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Home My WebLink About20151387.tiff RESOLUTION RE: APPROVE TASK ORDER CONTRACT FOR AMENDMENT 35 TOBACCO USE PREVENTION AND CESSATION EDUCATION 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 Amendment 35 Tobacco Use Prevention and Cessation Education 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 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 Amendment 35 Tobacco Use Prevention and Cessation Education 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 May, A.D., 2015. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COL RADO ATTEST: derAvv �'• 4 •t,� �' � -�cwLi� t //2-e' i Barbara Kirkmeyer, hair Weld County Clerk to the Board - l✓tzs BY: a) Mike Freeman, Pro-Tern D: p Ry Clerk to the ,- t .\ Sean P. Conway K:lp APPROVED AS TO FO X1161 .�. s 1 `� �,,. 1 J( V/46t; A. Cozad �`- Count or -y , fi i 'Z-2-,..v 9 Steve Moreno Date of signature: i-f L TI-Ta)-VI 2015-1387 C C HL0044 Memorandum TO: Susan Brown, Clerk to the Board • t1_ GO U NT Y FROM: Skye Turchado z Department of Public Health & Environment DATE: May 14, 2015 SUBJECT: Routing Request— BOCC Agenda The following documents have been approved for placement on the Board's meeting agenda for the Board's final approval and the Chair's signature. We would like to have these items placed on the Board's agenda for Monday, May 18, 2015. NEW BUSINESS: 3 Original(s): A35 Tobacco Prevention & Cessation Education Contract Continuation Original(s): Original(s): Original(s): CONSENT AGENDA: Original(s): Original(s): Original(s): Original(s): Once signed by the Chair, please return the original, signed documents to my attention. If you have any questions, or if you require anything further in this regard, please let me know. I can be reached at Extension 2102 or via email. As always, thank you for all of your help with processing our paperwork with the Board. Memorandum TO: Barbara Kirkmeyer, Chair V T Board of County Commissioners GQ z FROM: Mark E. Wallace, MD, MPH, Executive Director Department of Public Health & Environment DATE: May 14, 2015 SUBJECT: CDPHE Amendment 35 Continuation Contract -Tobacco Use Prevention and Cessation Education 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. Tobacco use continues to be one of the main causes of death and disability in Colorado and Weld County. The State Health Department provides tobacco use prevention and cessation funding to local public health agencies from monies received via Amendment 35, a voter approved initiative to use a portion of state tobacco excise taxes to fund prevention and cessation activities. With the approval of the Board, the WCDPHE will enter into a continuation tobacco use prevention contract with CDPHE. The State Health Department is requesting this contract be signed and returned to them before May 28, 2015. The contract amount for year-one is $318,903; the contract becomes effective July 1, 2015, and ends June 30, 2016. With the prior approval of the Board, the contract will be renewed annually over a three-year period. Activities will be conducted by current staff; no additional FTE is being requested. Assistant Weld County Attorney, Frank Haug, reviewed this contract and determined that its terms are acceptable This Amendment 35 Tobacco Use Prevention and Cessation Education Continuation Contract was approved for placement on the agenda by the Board via pass-around dated May 7, 2015. I recommend approval of this contract continuation. 2015-1387 BOARD OF COUNTY COMMISSIONERS PASS-AROUND REVIEW/WORK SESSION REQUEST RE: CDPHE Amendment 35 Contract Continuation-Tobacco Use Prevention and Cessation Education DEPARTMENT: PUBLIC HEALTH & ENVIRONMENT DATE: May 7,2015 PERSON REQUESTING: Mark E. Wallace, MD,MPH, Executive Director Brief description of the problem/issue: Enclosed for the Board's review and approval is a year-one of a three-year continuation contract between the Colorado Department of Public Health and Environment (CDPHE) and the Board of County Commissioners of Weld County for the use and benefit of the Weld County Department of Public Health and Environment (WCDPHE). Tobacco use continues to be one of the main causes of death and disability in Colorado and Weld County. The State I{ealth Department provides tobacco use prevention and cessation funding to local public health agencies from monies received via Amendment 35, a voter approved initiative to use a portion of state tobacco excise taxes to fund prevention and cessation activities. With the approval of the Board, the WCDPHE will enter into