HomeMy WebLinkAbout20150494.tiff RESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR WOMEN'S WELLNESS CONNECTION
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 Women's
Wellness Connection Program 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 upon execution of signature, and ending June 29, 2015, 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 Women's Wellness Connection Program
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and the Colorado Department of Public Health and Environment, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said task order contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 18th day of February, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST lto��,c l EXCUSED
G. .X 1L Barbara Kirkmeyer, Chair
Weld County Clerk to the Board n
Mike Freeman, Pro-Tem 4.B n u°ycl kto he Bo .I Ed S
_-ean P. Conway
Iasi ��
APPROVED AS TO FOR ® �LrD i
/l ' ,r V curie A. Cozad
O1 r
County Attorney " ' / M,_2
g/a 7 Steve Moreno
Date of signature:
Lc; L(5Th )4(aa
2015-0494
HL0047
1861 Memorandum
1/ r. ! -
L� p TO: Barbara Kirkmeyer, Chair
r
GoCU'N T Yi Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Executive Director
Department of Public Health & Environment
DATE: February 12, 2015
SUBJECT: Women's Wellness Connection Targeted
Outreach Grant Program
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 Women's Wellness Connection (WWC) was established in 1991 by the Centers for Disease
Control. The main objectives of the program are to reduce breast and cervical cancer morbidity
and mortality rates and increase equity in screening, identification, and treatment of breast and
cervical cancer. The WCDPHE is a current recipient of WWC funding providing breast and
cervical cancer screening to qualifying uninsured and underinsured women age 40-64. Many
women in Colorado remain uninsured and are not receiving routine screenings for breast and
cervical cancer. There is a need for expanded outreach efforts to identify hard-to-reach women
in WWC's targeted population groups.
CDPHE's WWC program is offering WCDPHE grant funding in the amount of$29,318 beginning
February 16, 2015, until June 29, 2015. This funding opportunity allows WCDPHE to hire and
employ a full time Community Health Outreach Worker to recruit, screen, and schedule
qualifying women for WWC clinical services, provide a breast and cervical education and
awareness program in the community, and conduct a small media campaign encouraging
women to get recommended mammograms and cervical cancer screenings for prevention and
early cancer detection. Grant funding may continue for up to two years provided continued
funding availability and WCDPHE's ability to meet performance standards. Given the initial
shortened contract period of 4.5 months, it might be necessary to hire an independent
contractor for this start-up grant contract and proceed with hiring a full-time outreach worker
upon determining if funding will continue beyond this initial period.
Assistant Weld County Attorney, Frank Haug, has reviewed this contract and determined that
its terms are acceptable.
This contract was approved for placement on the agenda by the Board via pass-around dated
February 5, 2015.
I recommend approval of this contract. 2015-0494
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
CMS ROUTING NO.15 FHLA 75542
APPROVED TASK ORDER CONTRACT—WAIVER#154
This Task Order Contract is issued pursuant to Master Contract made 01/17/2012 with muting number U FAA 00051
STATE: CONTRACTOR:
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County
Department of Public Health and Environment (a political subdivision of the state of Colorado)
PSD-WWC 915 10th Street
4300 Cherry Creek Drive South Greeley,Colorado 80632-0758
Denver,Colorado 80246 for the use and benefit of the
Weld County Department of Public Health and
Environment
1555 North 17th Avenue
Greeley,Colorado 80631
TASK ORDER MADE.DATE: CONTRACTOR ENTITY TYPE:
12/24/2014 Colorado Political Sub Division
CORE ENCUMBRANCE NUMBER:
CT FHLA 2015000000000697
TERM: BILLING STATEMENTS RECEIVED:
This Task Order shall be effective upon approval by Monthly
the State Controller,or designee,or on 02/16/2015,
whichever is later. The Task Order shall end on
06/29/2015.
