HomeMy WebLinkAbout20141997.tiff OPTION LETTER
Date: Original Contract CMS#: Option Letter It I CMS Routing# •
05/19/2014 141HA65516 ' /57 t/-A- &/735'
1) OPTIONS: Change in amount of goods in conjunction with renewal for additional 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,routing number 14-IHA-65516,between the
State of Colorado,Department of Human Services,and Weld County Department of Human Services,the State
hereby exercises its option for an additional term beginning July I,2014 and ending on June 30,2015 AND an
increase in the amount of goods'services as specified in the attached Exhibit B-Option Letter Contractor Budget,
hereby incorporated by reference.
The amount of the contract value is increased by$150,000.00 as consideration for services goods ordered under the
contract for the state fiscal year 15 (SFY 15).The total contract value is increased to$200,599.13.The "Term",
"Contract Not To Exceed Price"and the "Maximum Amount Available Per Fiscal Year", on page one of the
Original Contract are hereby modified accordingly.
3) Effective Date.The effective date of this Option Letter is upon approval of the State Controller or July 1,2014.
whichever is later.
STATE OF COLORADO
John W Hickenlooper,Governor
Reg e icha, e Director
LA
By: Mary An Snyder,Director,Office of Early Childhood
s V
Date:
ALL CONTRACTS REOUIRE APPROVAL THE STATE CONTROLLER
�RS§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 andior services provided hereunder.
STATE CONTROLLER
Roe aros,DS A,
By:
Clint W ff
'druuI ,
Date: b ��J ��'f
2014-1997
Comrnurl i ca7l (Ms
1-02- (y I I ROOS5
EXHIBIT A
SFY 15 STATEMENT OF WORK
To Original Contract Routing Number 14 IHA 65516
Weld County Department of Human Services
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
I. Project Description(Description of Colorado Community Response program):
Weld County Department of Human Sex-vices in partnership with North Range Behavioral Health shall provide
comprehensive voluntary services for families reported to child protective services but screened out and"or closed
after initial assessment; shall increase enrolled families'protective capacities by promoting individual,family,and
community strengths; and shall address the link between poverty and child maltreatment by connecting enrolled
families to vital economic and other support services. By partnering with families in the early stages of child
maltreatment risk, a broader and richer child abuse prevention service continuum will be established for Colorado.
Weld County Department of Human Services shall provide intensive coordination of community based supports
(case management, financial decision making, social capital opportunities, and flex funding) based on family
identified goals primarily provided in families'own homes, or other locations convenient for the individual family.
II. Definitions(Explanation of acronyms):
CCR=Colorado Community Response
DHHS=Department of Health and Human Services
CCM:Community Case Manager
III. Performance(Work Plan and Requirements):
1. The Contractor's performance shall comply with Exhibits A, B, C, and D of the contract. Exhibit A is this
Statement of Work (SOW), Exhibit B is the Contractor's Budget and Budget Narrative, Exhibit C HIPAA
Business Associate Addendum,and Exhibit D is the Option Letter.
2. The Contractor shall act in a fiduciary capacity as the fiscal agent, whose duties include but are not limited
to the following:
a. Ensure the completion of duties, by itself or through subcontracts, as described in the SOW The
Contractor shall ensure that any service provided by any service provider (subcontractors) in the
targeted area complies with the SOW.
b. Provide qualified staff to coordinate and oversee the appropriate and lawful obligation and
expenditure of CCR funds, receiving and distributing funds, keeping records, and auditing
procedures of sub-contractors.
c. As fiscal agent, disburse funds hereunder in compliance with State requirements to
agencies/individuals providing CCR services.
d. Notify the State in writing of any anticipated or actual deviations front the agreed upon timeline,
or deviations within the SOW. Such deviations shall require the prior written approval of the State
through the amendment format as provided by the State.
e. Respond to and gather appropriate data for the State evaluation of CCR as determined by the
external evaluator.
f Maintain confidentiality of records.
g. Agree that any and all work products, which are the result of this contract(in whole or part), will
be the property of the State. Any product of this contract which is distributed to the public or made
available to the public must prominently acknowledge the use of CCR funds through the Colorado
Department of Human Services;Division of Community and Family Support.
h. Ensure participation with the State staff as requested, to allow for open discussions of progress,
problems encountered and problem solutions both at local and state level of operations.
Pdge I of 3
Lxif Ii.-A-Stdternent of A14ir,
CCR blac?Ilia
EXHIBIT A
i. Ensure participation with the other CCR sites in aspects of the ongoing technical assistance
provided by the State, specifically; but not limited to, monthly peer conference calls, Annual
training,and annual Grantee Meetings.
j. Ensure participants are informed of the short-terra nature of benefits and ensure participants are
• not financially harmed by this program.