a continuation tobacco use prevention contract with CDPILE. The State health Department is requesting this contract he signed and returned to them before May 28, 2015. The contract amount for year-one is $318,903; the contract becomes effective July 1,2015, and ends June 30, 2016. With the prior approval of the Board,the contract will be renewed annually over a three-year period. Activities will be conducted by current staff; no additional FTE is being requested. Assistant Weld County Attorney, Frank Ilaug, reviewed this contract and determined that its terms are acceptable. What options exist for the Board? (Include consequences, impacts, costs, etc. of options) Declining this contract will result in the loss of$318,903 of state tobacco tax monies to be used for tobacco use prevention and cessation activities within Weld County. Youth may begin using tobacco and other drugs as a result of lost prevention activities; adults who want to quit may have less incentive or resources to quit. Approving and signing this contract will enable the continuation of various tobacco use prevention activities aimed at youth prevention and cessation. Recommendation: I recommend approval of this continuation contract with CDPHE. Approve Schedule Recommendation Work Session Other/Comments: Rarb Kirkmcyer,Chair Mike Freeman, Pro-Tem Julie Cozad Git . —_ Sean P. Conway 15/[--.1 Steve Moreno X ---- . —. ...--..—_-- -. DEPARTMENT OF PUBLIC FIE VLTH AND ENVIR()N\IENT CMS ROUTING NO. 16 FHLA 76437 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: CONTRACTOR: State of Colorado for the use&benefit of the Board of County Commissioners of Weld County for the use and benefit of the Department of Public Health and Environment Weld County Department of Public Health and Environment Prevention Services Division-Tobacco 1555 North 17th Avenue 4300 Cherry Creek Drive South Greeley,Colorado 80631 A-5 CONTRACTOR DI:NS. 075757955 Denver,Colorado 80246 CONTRACTOR ENTITY TYPE: Political Subdivision Colorado TASK ORDER N!AID DATE 4/13/2015 BILLING STATEMENTS RECEIVED. CORE ENCNUIR ANCL NI NIBER_ Monthly CI FHLA TERM' SrarC-rORY Al_ IHORITY. C.R.S. 25-3.5-804, et-seq., as amended This Task Order shall be effective upon approval by the State Controller,or designee,or on 07/01/2015, CLASSIFICATION. Sub-Recipient whichever is later.The contract shall end on 06/30/2016. CON RACE PRICE NOT TO EXCEED $318,903.00 PRO('t REMEN I MI i I HOD: RFA 1278 FEDERAL.FUNDING DOLLARS. $0.00 BID REP IS"E PRICE AGREEMEN I NCMBEfR STATH FENDING DOI.I.ARS. 5318,903.00 Not Applicable YlAxan Al AAIO(NT AA All MO I.PER EIS(Al YEAR'. I,NW SPECIFIED YEND0R Sr AI TE FYl6: $318,903.00 Not Applicable STATE RIIPRPSLNI 1 V E. Natalya Verscheure, MA Tobacco Program Manager Prevention Services Division PRICESIIRUCIL RE. Cost Reimbursement 4300 Cherry Creek Drive South CONTR ACTOR REPRESF NI ArIVE. A-5 Tanya Geiser Denver, Colorado 80246 Administrative Services Director 1555 North 17th Avenue Greeley, Colorado 80631 PROJECT DESCRIPTION. I his project serves to increase tobacco cessation_reduce initiation of tobacco use decrease tobacco prevalence among youth and decrease exposure to secondhand smoke by working toward goals Identified In the Statement of Work- Contract_Template_Task_Order 0I 2213 doc Page 1 of 6 EXHIBFIS. The following exhibits are hereby incorporated: Exhibit A - Additional Provisions(and any of its Attachments; e.g., A-I, 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-l. 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. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract including,but not limited to, Exhibit One thereto.The total term of this Task Order Contract, including any renewals or extensions, may not exceed five(5)years.The parties intend and agree that all work shall be performed according to the standards,terms and conditions set forth in the Master Contract. 2. In accordance with section 24-30-202(I I.C.R.S.,as amended,this Task Order Contract is not valid until it has been approved by the State Controller, or an authorized delegee thereof. The Contractor is not authorized to,and shall not;commence performance under this Task Order Contract until this Task Order Contract has been approved by the State Controller or delegee. The State shall have no financial obligation to the Contractor whatsoever for any work or services or,any costs or expenses, incurred by the Contractor prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order Contract on or before its proposed effective date,then the Contractor shall commence performance under this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order Contract after its proposed effective date,then the Contractor shall only commence performance under this lask 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 Contract Template_lask_Order_012215 doc 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: 1)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 5100,000 or higher/ By entering into this Task Order Contract,Contractor agrees to be governed, and to abide, by the provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning the monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide contract management system. Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order Contract,State law, including CRS §24-103.5-101.and State Fiscal Rules, Policies and Guidance. Evaluation of Contractor's performance shall be part of the normal contract administration process and Contractor's performance will be systematically recorded in the statewide Contract Management System. Areas of review shall include, but shall not be limited to quality,cost and timeliness. Collection of information relevant to the performance of Contractor's obligations under this Task Order Contract shall be determined by the specific requirements of such obligations and shall include factors tailored to match the requirements of the Statement of Project of this Task Order Contract. Such performance information shall be entered into the statewide Contract Management System at intervals established in the Statement of Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract term.Contractor shall be notified following each performance and shall address or correct any identified problem in a timely manner and maintain work progress. Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the performance measures established under the Statement of Project,the Executive Director of the Colorado Department of Personnel and Administration(Executive Director), upon request by the Colorado Department of Public Health and Environment and showing of good cause, may debar Contractor and Contract Template_task_Order_012215.doc 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 012215 doc 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: JOHN W. HICKENLOOPER,GOVERNOR Board of County Commissioners of Weld County for the use and benefit of the Weld County Department of Public Health and Environment - Legal Name of Contracting Entity n By: U Y Barbara Kirkmeyer For Executi a Director Print Name of Authorized Officer Department of Public Health and Environment Si ature of Authorized Officer MAY 1 8 2015 Date // Depat{tm nt P ogram Approval: I�Chair 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. STATE CONTROLLER: Robert Jaros, A,MBA,JD By: Date leliqt5 poi.'- /3I7(2 ) Contract Template_Task_Order_0122I5.doc Page 5 of 6 This page left intentionally blank. Contract_lemplate_Task_Order_012215 doc Page 6 of 6 Tobacco Education and Prevention Program atrifeATTEST: BOARD OF COUNTY COMMISSIONERS Weld C..nty Clerk to the Bo-rd# WELD COUNTY, COLORADO Deputy Cl') to the r. �Barbara Kirkmeyer, Chair/MAY 1 8 2015 �111O� AP OVED AS • F � J � APPROVED AS TO SUBSTANCE: �� 1-2 1/4)e--D C G-t_7 Controller Elected Official or Department Head APPR A T '— NIA` Director of General Services County A oZ0/5- /3g 7O EXHIBIT A ADDITIONAL PROVISIONS To Contract Dated 04/13/2015-C%IS Contract Routing Number 16 FAAA 76437 These provisions are to be read and interpreted in conjunction with the provisions of the Contract specified above. This Task Order Contract contains state funds. 2. 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 http://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. 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: Tobacco Program at cdphe stepp pg(&,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 forty-five(45) 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 the appropriate federal agency. 3. Time Limit For Acceptance Of Deliverables. a. Evaluation Period.The State shall have thirty(30)calendar days from the date a deliverable is delivered to the State by the Contractor to evaluate that deliverable,except for those deliverables that have a different time negotiated by the State and the Contractor. b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design specifications for that particular deliverable.or is otherwise deficient,then the State shall notify the Contractor of the failure or deficiencies, in writing, within thirty (30)calendar days of. I)the date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or deficiency at the time of delivery;or 2)the date the State becomes aware of the failure or deficiency.The above time frame shall apply to all deliverables except for those deliverables that have a different time negotiated by the State and the Contractor in writing pursuant to the State's fiscal rules. c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed deliverable,the Contractor shall have a reasonable period of time, not to exceed thirty(30) calendar days,to correct the noted deficiencies. 