HomeMy WebLinkAbout20151808.tiff RESOLUTION
RE: APPROVE CONTRACT AMENDMENT FOR TASK ORDER #1 FOR CHILD FATALITY
PREVENTION SYSTEMS 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 Contract Amendment for Task Order#1
for Child Fatality Prevention Systems 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, 2015, and ending June 30, 2016, with further terms and
conditions being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Contract Amendment for Task Order#1 for Child Fatality Prevention
Systems 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 amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 22nd day of June, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WE D COUNTY, COL RADO
ATTEST: dartAet) el
arbara Kirkmeyer, hair
Weld County Clerk to the Board -1-1•nn � n ' Mike Freeman, Pro-Tem
C7:71BY: 646,1 L) ®
D y Clerk to the Bo re ohm r, �___J — --
eN s.. i ASean P. Con y
APPROVED S TO FOI : f � ;;, �` (,/t61!
r,� Julie A. Cozad 460, liftel
County Attorney Vr • 117 --�
®(�T °� , , Steve Moreno
Date of signature: w
2015-1808
& :, 7�9 HL0047
1861 Memorandum
r y
r ' TO: Barbara Kirkmeyer, Chair
2 �=cou N T Y1. Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Executive Director
Department of Public Health & Environment
DATE: June 18, 2015
SUBJECT: Child Fatality Prevention System—Contract
Renewal
Enclosed for Board review and approval is a contract between the Colorado Department of
Public Health and Environment and the Board of County Commissioners of Weld County on
behalf of the Weld County Department of Public Health and Environment.
The Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes) established
the Child Fatality Prevention System (CFPS), a statewide, multidisciplinary, multi-agency effort
to prevent child deaths. Under this professional agreement, the WCDPHE will take the lead in
establishing and coordinating the local, multidisciplinary child fatality prevention review team.
The purpose of the review team is to review all preventable child deaths, identify trends, and
implement strategies to prevent future deaths from occurring.
The contract period is from July 1, 2015, through June 30, 2016. No new staff will be required to
meet the deliverables specified in the Statement of Work. CDPHE agrees to pay WCDPHE
$12,000.00 for services provided in this continuation contract.
This continuation contract was approved for placement on the agenda by the Board via pass-
around dated June 9, 2015.
I recommend approval of this Child Fatality Prevention System—Contract Renewal.
2015-1808
r
BOARD OF COUNTY COMMISSIONERS
PASS-AROUND REVIEW/WORK SESSION REQUEST
RE: Child Fatality Prevention System—Contract Renewal
DEPARTMENT: PUBLIC HEALTH & ENVIRONMENT DATE: June 9, 2015
PERSON REQUESTING: Mark E. Wallace, MD, MPH, Executive Director
Brief description of the problem/issue:
Enclosed for Board review and approval is the Child Fatality Prevention System continuation contract between
the Colorado Department of Public Health and Environment (CDPIIE) and the Weld County Department of
Public Health and Environment (WCDPHE).
The Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes) established the Child
Fatality Prevention System (CFPS), a statewide, multidisciplinary, multi-agency effort to prevent child deaths.
Under this professional agreement, the WCDPHE will take the lead in establishing and coordinating the local,
multidisciplinary child fatality prevention review team. The purpose of the review team is to review all
preventable child deaths, identify trends, and implement strategies to prevent future deaths from occurring.
The contract period is from July 1, 2015, through June 30, 2016. No new staff will be required to meet the
deliverables specified in the Statement of Work. CDPHE agrees to pay WCDPHE $12,000.00 for services
provided in this continuation contract.
Assistant Weld County Attorney, Frank Ilaug, has reviewed this contract and determined that its terms are
acceptable.
What options exist for the Board? (Include consequences, impacts, costs,etc. of options)
1. Declining this contract will disregard the mandates of the state legislature. refuse $12,000.00 in funding,
and hinder the possible prevention of children's deaths.
2. Approval of this contract will comply with state statutes, permit WCDPIIE to receive funding for services
provided, and allow for review and implementation of strategies to prevent child fatalities in Weld
County.
Recommendation: I recommend approval of this Contract Renewal.