Sample:Please edit Position of Person Responsible as appropriate for your program.
Primary Task 1.0:Shall provide comprehensive voluntary services for up to 50 families reported to child protective
services but screened out and/or closed after initial assessment during the 2014-2015 grant year.
Activity Quarters of Measurement Deadline Position of Person/Agency
activity Responsible
1.1 Referrals provided to program weekly QI-Q4 Referrals received Ongoing County worker, RED Team
via secure method. by CCR program. Supervisor
1.2 Referred families are assigned to QI-Q4 CCR Referral Log 0630%15 Prevention Programs
CCR staff and CCR case manager will completed for Supervisor
outreach to referred families, each referred CCM
family.
1.3 Families will voluntarily enroll in the I QI-Q4 Up to 50 06!30'15 CCM
CCR program, shown by completing unduplicated i Family Engagement
Caregiver pretest data instruments families will Facilitator
complete CCR
•
Caregiver pretest •
instrumentation.
1 4 Families will voluntarily engage in ' QI-Q4 Up to 50 06 30 15 CCM
prevention service areas identified by the unduplicated Prevention Programs
I family during the goal setting phase of families will Supervisor
program. complete •
Colorado Family
Support
Assessment and
• Caregiver posttest
instrumentation. _
1.5 Submit monthly data exhibiting QI-Q4 Submit monthly I Ongoing Prevention Programs
contract performance measures to be I data as Supervisor •
identified through the C-Stat Action plan. applicable.
1.6 Submit mid-year and year-end ' Q3 & Q4 Reports submitted Mid-year Due Prevention Programs •
progress reports to CDHS_Report shall I in timely fashion 01'30/2015 Supervisor
contain descriptions of accomplishments and include all Year-end Due:
with reporting standards provided by requested 07'30.2015
CONS. information.
-- _ T .--_—_.-
I I
Primary Task 2.0:Shall increase enrolled families'protective capacities by promoting individual,family,and community
strengths during the 2014-2015 grant year.
Activity Quarters of Measurement Deadline Position of Person/Agency
activity _ __-_--.- Responsible _
2.1 Families'existing strengths will he QI-Q4 Up to 50 : 06 30 15 CCM
identified and acknowledged I unduplicated
families will
complete CCR
Caregiver pretest
and posttest
instrumentation.
2 2 Strengthening Families Protec is e i O1/22 i. All CCR staff will 06 30 15 CCM Prevention Programs
Factors are integrated thro bout till , I("nplete the Supervisor.
Puke 2 at
Exhibit A-Sat aver:of Work
('ER XIas 20i4
EXHIBIT A
CCR services offered. online
• Strengthening
• Families training. _
Primary Task 3.0: Shall address the link between poverty and child maltreatment by connecting enrolled families to vital
economic and other support services during the 2014-2015 grant year.
Activity Quarters of Measurement Deadline Position of Person/Agency '..
activity Responsible
3.1 CCR program will assess families' QI-Q4 Completed CCR 06/30/15 CCM
eligibility for public benefits and help Income and
families apply for these benefits. Benefits Inventory
for enrolled
families.
Appropriate
applications
_ E _ completed.
3.2 Connect enrolled families to one-time QI-Q4 Completed CCR 06/30/15 CCM, Prevention Programs
flexible funds to address concrete Flex Funds form. • Supervisor
economic need that has child well-being Funds distributed.
and/or-family stability implications.
IV. Monitoring:
CDHS's monitoring of this contract for compliance with performance requirements will be conducted throughout
the contract period by the Colorado Community Response Program Coordinator at CDHS. Methods used will
include a review of documentation determined by CDHS to be reflective of performance to include progress
reports and other fiscal and programmatic documentation as applicable.
V. Resolution of Non-Compliance:
The Contractor will be notified in writing within 30 calendar days of discovery of a compliance issue. Within 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 Colorado
Community Response Program Coordinator and receive approval for a new due date. The State will oversee the
completion/implementation of the action(s) to ensure time lines are met and the issue(s) is resolved. If the
Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may
exercise its rights under the provisions of this contract.
