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Home My WebLink About20141468.tiff RESOLUTION RE: APPROVE TASK ORDER CONTRACT FOR CHILD FATALITY PREVENTION SYSTEMS - PHASE II 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 Child Fatality Preventions Systems — Phase II 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, 2014, and ending June 30, 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 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 Child Fatality Preventions Systems—Phase II 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 14th day of May, A.D., 2014. BOARD OF COUNTY COMMISSIONERS WELD COUNT COLORADO ATTEST: thaw w yno, / (AYE) ougl2s Radem ch r, Chair Weld County Clerk to the B• ,t� `► Ica - (AYE) 1 / tut 1 ��rbara Kirkmey r, Pro-Te BY. uty Clerk to the B.\Y� .* XCUSED UN'S Sean P. Conway APPROD AS T RM: (AYE) Mike F an County Attorney (NAY) William F. Garcia Date of signature: 51aDfiq GC : HzCTc., 2011 2014-1468 HL0044 Memorandum r r\!I ' L? r' TO: Douglas Rademacher, Chair N T Y Board of County Commissioners GO_U _T FROM: Mark E. Wallace, MD, MPH, Executive Director Department of Public Health & Environment DATE: 5/9/2014 SUBJECT: Child Fatality Prevention Systems- Phase II Task Order Contract with CDPHE Enclosed for Board review and approval is a contract between the Colorado Department of Public Health and Environment and the Board of County Commissioners of Weld County on behalf of the Weld County Department of Public Health and Environment. The Child Fatality Prevention Act (Article 20.5 of Title 25, Colorado Revised Statutes) established the Child Fatality Prevention System (CFPS), a statewide, multidisciplinary, multi-agency effort to prevent child deaths. Under this Task Order Contract, the WCDPHE will take the lead in establishing and coordinating the local, multidisciplinary child fatality prevention review team. The purpose of the review team is to review all preventable child deaths, identify trends, and implement strategies to prevent future deaths from occurring. The contract period is from July 1, 2014, through June 30, 2015. CDPHE agrees to pay WCDPHE $15,000.00 for services provided in this contract. This Task Order Contract was approved for placement on the agenda by the Board via pass- around dated May 8, 2014. I recommend approval of this Child Fatality Prevention Systems - Phase II Task Order Contract with CDPHE. 2014-1468 DEPARTMENT OF PUBLIC I IEALFII AND ENVIRONMENT ROUTING NO.15 FLA 68349 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 0051A STATE. CONTRACTOR: State of Colorado for the use&benefit of the Board of County Commissioners of Weld Department of Public health and County Environment (a political subdivision of the state of (Division Name) Colorado) (Program Name) 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 I Iealth and Environment 1555 North 17th Avenue Greeley, Colorado 80631 TASK ORDER MADE DATE: CONTRACTOR ENTRY TYPE: 04/21/2014 Colorado Political Subdivision PO/SC ENCUMBRANCE NUMBER: PC) FLA PSD1568349 TERM: BILLING STATEMENTS RECEIVED: This Task Order shall be effective upon Monthly approval by the State Controller,or designee, or on 07/01/2014,whichever is later. The STATUTORY ALMIORr1Y: Task Order shall end on 06/30/2015. C.R.S. §25-20.5-404-405 PRICESl'RUCI'URI: CON I RACE PRICE NOII t)EXCEED_ Cost Reimbursement $15,000.00 PROCUREMENT MIXITOD: FIEDERAI.PENDING DOI LARS. $0.00 Exempt STA'Dl14T1DNG DOI.I.AIiS: $$15,000.00 RID/RIB'/LIST PRICE AGREEMENT NUMBER_ MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR: Not Applicable 1Y 15: $15,000.00 LAW SPFCImED VENDOR stAtUrE: Not Applicable STATE RI:PRI:SEN INrnVI_ CONI IL\CTOR RI;PRESINI'KI'IVE: Colleen Kapsimahs "Tanya Geiser Department of Public Health and Environment Administrative Services Director Prevention Services Division 1555 North 17th Avenue Child Fatality Prevention System Program Greeley,CO 80631-9117 4300 Cherry Creek Drive South Denver,CO 80246 SCOPE OF WORK: Establish and coordinate local child fatality review teams to conduct systematic,comprehensive,multidisciplinary reviews of all preventable child deaths to better understand how and while children die,to identify trends,to improve systems,and to implement strategies that may prevent future deaths. Contract_Template_Task_Order_083010 Page I of 6 GXIIIn11S: 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. 