Approve Schedule
Recommendation Work Session Other/Comments:
Barb Kirkmeyer,Chair
Mike Freeman, Pro-Tem mr
Steve Moreno
Sean P.Conway
Julie Cozad
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
FHLA-VIP MHP
DEPARTMENT OR AGENCY NUMBER
FAAA
CONTRACT ROUTING NUMBER
16 FHLA 80344
AMENDMENT FOR TASK ORDERS#1
This Amendment is made this27 day of May.2015,by and between the State of Colorado,acting by and through the
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT whose address or principal place of business
is 4300 Cherry Creek Drive South.Denver,Colorado 80246 hereinafter referred to as the"State";and,Board of
County Commissioners of Weld County.(a political subdivision of the state of Colorado),915 10i°Street.
Greeley,Colorado.80632-0758,for the use and benefit of the Weld County Department of Public Health And
Environment whose address or principal place of business is 1555 North 17th Avenue,Greeley.Colorado.80631
hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract,dated January 17,2012,with contract routing number 13 FAA 0051A.
Pursuant to the terms and conditions of the Master Contract,the parties entered into a Task Order Contract,dated
April 21,2014,with encumbrance number CT FHLA 2015000000000027,and contract routing number 15 FLA
68349.collectively referred to herein as the"Original Task Order Contract,whereby the Contractor was to provide
to the State the following:
Establish and coordinate local child fatality review teams to conduct systematic,comprehensive,
multidisciplinary reviews of all preventable child deaths to better understand how and why children die,to
identify trends,to improve systems and to implement strategies that may prevent future deaths.
The State promises to increase the amount of funds to be paid to the Contractor by Twelve Thousand Dollars,
($12,000.001 for the renewal term of one year,ending on June 30,2016,in exchange for the promise of the
Contractor to perform the increased work described herein.
NOW THEREFORE, in consideration of their mutual promises to each other,stated below,the parties hereto agree
as follows:
1. Consideration for this Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Amendment,and promises and agreements herein set forth.
2. It is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order
Contract,contract routing number 15 FLA 68349 which is by this reference incorporated herein. All terms,
conditions,and provisions thereof, unless specifically modified herein,are to apply to this Amendment as
though they were expressly rewritten,incorporated,and included herein.
3. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified,
altered,and changed in the following respects only:
A. This Contract Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract
identified by contract routing number 15 FLA 68349.This Amendment is for the renewal term of
July 1.2015,through and including June 30.2016.This Amendment modifies the Original Task
Order Contract by adding descriptive elements.The following provision modifications are
Page 1 of 4
Contract_Amendment_TaskOrder_01-2015
incorporated herein by this reference.
i. The following information shall be added as a supplement to page I of the Task Order
Contract:
a Contractor DUNS:075757955
b Classification: Subrecipient
ii. The following information shall be added as a supplement to Exhibit A,Additional
Provisions,of the Task Order Contract:
a This award does not include funds for Research and Development.
B. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified
by contract routing number 15 FLA 68349. This Amendment is for the renewal term of July 1,
2015,through and including June 30,2016. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Twelve Thousand Dollars
f$12,000.001 for an amended total financial obligation of the State of Twenty Seven Thousand
Dollars,($27,000.00). This is an increase of Twelve Thousand Dollars ($12.000.00)of the
amount payable from the previous term. The revised Statement of Work is incorporated herein
by this reference and identified as"Exhibit D". The revised Budget is incorporated herein by this
reference and identified as"Exhibit E".
The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original
Task Order Contract are reaffirmed.
4. The Effective Date of this Amendment is July 1.2015.or upon approval of the State Controller,or an
authorized delegate thereof,whichever is later.
5. Except for the Special Provisions and other terms and conditions of the Master Contract and the General
Provisions of the Original Task Order Contract,in the event of any conflict, inconsistency,variance,or
contradiction between the terms and provisions of this Amendment and any of the terms and provisions of
the Original Task Order Contract,the terms and provisions of this Amendment shall in all respects
supersede,govern,and control.The Special Provisions and other terms and conditions of the Master
Contract shall always control over other provisions of the Original Task Order Contract or any subsequent
amendments thereto. The representations in the Special Provisions to the Master Contract concerning the
absence of personal interest of state of Colorado employees and the certifications in the Special Provisions
relating to illegal aliens are presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR
ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED,BUDGETED,
AND OTHERWISE MADE AVAILABLE.
Page 2 of 4
Contract_Amendment_TaskOrder_01-2015
IN WITNESS WHEREOF,the parties hereto have executed this Amendment on the day first above written.