4. 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 f IIP.AA. Page 1 of 2 Contract Exhibit-A AdditionalProvisions 040715 EXHIBIT A 5. This award does not include funds for Research and Development. 6. If Contractor indicates full expenditure of funds under this Task Order Contract by February 28 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. CDPHE will notify the Contractor of the potential need to decrease the current or upcoming budget. If the Contractor indicates at a later date than February 28 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 February 28,CDPHE will reallocate unspent funds without any penalties to the Contractor. 7. Contractor shall request prior approval in writing from CDPHE for all modifications to the Statement of Work or for a cumulative modification to the direct costs in excess of twenty-five percent(25%)of the total budget for direct costs, between budget categories. Budget revisions are also required to incur expenses against a budget category with zero funds budgeted. To open a new budget category line,the Contractor must seek approval from CDPHE prior to incurring expenditures against the new budget line. Any request for modifications to the Budget in excess of twenty-five(25%)percent of the total budget for direct costs or $250,000.00,whichever is less,shall be submitted to CDPHE at least ninety(90)days prior to the end of the contract period and may require an amendment in accordance with Genera(Provisions, Section 5 of this Task Order Contract. 8. Funds provided under this Task Order Contract may not be used to: supplant funding for any existing programs/models;develop new cessation programs/models; develop curricula for youth or adults not reviewed and approved by the State; pay for individual cessation aids or nicotine replacement therapy; fund capital improvements: or fund costs of enforcement of state or local laws and ordinances. 9. Contractor affirms that it maintains no affiliations or contractual relationships, direct or indirect,with tobacco companies,owners,affiliate, subsidiaries, holding companies,or companies involved in any way in the production,processing,distribution, promotion,sales,or use of tobacco. 10. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be the owner of all equipment as defined by the Federal Accounting Standards Advisory Board(FASAB) Generally Accepted Accounting Principles(GAAP) purchased under this Task Order Contract. At the end of the term of this Contract,the State shall approve the disposition of all equipment. I I. 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). 12. CDPHE may increase or decrease funds available under this Task Order Contract using a Grant Funding Change 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. 13. CDPI IE may require continued performance for a period of up to two(2)years at the same rates and same terms specified in the Task Order Contract. If CDPHE exercises this option, it will provide written notice to Contractor at least thirty (30)days prior to the end of the current Task Order 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 Contract. The total duration of this Task Order Contract, including the exercise of any options under this clause,shall not exceed three(3)years. Page 2 of 2 Contract Exhibit-A AdditionalProvisions 040715 Attachment A- 1 GRANT FUNDING CHANGE LETTER Date: State Fiscal Year: Grant Funding Change CMS Routing # Letter # 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 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 <insert start date of original contract> and ending on Insert ending date <insert ending date of current contract amendment> , the undersigned commits the following funds to the Grant: The amount of grant funds available and specified in Section of <insert contract amendment number and routing number> is increased or decreased by $amount of change to a new total funds available of $ <insert new cumulative total> for the following reason: . Section 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 belo.. b� 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 pros ided hereunder. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: Date: Contract_GrantFundingchangeLetter_01-2015 Page 1 of 1 Attachment A-2 OPTION LETTER Date: State Fiscal Year: Option Letter No. CMS Routing# CORE Encumbrance# 1) OPTIONS: Choose all applicable options listed in §1 and in §2 and delete the rest. a. Option to renew only(for an additional term) b.Change in the amount of goods within current term c. Change in amount of goods in conjunction with renewal for additional term d.Level of service change within current term e. Level of service change in conjunction with renewal for additional term f. Option to initiate next phase of a contract 2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below: a. For use with Options 1(a-e): In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed Institution , and Contractor's Name, the State hereby exercises its option for an additional term beginning Insert start date and ending on Insert ending date at a cost/price specified in Section , AND/OR an increase/decrease in the amount of goods/services at the same rate(s) as specified in Identify the Section, Schedule, Attachment, Exhibit etc. b. For use with Option 1(f), please use the following: In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed Institution , and Contractor's Name, the State hereby exercises its option to initiate Phase indicate which Phase: 2, 3, 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price specified in Section c. For use with all Options 1(a-f): The amount of the current Fiscal Year contract value is increased/decreased by$ amount of change to a new contract value of Insert New$Amt to as consideration for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first sentence in Section is hereby modified accordingly. The total contract value including all previous amendments, option letters, etc. is Insert New$Amt. 3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or whichever is later. STATE OF COLORADO John W. Hickenlooper, GOVERNOR PROGRAM APPROVAL: Department of Public Health and Environment By: By: Lisa McGovern, Purchasing & Contracts 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 Jaros, CPA, MBA, JD By: Date: Contract_OptionLetter 01-2015 Page lV 1 o u Y o 3 O u O '0 u 0 1 a 0 td = N 0 G_ o G C O 0 50 T q E v , o ^ M Y 0 O G :JJ O O-- v =r1 N i E O . o 0 © C a O n > O e Oa .oj .t.. v, O @ �n 1 L c ,- E O � L C 03 U 0 a o co 1) CO c CLJ i-@ o Q @ C T u 6 L c 0 a C u c p O 0 U N o Ln 0 Le N 6 C a .0 CO = 9 > X N ', u T-o ch ` o 0 v _ @ 0 -e- a N d ¢ d On N l'iO o G O Y oo 21 O o O C O 0 U vl j .. —_ o u .- u 0 Lc E u a _ o - o > 0 n c a c IQ m o < z 0 s °. -0 a ti to n °o c c U c n _ @ i 1 0- o L:.I a O^ Y N _ u, [6 `I] E @ Y �, ., a � ^ o •c ... >, o o c u C ' c - @ E w'c ct > 3 a c S 7 CO c u c r' ❑ .0 u 0 s O o — 0 .• u Y J E " ti -,73 7 lo F G— 'C F a s 7 C I j - - O v F = u d Q - 1 a @ J O co Z % o a o o = o a o c [a. MO C. O N — N - = �1 6 @ d 9 u 3 O C CC N a O .- L 2 O E _= @ t_A o co = o q Wv. ^ p O O o - z c t E . o n v u > >4 5 o c o - 0 3 IL v U o % an R A o 1 ^ E v a 0 o o L.,.. 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T 3 m U c Y Y 'O , t0 U L '3 C m C 7 64 46 v G V " c E y ❑ � �, s "ate c 3 =o ._ .6-0y _ > '63 = .., -5 _ O u E _ - E , y - �0 ..4 -o _ C a q C ._ Y a C0pv'"i COS C oo _.. co- _ � :0 FO3 O 'J L Y O O o -O O u '� _ O O y p v o 0 Cr -Q a Y i ^= L U m _ v J 00 v C LS'.O c Y Y v u Y v O 0 R .0 �. T_J G 3 i C y .C __ O La G N _D CO ., i.Y Y Y 0 0 N Y V C O V 3 O 1' a Y t O 3 .7 Y Y J y O R F 'J u a r R . O J y V = v ,G la Y C E 2 L v C 'OL o a 6S S o C S q a .. u _ Q � C y C O '0 4-' Y Y O '.Oj .D - .F C .. .0 'd u O - Y _ O L t3 U 7. O v O V $ G O o co = L O N Y O >' :u0. .L- T- 6 C ? a 5 O 'O = n 0 '❑ en 'J F O ^n R1 3 W ^ co <6 Q Y 43 .G. 9 Y v o _ u E.' a Y 3 E .. I?. L a ...i F IC] W O • 7 >r'N• N r M G K U C Y i M N r � C L >.-o _0. T th i, CO H C T hA _T a u >y.,i v T O .- 0 � _ 0 v • C H O 1 Y V y �' C C - ➢ ` U L i v t .. y v G[ .C .≥ — F - v p a .— i O 0 . r Y ` i L Y 0 S `t ---- (2,` :. 2 0 a O ' v p. 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CI o O > E y`Y' a= a = m � a 3 -17-)C bL .C c - R R = 0 e 4 6 N C y O 'O a - a N L ti E y0 O Ct v 0 = = 0• =0 Lu a v iii _ = _ a $ G v co a = i v R ° « � o � [:.] = Y n T Ni ;, a0. y E �' = 0 • ,� L u L t q 0. a9 c_ n 0 0 0 0 N . 0 0 - ..: J J • -0 _ eL = OOla p 0 7 V U 0 U — RU 7.' O N R L L V! - `S C L N — Y y d h L" td u . OL c - > 3 ` v - a T • E cyC '° E .m omG'O az a a a H a T O O Y E = V C. v .r. co-, M N N V N t- N �t - `La = y ' i •.