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),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_083010 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 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_083010 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_I'emplate_Task_Order_083010 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 (ao) olithel subdivision and of the state of Colorado) for the use and benefit of the nWeld County-Department of Public HealthTht:Qa,- a ' I and Environment t A Legal Name of Contracting Entity By For Executive Director t (� p L; r��d1.u,T' {y^ Department of Public Health and Environment Signal of Authorized fficer MAY 1 4 2014 Douglas Rademacher Print Name of Authorized Officer Department o�yP o,gr-amr�,'Approval: /I chair Rnard of Weld County BY� Afrth1 "�A( ttrl ilmli ) Print Title of Authorized Officer Commissioners MM 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 : �./JN� Date Contract_Template_Task_Order_083010 Page 5 of 6 O,9e/V- /968 This page left intentionally blank. Contract_Template_Task_Order_083010 Page 6 of 6 EXHIBIT A ADDITIONAL PROVISIONS To Task Order Contract Dated 04/21/2014-Contract Routing Number 15 FLA 68349 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. I. 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 h> ://www.colorado.gov/cs/Satellite/CDPHE-Main/CBON/I 25162294 1 228 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: Colleen Kapsimalis,Child Fatality Prevention System Program Manager(colleen.kapsimalis@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 CDPHE. 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. 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. To be attached to CDPHE Page I of 3 Revised: 12/19/06 Task Order v1.0(3/12)contract template EXHIBIT A 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 HIPAA. 5. The list of acronyms attached hereto as Attachment A-I may be referenced to in Exhibit A, Exhibit B, and all and any attachments thereof in this Task Order Contract. 6. Contractor shall request prior approval in writing from the State for all modifications to the Statement of Work/Work Plan or for any modification to the direct costs in excess of twenty-five percent(25%)of the total budget for direct costs. Any request for modifications to the Budget in excess of twenty-five percent (25%)of the total budget for direct costs or$250,000.00,whichever is less, shall be submitted to the State at least 90 days prior to the end of the contract period and may require an amendment in accordance with General Provisions,Section 5,of this Task Order Contract. 7. Contractor shall request prior approval in writing from the State for all modifications to the Statement of Work/Work Plan or Budget,except the Contractor may move funds from indirect costs to direct costs in the Budget without prior approval. Any request for a modification to the Statement of Work/Work Plan or Budget shall be submitted to the State at least 90 days prior to the end of the contract period or fiscal year and may require an amendment in accordance with General Provision,Section 5,of this Task Order Contract. 8. If Contractor indicates full expenditure of funds under this Task Order Contract by March I 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 I 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 1,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. 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,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. To be attached to CDPHE Page 2 of 3 Revised: 12/19/06 Task Order v1.0(3/12)contract template EXHIBIT A 10. 