STATUTORY AUTHORITY:
No Applicable
PRICE STRUCTURE: CONTRACT PRICE NOT TO EXCEED:
Cost Reimbursement $29,318.00
PROCUREMENT METHOD:
Exempt/RFA STATE FUNDING DOLLARS:29,318.00
BID/REP/LIST PRICE AGREEMENT NUMBER: MAXIMUM AMOUNT AVAILABLE PER FISCAI.YEAR:
Not Applicable FY 15: $29,318.00
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE::
Emily Kinsella/Department of Public Health and Tanya Geiser,Administrative Services Director
Environment Weld County Department of Public Health and
PSD-W WC/Outreach Environment
4300 Cherry Creek Drive South 1555 North 17th Avenue
Denver,CO 80246 Greeley,Colorado 80631
SCOPE OF WORE
Increase outreach to WWC-eligible women,with an emphasis on prioritized populations,and to connect those women
to local breast and cervical cancer screening services at WWC-funded service delivery providers.
Contract_Template_Task_Order_070714 Page 1 of 6
EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A- Additional Provisions (and its attachments if any—e.g.,A-1,A-2,etc.)
Exhibit B- Statement of Work(and its attachments if any—e.g.,B-1,B-2,etc.)
Exhibit C- Budget(and its attachments if any—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
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: 1)the
Contract_Template_Task_Order_070714 Page 2 of 6
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 1, 2009 and the maximum amount payable to Contractor hereunder is S100,000 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-I01 and§24-105-102 concerning
the monitoring of vendor performance on state contracts and inclusion of contract performance information
in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract,State law,including CRS §24-103.5-101,and State Fiscal Rules,Policies and Guidance.
Evaluation of Contractor's performance shall be part of the normal contract administration process and
Contractor's performance will be systematically recorded in the statewide Contract Management System.
Areas of review shall include,but shall not be limited to quality,cost and timeliness.Collection of
information relevant to the performance of Contractor's obligations under this Task Order Contract shall be
determined by the specific requirements of such obligations and shall include factors tailored to match the
requirements of the Statement of Project of this Task Order Contract.Such performance information shall
be entered into the statewide Contract Management System at intervals established in the Statement of
Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term.Contractor shall be notified following each performance and shall address or correct any identified
problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project,the Executive Director of the Colorado
Department of Personnel and Administration(Executive Director),upon request by the Colorado
Department of Public Health and Environment and showing of good cause,may debar Contractor and
Contract_Template_Task_0rder_070714 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.
Contract_Template_Task_Order_070714 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:
STATE OF COLORADO:
Board of County Commissioners of Weld John W. Hickenlooper, GOVERNOR
County
(a political subdivision of the state of Colorado)
for the use and benefit of the
Weld County Department of Public Health and
Environment .
Legal Name of Contracting Entity ,' / �^""�
B
FEB 1 8 2015 3
For Executive Director
Date 11
Department of Public llealth and Environment
Signature of Authorized Officer
Mike Freeman
Print Name of Authorized Officer
t Pro r pro‘ .
Pro—Tem
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.
STATE CONTROLLER:
Robert Jaros,CPA,MBA,JD
By
Date 5(81.
Contract_Template Task Order070714 Page 5 of 6
Women's Wellness Connection Targeted Outreach
/�►t'4
�� � ,`Program
ATTEST: d , ► BOARD OF COUNTY COMMISSIONERS
Weld C.. ty Clerk tote { WELD COUNTY, COLORADO
Deputy CI k to the B Mike Freeman, Pro-Tem FEB 1 8 2015
I
APPROVED AS T FUNDING: APPROVED AS TO SUBSTANCE:
Controller Elected Official or Department Head
APPROVFQ AS TO FORM: Wei
Director of General Services
County Attorney
07C/.5 e V`>,`
This page left intentionally blank.
Contact_Template_Task_Order_070714 Page 6 of 6
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 12/24/2014 Contract Routing Number 15 FHLA 75542
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order
Contract specified above.
1. This Task Order Contract contains state funds
2. 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. Notwithstanding the terms contained in General Provisions of the Master Contract,Section 27,Annual
Audit,for the purpose of this Task Order,the Contractor is a Vendor as defined by Office of Management
and Budget(OMB)Circular A-133 (Audits of States,Local Governments,and Non-Profit Organizations).
4. To receive compensation under the Task Order Contract,the Contractor shall submit a signed Monthly,
CDPHE Reimbursement Invoice Form. This form is accessible from the CDPHE Internet website
httpJ/www.colorado.gov/cs/Satellite/CDPHE-Main/CBON/1251622941228 and is incorporated and made
part of this Task Order 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. The
Contractor shall submit the invoice using the address listed below.