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR: STATE:
Board of County Commissioners of Weld County STATE OF COLORADO
(a political subdivision of the state of Colorado) John W. Hickenlooper,Governor
for the use and benefit of the
Weld County Department of Public Health and
Environment
n-L.4: 1)(y\
�, .�� By:
Signature of thorized fficer For the Executive Directo
DEPARTMENT OF PUBLIC HEALTH
JUN 2 2 2015 AND ENVIRONMENT
Date
Barbara Kirkmeyer
Print Name of Authorized Officer
Chair, Board of Weld County Commissioners
Print Title of Authorized Officer
PROGRAM APPROVAL:
ZIP5--2"--11/:7,07/42
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.
ST TE CONTROLLER
Rob t Jaros,CPA,M JD
By:
Date: (46115
Page 3 of 4
0200% /MO)Contract Amendment TaskOrder 01-2015
Amendment for Task Orders #1 for Child Fatality
Prevention System (CFPS) Contract
C!�� ag5ATTEST: GI '€1 BOARD OF COUNTY COMMISSIONERS
Weld r • my Clerk to the Bard WELD COUNTY, COL RADO
BY'
:eputy CIS rk to he =o < j� rbara Kirkmeyer, hair Aim yl 2015
21n/A 'ill A� %` :1�_�APPROVED AS TO SUBSTANCE:
Controller ` � r � Elected Official or Department Head
�
APPR AS TO NIA
Director of General Services
Coun y
02/6- /fogO
e
EXHIBIT D
STATEMENT OF WORK
To Original Contract Routing Number 15 FLA 68349
Contract Amendment # 1 Routing Number 16 FHLA 80344
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 & Environment
Term : July 1 , 2015-June 30, 2016
II. Project Description :
This project serves to support the Child Fatality Prevention Act (Article 20.5 of Title 25 , Colorado Revised
Statutes), which is a statewide, multi-agency effort to prevent child deaths. Pursuant to C . R.S . § 25-20.5-404-405 ,
local public health agencies, or agencies designated by local public health agencies, are required to establish and
coordinate local, multidisciplinary child fatality prevention review teams. The purpose of local child fatality
prevention review teams to conduct systematic, comprehensive, multidisciplinary reviews of child deaths to better
understand how and why children die. The child fatality review process uses a public health approach to identify
trends and patterns, to take action, to improve systems, and to implement strategies that may prevent future deaths
from occurring.
III. Definitions:
;1. . 1 . CDPHE — Colorado Department of Public Health and Environment
2 . CFPS — Child Fatality Prevention System
3 . FTP — File Transfer Protocol
4. SUID - Sudden Unexpected Infant Death
IV. Work Plan :
T/ -
ti Goal # 1 : Reduce the number of child deaths in Colorado due to the following causes: undetermined,
. unintentional injury, violence, motor vehicle incidents, child abuse and neglect, sudden unexpected infant deaths,
and suicide.
Objective # 1 : No later than the expiration date of this contract, the Contractor shall conduct individual, case-
specific, multidisciplinary reviews of child fatalities assigned to the local child fatality prevention review team.
. The Contractor shall conduct individual, case-specific, multidisciplinary reviews of child
Primary Activity fatalities assigned to the local child fatality prevention review team based on coroner' s
# 1 jurisdiction.
1 . The Contractor shall access the Death Certificate File Transfer Protocol ( FTP) Website
_� .. on a monthly basis to obtain death certificates for each child fatality assigned to the
t . local child fatality review team.
2 . The Contractor shall gather case records from the coroner' s office, law enforcement
agencies, department of human services, hospitals, and other agencies for each child
r fatality assigned to the local child fatality review team.
3 . The Contractor shall abstract critical data from case records and enter the data into the
Sub-Activities # 1 National Center Data Collection Website for each child fatality assigned to the local
child fatality review team .
4. The Contractor shall develop case summaries for the purpose of completing the
"Narrative" section ( Section M) of the National Center Data Collection Website for
each child fatality assigned to the local child fatality review team.
5 . The Contractor shall coordinate and facilitate local child fatality review team meetings
with multidisciplinary local child fatality review team members to conduct individual,
case-specific reviews of child fatalities for the purpose of discussing and identifying
Page 1 of 5
Contract Statement of Work — Exhibit D
Colorado Child Fatality Prevention System — 04/20/ 15
EXHIBIT D
prevention recommendations in the"Review Meeting Process"section(Section L)of
the National Center Data Collection Website.