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. I I. The State of Colorado,specifically the Colorado Department of Public Health and Environment,shall be the owner of all equipment as defined by 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 Task Order Contract,the State shall approve the disposition of all equipment. 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-2.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 4 years 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-3. 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 5 years.(Note: 5 years is the maximum allowable.) To be attached to CDPHE Page 3 of 3 Revised: 12/19/06 Task Order v1.0(3/12)contract template Attachment A-I Commonly Used Acronyms and Abbreviations That May Be Referenced In the Scope of Work: ACS American Cancer Society ACNS Alamosa County Nursing Service ACE Administration for Children and Families ADA Americans with Disabilities Act ADAD Alcohol and Drug Abuse Division AHA American Heart Association AIDS Acquired Immune Deficiency Syndrome ALA American Lung Association ALA(C) American Lung Association(of Colorado) AMCHP Association of Maternal Child Health Programs ANR Americans for Non-Smokers' Rights ARC Addiction Recovery Centers ARRA American Recovery and Reinvestment Act ASC Adams State College ASSIST American Stop Smoking Intervention Study ASTHO Association of State and Territorial Health Office B&G Boys&Girls BACCHUS BACCHUS Peer Education Network BAG Build a Generation BBLHC Boulder Broomfield Latino Health Coalition BC Boulder County BCCP Breast and Cervical Cancer Program BCIID Bent County Health Dept BCPH Boulder County Public Health BCPI IA Baca County Public Health Agency BCDSS Baca County Dept Social Services BC IEPP Bent County Tobacco Education Prevention Partnership BGC Boys&Girls Club BGCMD Boys&Girls of Metro Denver BHS Broomfield High School BMTF Baby&Me Tobacco Free BOCES Board of Cooperative Educational Services BOH Board of Health BRFSS Behavioral Risk Factor Surveillance System BVBAG Buena Vista Build a Generation BVSD Boulder Valley School District Bx Biopsy C Choice CAD Coronary Artery Disease CASB Colorado Association of School Board CB Community-based System CBE Clinical Breast Exam CBO Community-based Organization CC Clear Creek CC Custer County CC Community Coordination/Coordinator CCAP l.arimer County Child Care Assistance Program CCC Colorado Cancer Coalition CCCHE Colorado Community Coalition for health Equity CCGC Colorado Clinical Guidelines Collaborative CCIAA Colorado Clean Indoor Air Act CCMC Colorado Clinical Managed Care Network CCMC Commission for Case Manager Certification CCPD Cancer,Cardiovascular,and Pulmonary Disease Page 1 of 6 Attachment A-1 CCTCI Colorado Chew Tobacco Collaborative Initiative CCTEPP Custer County Tobacco Education Prevention Partnership CDC Centers for Disease Control and Prevention CDE Colorado Department of Education CDPHE Colorado Department of Public Health and Environment CDU Chronic Disease Unit CEC Career Education Center CEO Chief Executive Officer CFDA Catalog of Federal Domestic Assistance CFTC Colorado Foundation for Families and Children CFPI Colorado Family Planning Initiative CHIN Community Health Information Network CICP Colorado Indigent Care Program CJD Colorado Judicial Department CM Case Management CMC Colorado Mountain College CMS Contract Management System CMS Creative Media Solutions CNCC Colorado Northwestern Community College CNS County Nursing Service CO Colorado COD Colorado Donated Dental Services Program COPAN Colorado Physical Activity and Nutrition Program COV Colorado Van Program CPCF Colorado Parent and Child Foundation CPHA Colorado Public I lealth Association CPT Current Procedural Technology CRC Colorectal Cancer CRCCP Colorectal Cancer Screening Program CRUE Culturally Responsive Urban Education