VI. Term and Renewal:
The State may require continued performance for a period of one year for any services at the rates and terms
specified in the contract.The State may exercise the option by providing written notice to the Contractor within 30
days prior to the end of the current term in a form substantially equivalent to Exhibit D. If the State exercises this
option,the extended contract will be considered to include this option provision. The total duration of this contract,
including the exercise of any options under this clause shall not exceed three years. Notwithstanding the state
contract term, the Contractor shall have a continued obligation to provide the final report stated in Paragraph 111.2.6
and Activity 1.6 of this Exhibit A.
•
•
Page 3 of 3
Exhibit A-statement lu'VA1,ri
CUR Vla, 21114
Option Letter Contractor Budget-Exhibit B
Applicant Name: Weld County Department of human Services Budget Period July 1,2014-June 30, 2015
PERSONNEL EXPENSES
`Fr6fCent -
of Actual Additional
Gross or Time
Personnel Services Annual Fringe (FTE)on Resources Amount Requested
Salary rnntr,rrr
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
education to families referred to them 4,200/mo. 1,550imo 100/ $0 00 $69,000.00
Family Engagement Provide facilitation to all famlf es within
Facilitator the grant 4,100/mo. 800/mo. 87% $0.00 $50,962.00
$0.00 $0.00
$0.00 $0.00
Total Personal Services
(including fringe benefits $118,962.00
SUPPLIES&OPERATIN EXPENSES
Additional
Item Description of Item Rate Resources Amount Requested
(not from CDHS
reaulred)
Printing/6opying
$0.00
Postage/Snipping $0.00
Phone/Fax/inter-net $0.00
Supplies
Meeting $0.00
$0.00
Other(Please list below by'tern) $0.00
Certification Coarse-
National Financial Eduction Council Certified Financial
Planner-Ongoing $297.00
Certification
Total Supplies
&Operating Expenses $297.00
TRAVEL
Item Description of Item Rate Quantity Amount Requested
from CONS
Mileage-Other Travel-Training!Home Visits Average 350 Miles $0.545/Mile
per Month 4255 $2.319.00
Lodging
$0.00
Meats Meals during Training
and Home Visits $23 per Day 14Days $322 00
r
$0.00
Total Travel
$2,641.00
OTHER COSTS
Item Description of Item Rate Quantity Amount Requested
Equipment from CDHS
$0.00
Flex Funds($5,000 required In first year and$10,000
required In second year) $10,000.00
Other(Please detail each item) $0.00
$0.00
Total Other Costs $10,000.00
CONTRACTUAL(payments to third parties or entitles)
Item Description of Item Rate Quantity Amount Requested
Consulting from CDHS
$0.00
Consulting-Training Quarterly:Skills and Reflective North Range $75/Hour 20 $1,500.00
Training-Infant/Early Mental Health North Range $75/Hour 208 $15,600.00
$0.00
Total Contractual $17,100.00
SUB-TOTAL BEFORE INDIRECT $150,000.00
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
$150,000.00
Esther Gesick
From: Judy Griego
Sent: Monday, June 30, 2014 9:42 AM
To: Esther Gesick
Cc: Susan Talmadge
Subject: FW: CCR FY15 Option Letter
Attachments: 69735_SIGNED.pdf
N E D.pdf
See attached and the e-mail below.
Judy A. Griego, Director
Weld County Department of Human Services
315 N 11th Avenue BLDG B
Greeley, CO 80631-2014
970.352.1551, extension 6510
Fax 970.353.5215
griegoja@weldgov.com
en, .
1 I) r -
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Haymond - CDHS, Teri [mailto:teri.haymond@state.co.us]
Sent: Monday, June 30, 2014 9:25 AM
To: Judy Griego
Cc: Heather Walker; Kathi Brown
Subject: CCR FY15 Option Letter
Happy Monday, Judy!
You have been awarded funds to administer the Colorado Community Response (CCR) program,
beginning July 1, 2014 — June 30, 2015. Your original signed copy will be mailed.
Your current allocation is listed on the attached Option Letter. The Option Letter indicates how much
you will receive this fiscal year and then also provides you with an accumulative amount which
includes all of the funds awarded for the two years of your current contract. If you are unsure of your
current operating amount contact me, as the Option Letter wording can be confusing.
The allocation should be spent according to the budget that you submitted as part of the renewal for
funding, and within the state requirements.
Cheers,
Teri
Teri Haymond, LCSW
Program Coordinator, Colorado Community Response
*wiw COLORADO
Co Office of Early Childhood
P 303.866-5227 I Fax 303.866.4453
1575 Sherman Street, Denver CO 80203
teri.haymond®state.co.us I www.coloradoofficeofearlychildhood.com
Disclaimer:This email and any attachments thereto,is intended only for use by the
addressees named herein and may contain legally privileged and/or confidential
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