6. No later two months after reviewing a child fatality,the Contractor shall complete data
entry for Sections A-N and click"Data entry completed"of the National Center Data
Collection Website for each child fatality assigned to the local child fatality review
team.
Objective#2: No later than the expiration date of this contract,the Contractor shall participate in statewide
efforts to implement the Colorado Child Fatality Prevention System(CFPS).
Primary Activity The Contractor shall promote evidence-based injury and violence prevention strategies.
#1
1. The Contractor shall provide input and vote on state-level prevention
recommendations to be prioritized by the CFPS State Review Team for the CFPS
annual legislative report.
2. The Contractor shall apply a public health approach to identify trends and patterns of
child fatalities using local child fatality prevention review team data reports.
Sub-Activities#1 3. The Contractor shall apply a public health approach to identify prevention strategies
and systems improvements to implement at the local level.
4. The Contractor shall implement evidence-based child fatality prevention strategies and
system improvements at the local level.
5. The Contractor shall complete the Prevention Strategies Tracking Form for any
prevention strategies and system improvements that are promoted and implemented at
the local level.
Primary Activity The Contractor shall participate in training opportunities facilitated by CFPS support staff at
#2 CDPHE.
1. The Contractor shall attend the annual local coordinator training hosted by CFPS
support staff at CDPHE.
Sub-Activities#2 2. The Contractor shall participate in web-based trainings facilitated by CFPS support
staff at CDPHE.
Primary Activity The Contractor shall participate in statewide evaluation of the Colorado CFPS and complete
#3 state-level data collection tools and surveys.
I. The Contractor shall complete and submit the Local CFPS Annual Survey on by
Sub-Activities#3 August 31,2015.
1. The content of electronic documents located on CDPI-IE and non-CDPHE websites and
information contained on CDPI-IE 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.
Standards and 2. The Contractor shall comply with the Child Fatality Prevention Act C.R.S.25-20.5-
404-409.This document is incorporated and made part of this contract by reference and
Requirements
is available on the following website http://www.sos.state.co.us/CCR/Welcome.do.
3. The Contractor shall adhere to processes and policies outlined in the Colorado Child
Fatality Prevention System(CFPS)Operations Manual to conduct individual,case-
specific review of fatalities; identify prevention recommendations;and enter
information regarding the child fatality into the National Center Data Collection
Page 2 of 5
Contract Statement of Work—Exhibit D
Colorado Child Fatality Prevention System—04/20/15
EXHIBIT D
Website.This document is incorporated and made part of this contract by reference
and is available on the following website
http://www.cochi ldfatalitvorevention.com/p/cfps-operations-manual.html.
4. Reviewable child fatalities include one or more of the following causes:undetermined
causes,unintentional injury,violence,motor vehicle incidents,child abuse/neglect,
sudden unexpected infant death(SUID),and suicide.
5. The Contractor shall maintain access and ensure the Local Child Fatality Prevention
Review Team Coordinator has login credentials to the Death Certificate File Transfer
Protocol(FTP)Website and the National Center Data Collection Website. This
website content is incorporated and made part of this contract by reference and is
accessible at https://www.cdrdata.org/auth/login.
6. CDPHE will assign child fatalities for review to the Contractor based on the coroner's
jurisdiction using the Death Certificate File Transfer Protocol(FTP)Website on a
monthly basis.This website content is incorporated and made part of this contract by
reference and is accessible at https://secft2.dphe.state.co.us/thinclient/Login.aspx.
7. The Contractor shall complete individual,case-specific,multidisciplinary reviews and
data entry of child fatalities in the National Center Data Collection Website.This
website content is incorporated and made part of this contract by reference and is
accessible at https://www.cdrdata.org/auth/login.
8. CDPHE will conduct quality assurance checks as defined on the Colorado Child
Fatality Prevention website on the data entered into the National Center Data
Collection Website for child fatalities reviewed by the Contractor.This information is
incorporated and made part of this contract by reference and is available on the
following website http://www.cochildfatalityprevention.com/.
9. The Contractor shall request technical assistance and training from the CFPS support
staff at CDPHE by completing and submitting an online form.This form is
incorporated and made part of this contract by reference and is available on the
following website http://www.cochildfatalitvprevention.com/p/contact-cfps-staff.html.