CSAP Colorado Student Assessment Program CSH Coordinated School Health CSU Colorado State University CSU-P Colorado State University-Pueblo's CI'C Connect to Care CTEPA Colorado Tobacco Education and Prevention Alliance CTFK Campaign for Tobacco-Free Kids CTRP Colorado Tobacco Research Program CTP Crossroads Turning Point CU University of Colorado,Boulder CWCCI Colorado Women's Cancer Control Initiative CY Contract Year DAISI Denver At-home Intervention Service Initiative DASH Division of Adolescent&School Health (CDC) DCMH Delta County Memorial Hospital DI I Denver Health DHHA Denver Health and Hospital Authority DHS Department of Human Services DIMS Unites States Department of Health and Human Services DOR Department of Revenue DOS Delta Opportunity School DSS Department of Social Services F&I Education and Information EAP Employee Assistance Program EBI IV Evidence-Based Home Visiting to Prevent Child Maltreatment Grant Program ECC Early childhood council ECC Electrocardiogram ECCLC Early Childhood Council of Larimer County Page 2 of 6 Attachment A-1 ECLC Early Childhood Leadership Council/Commission ED. Executive Director EHR Electronic Health Record • El IS Early Head Start EMR Electronic Medical Record EMT Emergency Medical Technicians EPA Environmental Protection Agency EPE Epidemiology Planning and Evaluation ESL English as a Second Language ETS Environmental Tobacco Smoke(a.k.a.secondhand smoke) FIRC Family and Intercultural Resource Center FICA The Federal Insurance Contribution Act FDA Food and Drug Administration FIT/POET Fecal Immunochemical Test/Fecal Occult Blood Test FNA Final Needle Aspiration EPP Family Planning Program FPL Federal Poverty Level FRCC Front Range Community College FTE Full Time Equivalent FTP File Transfer Protocol • FY Fiscal Year • FYI Family Youth Initiatives GASO Great American Smoke-out GED General Education Development GASP CO Group to Alleviate Smoking Pollution of Colorado Get R!EAL(GR) Resist! Expose Advertising Lies(Youth Empowerment Program) GLBT Gay,Lesbian,Bisexual,and Transgender GYN Gynecological HCP Health Care Program For Children with Special Needs HCYS Huerfano County Youth Services HMS Health and Human Services HIPPA Health Insurance Portability and Accountability Act of 1996 HIPPY Home Instruction for Parents of Preschool Youngster HIT I lealth Improvement Team HIV Human Immunodeficiency Virus HPV Human Papillomamavirus HR Human Resources hr hour HRSA Health Resources and Services Administration HSI, High School Leadership ID Identification IIK Invest in Kids ISHT Interagency School Health Team IT Information Technology JAC Juvenile Assessment Center KIS Keeping in STEPP KMH Keefe Memorial Hospital • KPC Kevin Patrick Caleum LAI ICDHD Las Animas Huerfano Counties District I lealth Department LBW Low Birth Weight LC Learning Community LGBT Lesbian,Gay,Bisexual,Transgender LEM Latinas en Movimiento LHA Local Health Agency LHD Local Health Department LLC Limited Liability Company LRCC Latino Regional Community Coalition LRPC Latino a Research and Policy Center Page 3 of 6 Attachment A-1 LST Life Skills Training LSTPEN Latino Statewide Tobacco Prevention and Education Netw LWB Live Well Broomfield MCHA Montezuma Housing Authority MCHD Montezuma County Health Department MCHS Montezuma-Cortez High School MCPN Metro Community Provider Network MCRC Media Campaign Resource Center—CDC MD Medical Doctor MHCBBC Mental Health Center Serving Boulder and Broomfield Counties MIECHV Maternal,Infant and Early Childhood Home Visiting Program MO Month MOB Medical Office Building MOU Memorandum of Understanding MPA Master of Public Administration in Health and Human Services MPH Master of Public Health MRI Magnetic Resonance Imaging Scan MS Master of Science MSA Master Settlement Agreement MUH Multi-user Housing MYAT Multi-Disciplinary Youth Assessment Team N/A Not Applicable NACCI 10 National Association of County and City Health Officials NACR Native American Cancer