Mail to:
Emily Kinsella,Women's Wellness Connection(WWC)and WISE WOMAN
Colorado Department of Public Health and Environment
PSD-A4-HSCB
4300 Cherry Creek Drive South
Denver,Colorado 80246
Emily.kinsella@state.co.us
Final billings under the Task Order Contract must be received by the State within a reasonable time after
the expiration or termination of the Task Order Contract;but in any event no later than thirty(30)calendar
days from the effective expiration or termination date of the Task Order Contract.
Unless otherwise provided for in the Task Order Contract,"Local Match",if any,shall be included on all
invoices as required by funding source.
The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless
approved in writing by CDPHE.
To be attached to CDPHE Page 1 of 4 Revised: 12/19/06
Task Order v1.0(3/12)contract template
EXHIBIT A
5. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty(30)calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable,except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable,or is otherwise deficient,then the State shall notify
the Contractor of the failure or deficiencies,in writing,within thirty(30)calendar days of: 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.
6. Health Insurance Portability and Accountability Act(HIPAA)Business Associate Determination.
The State has determined that this Task Order Contract does not constitute a Business Associate
relationship under HIPAA.
7. If Contractor indicates full expenditure of funds under this Task Order Contract by June 30th of each grant
year and the full expenditure does not occur,CDPHE has the option to reduce current or upcoming Task
Order Contract by said amount or a percent deemed reasonable by CDPHE.The State will notify the
Contractor of the potential need to decrease the current or upcoming budget. If the Contractor indicates at a
later date than March 31 of each grant year an expectation of surplus of funds or inability to fully expend
said funds for unforeseen circumstances that Contractor had not anticipated by March 31,CDPHE will
reallocate unspent funds without any penalties to the Contractor.
Upon receipt of timely written notice of an objection by the State for inability to fully expend funds,the
Contractor shall have a reasonable period of time not to exceed ten(10)calendar days to respond to the
action. If no dispute is received by the State within ten(10)calendar days,the State has the option to
reduce the current budget for the current year and any upcoming budget for future contractual agreements.
The State may require forms attached to this Task Order Contract and incorporated herein to be updated by
the Contractor during the term of this Task Order Contract. The State shall notify the Contractor of newly
developed forms. Forms are incorporated and made part of this Task Order Contract by reference and
To be attached to CDPHE Page 2 of 4 Revised: 12/19/06
Task Order v1.0(3/12)contract template
EXHIBIT A
located on http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251618366665 under
Administrative Forms tab.
8. 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.
9. 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.
10. 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
To be attached to CDPHE Page 3 of 4 Revised: 12/19/06
Task Order vl.0(3/12)contract template
EXHIBIT A
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.
11. 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.
12. The Contractor shall not use funds provided under this Task Order Contract for the purpose of lobbying as
defined in Colorado Revised Statutes(C.R. S.)24-6-301(3.5)(a).
13. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding
Letter substantially equivalent to Attachment A-I.The Grant Funding Change Letter is not valid until it
has been approved by the State Controller or designee.
14. The State may require continued performance for a period of up to August 2017 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-2. 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 August 2017.
15. The State may increase or decrease the quantity of goods/services described in Exhibit B based upon the
rates established in the Task Order Contract. If the State exercises the option,it will provide written notice
to Contractor as least 1 day prior to the end of the current contract term in a form substantially equivalent to
Attachment A-2.Delivery/performance of the goods/service shall continue at the same rates and terms.If
exercised,the provisions of the Option Letter shall become part of and be incorporated into the original
Task Order Contract.
To be attached to CDPHE Page 4 of 4 Revised: 12/19/06
Task Order v1.0(3/12)contract template
Attachment A-1
GRANT FUNDING CHANGE LETTER
Date: State Fiscal Year: Grant Funding Change Letter# CMS Routing#
TO: >Insert Grantee's name< [including entity type: not-for-profit,political subdivision,etc.The name and entity type
should exactly duplicate the original contract or modification that changed the name.]