10. CDPHE will analyze and aggregate child fatality data and disseminate this data to the
Contractor in local child fatality prevention review team data reports. In addition,
CDPHE will provide information and resources for evidence-based injury and violence
prevention strategies and will make this information available on the Colorado Child
Fatality Prevention website. This information is incorporated and made part of this
contract by reference and is accessible at
http://www.cochildfatalityprevention.com/p/prevention-efforts.html.
l 1. The Contractor shall incorporate information from the Colorado Child Fatality
Prevention website on acceptable and approved uses of funding for child fatality,
injury,and violence prevention strategies when implementing local prevention
strategies.This website content is incorporated and made part of this contract by
reference and is accessible at http://www.cochildfatalitvprevention.com/p/prevention-
efforts.html.
12. The Contractor shall use the electronic Prevention Strategies Tracking Form located on
the Colorado Child Fatality Prevention website when tracking prevention strategies
and system improvements.This information is incorporated and made part of this
contract by reference and is available on the following website
http://www.cochildfatalityprevention.com/.
13. The Contractor shall notify CFPS support staff at CDPHE within thirty(30)calendar
Page 3 of 5
Contract Statement of Work—Exhibit D
Colorado Child Fatality Prevention System—04/20/15
EXHIBIT D
days of a change of the Local Child Fatality Prevention Review Team Coordinator
responsible for the performance of services provided under this contract.
I. Improved understanding of child fatality data in Colorado including circumstances,
risk and protective factors,trends,and patterns surrounding the child deaths
Expected Results 2. Identification of evidence-based prevention recommendations to prevent future child
of Activity(s) fatalities from occurring in Colorado.
3. Implemented and evaluated child fatality prevention strategies at the state and local
levels.
I. Sections A-N of the National Center Data Collection Website will be completed for
100%of child fatalities that occurred in Colorado and meets CFPS's review criteria
Measurement of within the local child fatality prevention review team's jurisdiction.
Expelled Results 2. Increased number of prevention strategies implemented at the state and local levels as
documented in the CFPS annual report,the Local CFPS Annual Survey,and the
Prevention Strate_•ies Trackin! Form.
Completion
,,. ..e Date
Deliverables 1. The Contractor shall complete entry of 2014 child fatality data into No later than
the National Center Data Collection Website for each 2014 child January 1,2016
fatality assigned to the local child fatality review team.
2. The Contractor shall complete entry of 2015 and 2016 child No later than
fatality data into the National Center Data Collection Website for two months after
each 2015 and 2016 child fatality assigned to the local child conducting the
fatality review team. child fatality
review meeting.
3. The Contractor shall submit the web-based Local CFPS Annual No later than
Survey provided by CDPHE electronically. August 31 ,2015
4. The Contractor shall provide input and vote on state-level No later than
prevention recommendations via a web-based survey provided by April 15,2016
CDPHE electronically.
5. The Contractor shall submit the online Prevention Strategies No later than
Tracking Form for any prevention strategies that are promoted and September 30,
implemented at the local level. 2015;January
31,2016;and
May 31,2016
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the Child Fatality Prevention System Technical Assistance and Prevention Coordinator.
Methods used will include a review of documentation determined by CDPHE to be reflective of performance to
include progress reports,invoices,data entered into the National Center Data Collection Website,and other fiscal
and programmatic documentation as applicable. The Contractor's performance will be evaluated at set intervals
and communicated to the contractor.A Final Contractor Performance Evaluation will be conducted at the end of
the life of the contract.
VI. Resolution of Non-Compliance:
The Contractor will be notified in writing within (15) calendar days of discovery of a compliance issue. Within
(30)calendar days of discovery,the Contractor and the State will collaborate,when appropriate,to determine the
Page 4 of 5
Contract Statement of Work—Exhibit D
Colorado Child Fatality Prevention System—04/20/15
EXHIBIT D
action(s) necessary to rectify the compliance issue and determine when the action(s) must be completed. The
action(s)and time line for completion will be documented in writing and agreed to by both parties. If extenuating
circumstances arise that requires an extension to the time line, the Contractor must email a request to the Child
Fatality Prevention System Technical Assistance and Prevention Coordinator and receive approval for a new due
date. The State will oversee the completion/implementation of the action(s)to ensure time lines are met and the
issue(s)is resolved. If the Contractor demonstrates inaction or disregard for the agreed upon compliance resolution
plan,the State may exercise its rights under the provisions of this contract.