Research NAQC North American Quitline Consortium NASBE National Association of State Board of Education NCCRT National Colorectal Cancer Round Table NCIID Northeast Colorado Health Department NCI National Cancer Institute NE North East NIP Nurse-Family Partnership NFPNSO Nurse-Family Partnership National Service Office NHVP Nurse Ilome Visitor Program NIDA National Institute on Drug Abuse NII I National Institute of Health NJH National Jewish Medical and Research Center N-O-T Not-on-Tobacco,(ALA's Youth Smoking Cessation Program) NP Nurse Practitioner NPP Nurturing Parenting Program NRT Nicotine Replacement Therapy NSBA National School Boards Association OSH Office on Smoking or Health (CDC) OTC Over the Counter PA Physician's Assistant PAC Prevention Awareness Crew PACT Partners Assessing Chew Tobacco PAT Parents as Teachers PCCHD Pueblo City-County Health Department PPC Personal Care Providers PF. Presumptive Eligibility PEN Parent Engagement Network PVCI IC Peak Vista Community I lealth Center PHN Public I lealth Nurse PIO Public Information Officer PM Peer Mentor PMC Parkview Medical Center PMR Planning Management Region PN Patient Navigator Page 4 of 6 Attachment A-I PO Purchase Order PPC Policy Partner Committee PPFC Pikes Peak Family Connections PPN Prevention Policy Network PRA Policy Resource Alliance PRAMS Pregnancy Risk Assessment and Monitoring Survey PRIDE Pure Respect Initiative Direct Education PSA Public Service Announcement PSD Prevention Service Division PTFPP Pueblo Tobacco Education and Prevention Partnership PVC Prairie View Clinic QI Quarter One Q2 Quarter Two Q3 Quarter Three Q4 Quarter Four QI Quality Improvement QOL Quality of Life RDAC Regional Disparities Advisory Council RFA Request for Applications RFP Request For Proposals RIE Reach,Implementation and Effectiveness RIHEL Regional Institute for Health and Environment RMC Rocky Mountain Center for Health Promotion&Education RMRH Rocky Mountain Rural I lealth RMYC Rocky Mountain Youth Corps RN Registered Nurse Rx Prescription RY Reconnecting Youth SafeCare SAMHSA Substance Abuse Mental I lealth Services Administration SB School-based System SHAG Salida Build A Generation SBHC School-Based Health Centers SCYC School Community Youth Coalition SCRI IC Southern Colorado Regional Health Collaborative SD Service Delivery SECH Southeast Colorado Hospital SEMHS Southeast Mental Health Services 513 Socio-Economic Status SEW School Employee Wellness SGR Surgeon General's Report SHAC Smoke-free I lousing Action Committee SHI School Health Index SI IS Secondhand Smoke SIDS Sudden Infant Death Syndrome SLV San Luis Valley SMART Staying Motivated at Reducing Temptations SMART OUTCOME OBJECTIVE Specific,Measurable,Achievable,Realistic,Time-Bound SMSU Self Management Service Unit SOW Scope of Work SRO School Resource Officer STD Sexually Transmitted Disease STEPP State Tobacco Education and Prevention Partnership STW Straight-to-Work SVVSD St.Vrain Valley School District SWOT Strengths,Weaknesses,Opportunities,Threats SYNAR Synar Regulation TA Technical Assistance Page 5 of 6 Attachment A-1 TABS Tobacco Attitudes and Behavior Survey TAG Technical Advisory Group(for evaluation&TPEG) TANF Temporary Aid to Needy Families TARP Tobacco Advocacy and Resource Partnership TBD To Be Determine TCP Tobacco Control Partners TDAC Tobacco Disparities Advisory Council TDG Tobacco Disparities Grant TDS Tobacco Disparities Subcommittee TEACH Teaching Equity to Advance Community Health TEFAP The Emergency Food Assistance Program TEPCGP Tobacco Education Prevention and Cessation Grant Program TBPP Tobacco Education Prevention Partnership TFCCI Tobacco-Free Colorado Communities Initiative TFI.C Tobacco Free Larimer County TFS Tobacco-Free Schools TFS Law Tobacco-Free Schools Law TGYS Tony Grampsas Youth Services Title V Title V of the Social Security Act TND Project Toward No Drug Abuse TPEG Tobacco Program Evaluation Group TPI Tobacco Prevention Initiative 'FRC