In accordance with Section of Exhibit A, Additional Provisions >Choose an item<, 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 word here if previous
amendment(s), renewal(s)have been processed] between the State of Colorado, Department of Public Health
and Environment and <Contractor's Name> beginning <Insert start date of original contract> and ending
on <Insert ending date>, the undersigned commits the following funds to the Grant:
The amount of[state/federal/foundation/tax rebate]grant funds available and specified in >Choose an
item< of <insert contract amendment number and routing numbers is by$<amount of change for
this source>[insert semi-colon and repeat the previous text(starting from"the"}for each type of funds being modified;
ensure that the correct fund type(federal,state,etc.)is inserted each time.]to new total funds for the period
through of$<total new amount for the period>for the following reason:
The change results in a new cumulative grant total of funds available under this agreement of$
[include contract life-time total amount].
The revised budget is incorporated herein by reference and identified as [for example, insert as
°Revised Exhibit C"].
>Choose an item< is hereby modified accordingly.
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 , whichever is later.
STATE OF COLORADO
John W. Hickenlooper,GOVERNOR
Department of Public Health and Environment PROGRAM APPROVAL:
By: Lisa McGovern, Purchasing&Contracts Unit By:
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 Jams, CPA, MBA,JD
By:
Date:
Grant_Funding_Change_Letter_OSC_082509 Page 1 of 1
Attachment A-2
OPTION LETTER
Date: State Fiscal Year: Option Letter No. CMS Routing#
1) OPTIONS: Choose all applicable options listed in§1 and in§2 and delete the rest.
a. Option to renew only(for an additional term)
b.Change in the amount of goods within current term
c.Change in amount of goods in conjunction with renewal for additional term
d.Level of service change within current term
e. Level of service change in conjunction with renewal for additional term
f. Option to initiate next phase of a contract
2) REQUIRED PROVISIONS.All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options 1(a-e): In accordance with Section(s) of the Original Contract routing number
between the State of Colorado, Insert Name of Department or Higher Ed Institution,and Contractor's
Name,the State hereby exercises its option for an additional term beginning Insert start date and ending on
Insert ending date at a cost/price specified in Section ,AND/OR an increase/decrease in the amount of
goods/services at the same rate(s) as specified in Identify the Section, Schedule, Attachment, Exhibit etc.
b. For use with Option 1(f), please use the following: In accordance with Section(s) of the Original
Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed
Institution , and Contractor's Name, the State hereby exercises its option to initiate Phase indicate which
Phase: 2, 3, 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price
specified in Section
c.For use with all Options 1(a-f): The amount of the current Fiscal Year contract value is
increased/decreased by$amount of change to a new contract value of Insert New$Amt to as consideration
for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first
sentence in Section is hereby modified accordingly.The total contract value including all previous
amendments, option letters, etc. is Insert New$Amt.
3) Effective Date.The effective date of this Option Letter is upon approval of the State Controller or
whichever is later.
STATE OF COLORADO
John W. Hickenlooper,GOVERNOR PROGRAM APPROVAL:
Department of Public Health and Environment
By:
By: Lisa McGovern, Purchasing &Contracts Unit 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 Jams, CPA, MBA,JD
By:
Date:
Page 1 of 1
Effective Date:1/6109-Rev 8/25/09
EXHIBIT B
STATEMENT OF WORK
To Contract Dated 12/24/2014 - CMS Contract Routing Number 15 FHLA 75542
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
I. Project Description:
The Weld County Department of Public Health and Environment shall provide outreach and recruitment
services for breast and cervical cancer screening to seventy-five (75)women utilizing evidence-based
interventions. The program shall also provide exposure to at least five thousand (5,000)women in regards
to breast and cervical cancer education and awareness.
II. Definitions:
WWC: Women's Wellness Connection
CDPHE: Colorado Department of Public
Health and Environment
CHW: Community Healthy Workers are trusted members of the community or intended population whom
they serve. CHWs are connectors to health care systems (providers, hospitals, community health
programming, etc.) through referrals ("warm-handoffs") based on relationships built with those systems
and knowledge of interested individuals/entities within their community. CHWs implement outreach
within their communities to provide basic health assessments and health education, community advocacy
and capacity building/empowerment and connect/refer to culturally-tailored resources to reduce risk
factors of the social determinants of health. CHWs may provide language interpretation and cultural
brokering to assure culturally responsive services for their clients.