Page 5 of 5
Contract Statement of Wodc—Exhibit D
Colorado Child Fatality Prevention System—04/20/15
Exhibit E Budget
CDPHE COLORADO
CO , Department of Public
Health b Environment •
PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM
Contract Routing# 16 FHLA 80344
Weld County Department of Public Health& Program Contact Name, edrnawwo,Director,Health co,n,num amn,
Contractor Name Education and Planning;990-30.6470ert
Environment Title,Phone and Email 2380;eaawwo@weidsov.com
Fiscal Contact Name,Title, Tanya Geiser,Director,Adm,nistnt,ve
Budget Period July I,2015,through June 30,2016 Phone and Email services;970-304-6410 eat 2122;
rreuer@weldrov.com
Project Name CFPS Phase Ill
Expenditure Categories
Personal Services
Salaried Employees
Budget Item Percent of Total Amount
Position Trtle/Employee Supports SOW Gross or Time on Requested from
Name Description of Work (Yes/No) Annual Salary Fringe Project CDPHE
Coordinator will facilitate local child fatality
prevention review team in examining preventable
child deaths to gain understanding of issue and
develop prevention methods.Coordinator will
coordinate and facilitate local CFR meetings,gather
case records,develop case summaries,enter data
into National Center Data Collection Website,
attend state CFPS trainings,provide input on state-
level prevention recommendations,and assist with
Public Health Nurse local prevention campaigns. Yes $ 67,141.50 $ 26,138.19 11.25% $ 10,496.00
Fringe benefits are 38.93%.Components included
are:1.45%551,.09%unemployment,.08%worker's
compensation,13.7%PERA,.33%life insurance,
12.13%health insurance,4.6%vacation,4.23%for
Fringe Detail holidays and 2.3%for sick leave.
Personal Services
Hourly Employees
Budget Item Total#of Total Amount
Position Title/Employee Supports SOW Hourly Hours on Requested from
Name Description of Work (Yes/No) Hourly Wage Fringe Project CDPHE
$0
TotalRronet Se rice(
WadingETrgeb.oanb) $ xqie9cale
Supplies&Operating Expenses
Budget Item Total Amount
Supports SOW Requested from
Item Description of item (Yes/No) Rate Quantity CDPHE
Food&supplies for review team meetings.Estimated 4 meetings at$15
Meeting Supplies per meeting. Yes $ 15.00 4 $60
Page 1 of 3
V.Ilan 2013
Exhibit E Budget
PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM
Contract Routing# 16 FHLA 80344
Weld County Department of Public Health& Program Contact Name, Eric Aalx°•Director,Health Communication,
Contractor Name Education and Planning;970-304-6470 ea[
Environment Title,Phone and Email 2380;eaahko@weideor.cmn
Fiscal Contact Name,Title, Tanya ceder,Director,Admminravve
Budget Period July 1,2015,through June 30,2016 Phone and Email semoa w0-304-Hmea n2:;
tgeiner@weidrov.com
Project Name CEPS Phase III
Travel
Budget Item Total Amount
Supports SOW Requested from
Item Description of Item (Yes/No) Rate Quantity CDPHE
$0
TOWTnvie .
Contractual
Budget Item Total Amount
Supports SOW Requested from
Subcontractor Name Description of Item (Yes/No) Rate Quantity CDPHE
$0
Total Contractual. BB
SUB-TOTAL BEFORE INDIRECT $ 10,556.00
Page 2 of 3
V.1 Jan 2013
Exhibit E Budget
PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM
Contract Routing# 16 FHLA 80344
Weld County Department of Public Health& Program Contact Name, EricAatto,Director,Health Communication,
Contractor Name Education and Planning;970-304-6470 ext
Environment Title,Phone and Email 2380;eutm@wewro,.com
Fiscal Contact Name,Title, Tanya Geiser,Director,Administrative
Budget Period July 1,2015,through June 30,2016 Services;970-304-6410 eat 2122;
Phone and Email treiser@wmldroccom
Project Name CFPS Phase Ill
Indirect
Total Amount
Requested from
Item Description of Item CDPHE
Negotiated Indirect cost
rate(Federal,State,or 2015 CDPHE contracted indirect rate=13.68%;we request that our indirect rate be changed in 2016 to our then
CDPHE) contracted indirect rate which at this time is unknown. $1,444
Indirect rate(other):
Indirect(modified or
additional base)
Total Lisa SUM
•
Page 3 of 3
V.1 Jan 2013
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