HomeMy WebLinkAbout20151527.tiff OPTION LETTER
Date:04/01/15 Original Contract CMS#: Option Letter#2 CMS Routing#
14IHA65516 15I11A77974
1) OPTIONS:Level of service change within current term.
2) REQUIRED PROVISIONS.All Option Letters shall contain the appropriate provisions set forth below:
In accordance with Exhibit A,Section VI of the Original Contract between the State of Colorado,
Department of Human Services,and Weld County Department of Human Services,the State hereby
exercises its option for an increase in the amount of services as specified in the attached Exhibit B-Option
Letter Contractor Budget,hereby incorporated by reference.
The amount of the current state fiscal year contract value is increased by$5,247.00 to a new contract value of
$205,846.13 as consideration for services ordered under the contract for the current fiscal year 15(SFY15).
The first sentence on page 1 of the Original Contract is hereby modified accordingly.The total contract value
including all previous amendments,option letters,etc.is$205,846.13(14IHA65516=$50,599.13;
l5IHA69735=$150,000;and 151HIA77974=$5,247.00).
3) Effective Date.The effective date of this Option Letter is upon approval of the State Controller or April 1,2015,
whichever is later.
STATE OF COLORADO
John W.Hickenlooper,Governor
Department of Human Services
eggie i a, xecu lye Director
By:Mary e yder,Director,Office of Early Childhood
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State contracts.This Option Letter 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:
flint ��Woodruff/Valri rmple
Date: '�/8/ad/,5
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C91Y\ atZnn 2015-1527
OTHER COSTS
Item Description of Item Rate Quantity Amount Requested
from CDHS
Equipment $0.00
Flex Funds($5,000 required in first year and$10,000 $10,000.00
required in second year)
Other(Please detail each item) $0.00
$0.00
Total Other Costs $10,000.00
CONTRACTUAL(payments to third parties or entities)
Item Description of Item Rate Quantity Amount Requested
from CDHS
Consulting $0.00
".."" a"., II,Li.nuie� $75l Hour 20 $1,500.00
R01:1?T1(15;11u
Training Infant/Early Mental Health �^""'' $75/Hour 208 $15,600.00
$0.00
Total Contractual $17,100.00
SUB-TOTAL BEFORE INDIRECT $155,247.00
INDIRECT
Item Description of Item Amount Requested
from CDHS
Indirect(other):Please list specific indirect costs in
description-NOT TO EXCEED 15%of Total Personnel. $0.00
Total Indirect $0.00
TOTAL AMOUNT REQUESTED FROM CDHS $155,247.00
COLORADO COMMUNITY RESPONSE--ADDITIONAL FUNDS
BUDGET REVISION REQUEST SFY 2015
Date: 6-Mar-15
County: WELD
Authorized Official(Name and Title):
Authorized Official Signature:
Phone: 970-352.1551 Email:
Proposed Additional
Budget Category Budget Line Item Existing Budget Funds Budget Difference Justification
Personnel(including
fringe benefits)
$ - $ $
$ - $ - $
Total $ - $ - $ -
Supplies&Operating CCR worker to be trained in
Love and Logic $ - $ 1,529.00 $ 1,529.00 Love and Logic Early Childhood
Parenting Wisely $ - $ 1,718.00 $ 1,718.00 facilitation and purchase
Total $ - $ 3,247.00 $ 3,247.00 curriculum
Travel
$ - $ - $ - Purchase Spanish and English
$ - $ - $ - CD-ROM of Parenting Wisely in-
Total $ - $ - $ - home parenting education
Other
Printing $ - $ 2,000.00 $ 2,000.00 Print resource directories,CCR
$ - $ - $ - handbooks and educational
Total $ - $ 2,000.00 $ 2,000. 0 materials
Contractual
$ - $ - $ -
Total'$ - $ - $ -
Indirect
$ - $ - $
Total $ - ' $ - $ -
TOTAL! $ - 1 $ 5,247.00 I $ 5,247.00 I — -
For Division of Community and Family 5ttpaTt_______.._.._.__._`.____
Approved: Date:
Option Letter #2 Contractor Budget-Exhibit B
Applicant Name: Weld County Department of Human Services
Budget Period: July 1,2014-June 30,2015
PERSONNEL EXPENSES
Percent
of Actual Additional
Gross or Time
Personnel Services Annual Fringe (FTE)on Resources Amount Requested
Salary Contract/ from CDHS
Purchase (not
Order required)
Description of Work
Position Title/Employee (for hourly employees, please include
Name the hourly rate and number of hours in
your description)
Community Case Manager Provide case management and $0.00 $69,000.00
g education to families referred to them 4,200/mo. 1,550/mo. 100%
Family Engagement Provide facilitation to all families within 4,100/mo. 800/mo. 87% $0.00 $50,962.00
Facilitator the grant
$0.00 $0.00
$0.00 $0.00
Total Personal Services
(including fringe benefits) $119,962.00
SUPPLIES&OPERATING EXPENSES
Additional
Item Description of Item Rate Resources Amount Requested
(not from CDHS
required)
Printing/Copying $2,000.00
Postage/Shipping $0.00
Phone/Fax/Internet $0.00
Supplies $0.00
Meeting $0.00
Other(Please list below by item) $0.00
Certification Course-
National Financial Education Council Certified Financial $297.00
Planner-Ongoing
Certification
CCR Worker to be
Love and Logic Early Childhood curriculum trained in Love and $1,529.00
Logic Early Childhood
Parenting Wisely Purchase Spanish
and English CD-ROM $1,718.00
Total Supplies
&Operating Expenses $5,544.00
TRAVEL
Item Description of Item Rate Quantity Amount Requested
from CDHS
Mileage-Other Travel-Training/Home Visits Average 350 Miles $0.545/Mile 4255 $2,319.00
per Month
Lodging $0.00
Meals Meals during Training $23 per Day 14Days $322.00
and Home Visits
$0.00
Total Travel
$2,641.00
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