CDC: Centers for Disease Control and Prevention
DHHA: Denver Health and Hospital Authority
Quarters of Activity: Q3: Feb 15 - Mar 30 and Q4: Apr 1 - June 29
III. Performance Requirements/Deliverables:
A. Goal 1: Implement evidence-based interventions to increase access to preventive breast and cervical
cancer services among WWC-eligible women.
Deliverable#1
By 06/29/2015, Weld County Department of Public Health and Environment shall provide outreach services
for breast and cervical cancer screening to seventy-five (75) WWC qualifying women utilizing evidence-based
outreach interventions.
Target Population: Women ages 40 - 64, with a household income between 139 - 250 percent of the Federal
Poverty Level, uninsured or underinsured, legally present.
Activity Quarters Measurement Deadline Responsible Agency
of
activity
Activity 1: Utilizing Q3 • At least seventy- 6/29/15 WCDPHE
I'.xhibit_B_Statement_of Work_Portrait_070714 Page 1 of 4
EXHIBIT B
community health workers Q4 five (75)women
(CHWs), recruit women for recruited for
breast or cervical cancer screening.
screening services and refer Barriers assessed
to WWC-funded clinics. for each woman.
Schedule and coordinate Progress report
breast and cervical cancer provided to
screening appointments for CDPHE including
women at appropriate WWC the number of
clinics. Provide coordination, women screened
arrange or provide for breast or
transportation, and cervical cancer.
interpretation for breast and
cervical cancer screening
services for women.
Deliverable#2
By 6/29/2015, Weld County Department of Public Health and Environment shall provide one hundred (100)
client reminders advising people that they are due for screening to supplement existing WWC activities.
Target Population: Women ages 40-64, with a household income between 139 - 250 percent of the Federal
Poverty Level, uninsured or underinsured, legally present.
Activity Quarters Measurement Deadline Responsible Agency
of
activity
Activity 1: Conduct reminder Q3 • By June 29, 2015 6/29/15 WCDPHE
phone calls; send Q4 all WCDPHE
letters/postcards utilizing clients due for
evidence based MIYO products screening shall be
(www.mivoworks.orq) to notified by phone
explain indications and and/or mail.
benefits of screening. Offer Quarterly report
assistance with scheduling shall be provided
appointments. to CDPHE.
B. Goal 2: Actively enhance and pursue community and clinic partnerships to increase target population
awareness and knowledge related to breast and cervical cancer screening.
Deliverable#1
By 06/29/2015, Weld County Department of Public Health and Environment shall provide breast and cervical
cancer education and awareness to at least five thousand (5,000)women in Weld County.
Target Population: women and their partners
Activity Quarters Measurement Deadline Responsible Agency
of
activity
Activity 1: Develop, plan and Q3 • By March 15, 6/29/15 WCDPHE
conduct breast and cervical Q4 2015, educational
education and awareness and self-care
program for women in the program
targeted population. developed, and
curriculum shall
I Ixhibit_B_Statement_of_Work_Pomait_070714 Page 2 of 4
EXHIBIT B
be provided to
and approved by
CDPHE. By June
29, 2015 at least
one hundred fifty
(150)women will
have participated
in a breast and
cervical education
and self-care
program.
Quarterly report
provided to
CDPHE.
Activity 2: Conduct small Q3 • By June 29, 2015 6/29/15 WCDPHE
media campaign to include Q4 at least five
social media through our thousand (5000)
County website and Face women will be
book page, bus bench provided with
advertisements, newspaper educational
articles; provide printed resources through
resources to community a small media
members and medical campaign.
providers; play educational Website and Face
videos in provider office book views will be
waiting rooms. recorded. Bus
bench ads will be
placed in high
traffic areas, and
newspaper
circulation will be
broad. Quarterly
report provided
to CDPHE.
Activity 3: Provide group • By June 29, 2015
education motivating and at least ten (10)
encouraging medical group education
professionals, businesses, sessions shalt be
men and women to conducted in
recommend and/or seek Northeastern
mammography and cervical Colorado.
cancer screening in a variety Quarterly report
of settings with an emphasis provided to
in Northeast Colorado. CDPHE.
C. Progress Reports:
Contractor shall participate in at least quarterly phone calls to be scheduled by the State
and Contractor at the start of the contract that will include, but not limited to, progress
Uxhibit_B_Statcmcnt_of Work_Portait_070714 Page 3 of 4
EXHIBIT B
updates on the implementation and accomplishments of the approved Work Plan.