> ° E % 6 0 0 0 a O a O a s a O' a L' V C R• G� v 9 ca " 'Ov C C 9 a C CL n m c _ t ° R Ce a " y c 3 w • O . .- - .n N A £s. - — E w -o G: Y Y >'ie . •- c t 'a v t j v J J O N v H L b[ Y N ti ° N V a c • L N a — v ti 7 N cr C O C = o ` 3 E Ce � v �_ c v v c'= .c " a 00 N - :� = Ce . U Ce `° - > _ OL t " R 0 y v w E y " 'O E . J " c.- ^ t S., N C. 0 c u _ o a �_ 'x = E .`o = 'N a ° V °'CZ E E 0 0 ≥ • -r L O °cal) _ on J✓ O - -O j — U `¢7. 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F y 2 u _ > ❑ ' r _ .n Y N a ti — _ > EXHIBIT C cp2i .,, Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing# 16 FHLA 76437 Colorado Dtlnannant of Public I leahh and Pmin nmmnt Weld County Department of Public Health and Program Contact Name, Eve uakko.Division eireenr,Hen corn%.Ping 970304.5470a 2380, Contractor Name eaakko welegovtorn Environment Title,Phone and Email Fiscal Contact Name,Title, Tanya Geiser,Director,Administrative Services Budget Period July 1,2015-June30,2016 Phone and Email 97oa045410xuzz,teen %er@weldgov.co Project Name Weld County Tobacco Control Program Expenditure Categories Personal Services Salaried Employees Match or In- Percent of Kind(If Total Amount Position Title/Employee Supports SOW Gross or lime on Required by Requested from Name Description of Work Deliverables Annual Salary Fringe Project RFA) CDPHE 10 FTE Health educator(12 mos) will coordinate activities related to cessation,and tobacco free Health Education Specialist coalition;including working with colleges,employers, $58,170.17 $22,645.65 100% $80,815.82 II/RF collaboration with community based organizations,and yes the Weld County tobacco free coalition.Additional duties are related to the paid and earned media. 1.0 FTE Health educator(12 mos)will coordinate youth prevention activities;including at risk young adults, Health Education Specialist to IIabora:ion with community based organizations' Yes $52,432.80 520,412.09 100% $72,844.89 II/CG youth organizations,school administrators and coordination of school based trainings and retailer audits. 0.75 FTE Health educator(12 most will coordinate youth prevention activities;including at risk young adults, collaboration with community based organizations, Health Educator I/LS yes $48,868.46 519,024.49 75% 550,919.71 youth organizations,school administrators and coordination of school based talnings and retailer audits. 0.20 FTE Bilingual health educator(12 mos)will provide Bilingual Health Education ssation and other media campaign related resources Yes $66,869.49 $26,032.29 20% 518,580.36 Specialist/00 in Spanish and will conduct outreach to Spanish speaking populations. 0.05 FTE Data and evaluation specialist(12 most will Data and Evaluation provide evaluation assistance on all work plan activities Yes $8],161.14 $33,931.83 5% 56,054.65 Specialist/CK and evaluation coordination with the Weld County Commun ty Health Improvement Plan(CHIP). 0.10 FTE Division director 112 most will provide overall Division Director/EA program administration,budget management,and staff Yes $85,584.80 $33,318.15 10% $11,890.30 supervision of 3.0 FTE tobacco staff. Page 1 of 4 EXHIBIT C Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM • Contract Routing# 16 FHLA 76437 Colorado I)upanmenc of Public Health and hmironincist Weld County Department of Public Health and Program Contact Name, Eric Aakko,owlsion Director,Hlth Comm.Ping 970 304 6550 51180, Contractor Name Environment Title,Phone and Email eaakko@wemeov.rvm Fiscal Contact Name,Title, Tanya Geiser,Director,Administrative Services Budget Period July 1,2015-tune 30,2016 Phone and Email 970.304 6410 x 2122,teeiser@weldeov cam Project Name Weld County Tobacco Control Program Office Technician III/MH 0.05 FTE will provide desktop publishing,design,and Yes $40,441.37 $15743.83 5% $2,80926 other duties as required in fulfilling activititie s. Fringe benefits are 38.93%.Components included are: 1.45%351,.09%unemployment,.08%worker's Fringe compensation,13.7%PER@.33%life insurance,12.13% health insurance,4_6%vacation,4.23%for holidays and 2.3%for sick leave. Personal Services Hourly Employees deliverable/ primary task Match or In- number(s)this Total p of Kind(If Total Amount Position Title/Employee budget item Hours on Required by Requested from Name Description of Work supports Hourly Wage Hourly Fringe Project RFA) CDPHE $0.00 $0.00 Total Personal Services (including fringe benefits) $o $243,914.98 Supplies&Operating Expenses 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 Printing and