Friday, September 23, 2016 12:22 PM
To: Tanya Geiser <tgeiser@co.weld.co.us>
Cc: Heather Baumgartner - CDPHE <heather.baumgartner@state.co.us>; Sara Almon - CDPHE
<sara.almon@state.co.us>; Joel Pavelis - CDPHE <joel.pavelis@state.co.us>
Subject: Re: CDPHE-Weld County Department of Public Health -17 FHLA 92905 -Notification
Good Afternoon,
The above contract end date has been corrected to match the two year Statement of Work, as this was written to be and is a multi -year
contract. Initially the end date was 9/30/17, it is now 9/30/18. I have attached a new Cover Page for your executed copy of the
contract. This does not affect any other part of the contract and no further action is needed on your end.
Please let me know if you have any questions or concerns.
Respectfully,
David Hood
Contract Administrator III
Prevention Services Division
P 303.692.6344
4300 Cherry Creek Drive South, Denver, CO 80246
david.hood@state.co.us J www.colorado.gov/cdphe
On Fri, Sep 16, 2016 at 3:20 PM, Hood - CDPHE, David <david.hood(astate.co.us> wrote:
Good Afternoon Ms. Geiser,
This email serves as notification of your FULLY EXECUTED Colorado Department of Public Health &
Environment (CDPHE) Task Order listed below:
Contractor Name: Weld County Department of Public Health
CMS Task Order Number: 17 FHLA 92905
Original CMS Contract Number: N/A
CORE CT Number: CT FAAA FHLA 201700001309
Division: Prevention Services Division (PSD)
Program Name: Children Youth and Families -Maternal and Child Health/CYF-MCH
1
Project Name: N/A
Reason for Contract: New Contract
Please "Reply to Sender" acknowledging the receipt of this email.
The Task Order listed above has been fully executed and you may begin work on October 1, 2016. An
original hard copy of the Task Order will be mailed to you soon.
Please contact me with questions or concerns. My contact information is listed below.
We want to hear from you.
As part of our contract improvement process, we're interested in how you think we're doing. Please click the link below to
take a quick survey that will provide valuable feedback on our process and customer service.
YOUR FEEDBACK IS APPRECIATED
Sincerely,
David Hood
Contract Administrator III
Prevention Services Division
P 303.692.6344
4300 Cherry Creek Drive South, Denver, CO 80246
david.hood@state.co.us I www.colorado.gov/cdphe
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