Contractor shall provide quarterly reports beginning March 30, 2015 and June 29, 2015.
Failure to submit progress reports in accordance with the above time frames may result in a
delay or denial of the reimbursement request for those periods.
IV. Personnel:
Contractor must notify the State within thirty (30) days of a change of the Project Director or
Principal Investigator responsible for the performance of services provided.
V. Monitoring:
Monitoring Provision for LPHAs
CDPHE's monitoring of this contract for compliance with performance requirements will be
conducted throughout the contract period by the WWC Section Manager. Methods used will
include review of documentation reflective of performance including progress reports and other
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 thirty (30) calendar days of discovery of a
compliance issue. Within forty five (45) calendar days of discovery, the Contractor and the
State will collaborate, when appropriate, to determine the action(s) necessary to rectify the
compliance issue and determine when the action(s) must be completed. The action(s) and time
line for completion will be documented in writing and agreed to by both parties. If extenuating
circumstances arise that requires an extension to the time line, the Contractor must email a
request to the WWC Section Manager 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 Remedies section of the
General Provisions of this contract.
Pxhibit_B_Statcmcnt_of Work_Poraait_070714 Page 4 of 4
Exhibit C Budget
ev.. Colorado Department of Public Health and Environment
' PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM
Contract Routing#15 FHLA 75542
Cando Dc
of Public fkahh t
and Emwnmmt
Contractor Name Weld County Department of Public Health and Program Contact Name, Kimberly Senn,Clinical Services Manager 970-304-
Environment Title,Phone and Email 6420 ext 2337 ksenn@weldgov.com
Fiscal Contact Name, Tanya Geiser,Director,Administrative Services
Budget Period 2/16/15-6/29/15
Title,Phone and Email 970-304-6410 ext 2122 tgeiser@weldgov.com
Project Name 2014-15 WWC Targeted Outreach Grant Program
Expenditure Categories
�+et tSbrvlaEa
Saidr1 41141oyees
List SOW
deliverable/
primary task Match or In-
number(s)this Percent of Kind(If Total Amount
Position Title/Employee budget item Gross or Time on Required by Requested from
Name Description of Work supports Annual Salary Fringe Project RFA) CDPHE
Community Health Provide all community health outreach activities as
Outreach Worker/TBD described in the SOW G1-G3/All activities $13,315.00 $ 5,184 100% $18,498.53
Public Health Practitioner Provide supervision for the community health
Coordinator/CH outreach activities as described in the SOW G1-G3/All activities $39,425.00 $ 15,348 2% $821.60
Weld County Fringe Benefits Calculation
1.45 Medicare
0.09 Unemployment
0.08 Workers'Compensation
13.7 PERA
0.33 Life/AD&D Insurance
12.14 Health Insurance
4.61 Accrual-Vacation
4.23 Accrual-Holiday
2.3 Accrual-Sick
38.93% $ $0.00
$ - $0.00
$ - $0.00
$ - 50.00
$ - $0.00
$ - $0.00
$ - $0.00
:Personal 5e,vlces c
Hourly Employees
List SOW
deliverable/ Match or In-
primary task Total#of Kind(If Total Amount
Position Title/Employee number(s)this Hourly Hours on Required by Requested from
Name Description of Work budget item Hourly Wage Fringe Project RFA) CDPHE
$0
$0
$0
$0
$0
$0
$0
Page 1 of 4
V.1 Jan 2013
Exhibit C Budget
Colorado Department of Public Health and Environment
' .av
l'y PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing#15 FHLA 75542
cubrado p�rtm�n
of Public t
sdEmwnment
Contractor Name Weld County Department of Public Health and Program Contact Name, Kimberly Senn,Clinical Services Manager 970-304-
Environment Title,Phone and Email 6420 ext 2337 ksenn@weldgov.com
Fiscal Contact Name, Tanya Geiser,Director,Administrative Services
Budget Period 2/16/15-6/29/15
Title,Phone and Email 970-304-6410 ext 2122 tgeiser@weldgov.com
Project Name 2014-15 WWC Targeted Outreach Grant Program
$0
k& fi r $ ,?r -s ts. f S,i. +S -v., Ka stsi ce r $0
-4:‘,"7-514
I a e x E ? XP'•t'2,t.,. k s i',:e?- d.'., „ ..,.. ,' txn"' u+Y it **"
a . �.� ,� .a , e�ray�s/l� n "Frl�:,4,,,,;3, ,� � '^" � �r„ .me:.:.