photocopying(black and white @ 0.02 cents per copy x 20.000= Printing/Copies $400;color @ 0.06 cents per cop x 3000=$180;replacement ink toners @ Yes $880.00 1 $880.00 $300.Printing supports all deliverables from 1 thru a in the workplan. Food and beverages for youth and community meetings related to deliverables 1 thru 8 @ 510 per person x 35 people per meeting per month x Meeting Supplies Yes 5370.00 12 $4,440.00 12 months=54,200.Additionally,5240 for flatware and cups and beverages ($20 per meeting per month x 12 months) Paper,pens,lamination supplies,etc.Rate is calculated at$20 per month x 12 General Office Supplies Yes $20.00 12 $240.00 months to support deliverables 1 thru 8 and 4 health educators. Gift Card intend sen to assist in the recruitment of youth coalition members. Youth Coalition Gift Card (67 at$15.00 each=$1005). Gift cards will be stored in a secure location, Yes $1500 67 $1,00500 Incentives checked out prior to use,and will be signed for by the gift card recipient. Page 2 of 4 EXHIBIT C Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing# 16 FHLA 76437 (olonde Ik5slronent of Public Health and Fn.in,nment Weld County Department of Public Health and Program Contact Name, (nr Aakko.Division Director,Frith Comm.Ping 970.30.WO X1100, Contractor Name eaaxxoiy via vv.cord Environment Title,Phone and Email Fiscal Contact Name,Title. Tanya Geiser,Director,Administrative Services Budget Period July 1,2015-June 30,2016 Phone and Email 2122,9713oa-6410xm[gasser@weldgovm Project Name Weld County Tobacco Control Program Total Supplies &Operating Expenses SO $6,565.00 Travel List SOW Match or In- Total Amount deliverable/ Kind(If Requested from Item Description of Item primary task Rate Quantity Required by CDPHE 4 health educators @'160 miles per month x 0.555 cents per mile for within Mileage Weld County and required travel to CDPHE state meetings and other yes $0.555 7679 $4,261.85 trainings. Total Travel $0 $4,261.8S Contractual re r, deliverable/ Kind(If Requested from Subcontractor Name Description of Item primary task Rate Quantity Required by CDPHE Purchase of paid media using radio,billboards,student newspapers,and -soial media platforms that support activite s related to deliverables 1 t h ru Media-TBD yes 515,685 00 1 $1568500 7. 55,228 x 3 media platforms(radio,outdoor,and print)=$15,685.Tobacco prevention ads will be utilized from CDPHE where applicable. Minigrant to support the work of the tobacco coalition in educating the public Tobacco Free Weld County about the various strategies around youth tobacco prevention.Supports Yes $5,10000 1 $5,100.00 Coalition monthly coalition meeting meals,purchase of paid media to support coalition education activities and policy initiatives,and maintain a coalition webs ite_ Consultant to coordinate and facilitate(21 two community-based discussion groups with low-income,straight-to-work young adults.Consultant will identify and invite the participants to the discussion groups and will develop d scussios group question guide in conjunction with WCDPHE staff. Consultant will facilitate,take notes,and write a final report on focus group Focus Group Facilitator findings.Consultant will provide incentives such as gift cards(cash value of Yes $2,500.00 2 $5,000.00 Consultant gift cards will not exceed 525) Gift cards will be stored in a secure location, checked out prior to use,and will be signed for by the gift card recipient. WCDPHE staff will work with technical assistance provider to determine the appropriate number focus group participants ($2500 per focus group x 2= $50001. Total Contractual $o $25,785.00 SUB-TOTAL BEFORE INDIRECT $280,526.83 Page 3 of 4 EXHIBIT C Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing# 16 FHLA 76437 Colorado D'pari sitnr of Public Health and[mire no Weld County Department of Public Health and Program Contact Name, [nc Aaiko,DMnon Director,Hint comm.Ping 970 304 64701(2380 Contractor Name raakke@wrmrov cam Environment Title,Phone and Email Fiscal Contact Name,Title, Tanya Geiser,Director,Administrative Services Budget Period July 1,2015-June 30,2016 Phone and Email 970.304.6410 x 2122,tgeiser@weldgovcom Project Name Weld County Tobacco Control Program Indirect Match or In- Total Amount Kind(If Requested from Item Description of Item Required by CDPHE Negotiated Indirect cost rate (Federal,State,or CDPHE) WCOPHE has a 2015 negotiated indirect rate of 13.68%of TDC with CDPHE. $38,376 07 Indirect Imodlfled or additional base) Total Indirect $0 $38,376.07 TOTAL MATCH OR IN KIND $D TOTAL $318,903 Page 4 of 4 Hello