Sltpplie#40PONSTIOExpenses' .t,�, a .
List SOW
deliverable/
primary task Match or In-
number(s) Kind(If Total Amount
this budget Required by Requested from
Item Description of Item item supports Rate Quantity RFA) CDPHE
laptop/bag/dock station _laptop for outreach events,screening,scheduling G1/A1;62/A2 $1,500.00 1.00 $1,500
Mobile phone (Phone to set up wifi during outreach,offsite communications GS-G3/all $500.00 1.00 $500
Monthly Phone Service Phone service-minuets and data package 61-63/all $50.00 4.50 $225
Business Cards 1 box of WCDPHE business cards for outreach services 61-63/all $13.00 1.00 $13
Post cards;postage 500 Appt.reminder post cards including postage G3/A1 $0.40 500.00 $200
Bus Bench Ms Bus Bench ad design and posting for 5 bus shelters 62/A2 $650.00 5.00 $3,250
Printed materials 1000 color brochures 61-63/all $0.26 1000.00 $260
$0
Travel
List SOW
deliverable/
primary task Match or In-
number(s) Kind(If Total Amount
this budget Required by Requested from
Item Description of Item Item supports Rate Quantity RFA) CDPHE
Travel Travel to meetings and educational events-900 miles total G1/A1;G2/A2 $054 900.00 $486
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
r f&' s '` >:< c� a" fd fi � t x Pao-.' r �.a.... ."'� .. +. � .C'.* Oa
C Yskt �
Page 2 of 4
V.1 Jan 2013
Exhibit C Budget
ct
Colorado Department of Public Health and Environment
PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM
eoc Contract Routing#15 FHLA 75542
Worse
ofPW4e- Ndt6
and Environment
Contractor Name Weld County Department of Public Health and Program Contact Name, Kimberly Senn,Clinical Services Manager 970-304-
Environment Title,Phone and Email 6420 ext 2337 ksenn@weldgov.com
Fiscal Contact Name, Tanya Geiser,Director,Administrative Services
Budget Period 2/16/15-6/29/15
Title,Phone and Email 970-304-6410 ext 2122 tgeiser@weldgov.com
Project Name 2014-15 WWC Targeted Outreach Grant Program
List SOW
deliverable/
primary task Match or In-
number(s) Kind Of Total Amount
this budget Required by Requested from
Subcontractor Name Description of Item item supports Rate Quantity RFA) CDPNE
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
SUB-TOTAL BEFORE INDIRECT $25,754
Page 3 of 4
V.1 Jan 2013
Exhibit C Budget
Colorado Department of Public Health and Environment
qF ` - PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
pe�rru� Contract Routing#15 FHLA 75542
ofd' Hahh t
and^ .
Weld County Department of Public Health and Program Contact Name, Kimberly Senn,Clinical Services Manager 970-304-
Contractor Name
Environment Title,Phone and Email 6420 ext 2337 ksenn@weldgov.com
Budget Period 2/16/15-6/29/15 Fiscal Contact Name, Tanya Geiser,Director,Administrative Services
Title,Phone and Email 970-304-6410 ext 2122 tgeiser@weldgov.com
Project Name 2014-15 WWC Targeted Outreach Grant Program
� tF.
� c
y
Match or In-
Kind at Total Amount
Required by Requested from
Item Description of Item prat CDPHE
Negotiated Indirect cost
rate(Federal,State,or
CDPHE) 2015 CDPHE Indirect Rate 13.84% $3,564
Indirect rate(other):
Indirect(modified or
additional base) x�
" ..t'i Y z "/' r ± ?,1 T44'1 /4:4 oi� r ffr F`i tiT §�it.h�,•It'
4- G ,!„ -Ix- Y -,h•yrm{ :3'''''''''"1:1 i. 1,.
TOTAL MATCH OR IN lUND
Page 4 of 4
V.1 Jan 2013
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