Tobacco Education and Prevention and Cessation Program Review Committee TRI Tobacco Rapid Improvement Activity TRIA Tobacco Rapid Improvement Assessment TTI Tony Grampsas Tobacco Initiative UCD University of Colorado—Denver UCDHSC Health Sciences Center at UCD(sometimes abr.UCHSC) UCDHSC University of Colorado at Denver and Health Sciences Center URL Uniform Resource Locator US United States of America USSTC US Smokeless Tobacco Company VP Vice President Well COA Wellness Councils of America WHU Women's Health Unit WIC Women,Infants,Children WWC Women's Wellness Connection Y u C Youth at Crossroads YE Youth Empowerment YPH Youth Partnership for Health Yr Year YRBS Youth Risk Behavior Survey YSAP Youth Substance Abuse Prevention Coalition YTS Youth Tobacco Survey YVMC Yampa Valley Medical Center 5 A's Ask,Advise,Assess,Assist.Arrange 2A's R Ask,Advise,Refer Page 6 of 6 Attachment A-2 GRANT FUNDING CHANGE LETTER Date: State Fiscal Year: Grant Funding Change Letter# CMS Routing # 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 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 Jaros, CPA, MBA, JD By: Date Page 1 of 1 Effective Date:1/6/09-Rev 8/25/09 Attachment A-3 OPTION LETTER Date: I State Fiscal Year: I 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 REOUIRE 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. 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X = 06.. o f _ d 3 ' [- .E U 3 U y y 3 3 y J 'rv; F- v mvim, o•SO— Q N E U 07 - L, - Exhibit C Budget N�cc Colorado Department of Public Health and Environment `-, � PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM ' •• Contract Routing# 15 FLA 68349 Colorado Department of Public Health and tnvimnmenc Eric Aakko,Director,Health Communication, Weld County Department of Public Health& Program Contact Name, Contractor Name Education and Planning;970-304-6470 ext 2380; Environment Title,Phone and Email eaa kko@weldgov.com Fiscal Contact Name, Tanya Geiser,Director,Administrative Services;970- Budget Period July 1,2014 through June 30,2015 Title,Phone and Email 304-6410 ext 2122;tgeiser@weldgov.com Project Name CEPS Phase II Expenditure Categories Personal Services Salaried Employees 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 Coordinator will facilitate local child fatality prevention review teams in examining preventable child deaths to better understand how and why children die.Coordinator will organize review teams,handle meeting logistics and order food and other materials as needed.Coordinator will also assist in determining appropriate child accidental death prevention campaign with the team Primary tasks 1.0, Public Health Nurse members,when appropriate. 1.1,2.0 $63,987.14 $ 24,910 12.50% $11,112.17 Personal Services Hourly Employees List SOW deliverable/ Match or In- primary task Total I 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 Total Personal Services (including fringe benefits) $0 $11,112 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 Primary tasks Office Supplies Misc office supplies for meetings,including name tags,etc. 1.0,1.1,2.0 $ 10.00 4 $40 Primary tasks Operating Expenses Other misc operating expenses,e.g.printing agenda and notes 1.0,1.1,2.0 $ 15.00 4 $60 Page 1 of 3 V.1 Jan 2013 Exhibit C Budget Colorado Department of Public Health and Environment 1: • PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM •:1*;;;.Y Contract Routing# 15 FLA 68349 Colorado Department of Public Health and E ivironment Eric Aakko,Director,Health Communication, Weld County Department of Public Health& Program Contact Name, Contractor Name Education and Planning;970-304-6470 ext 2380; Environment Title,Phone and Email eaakko@weldgov.com Fiscal Contact Name, Tanya Geiser,Director,Administrative Services;970- Budget Period July 1,2014 through June 30,2015 Title,Phone and Email 304-6410 ext 2122;tgeiser@weldgov.com Project Name CEPS Phase II Primary tasks Meeting Supplies Food&supplies for review team meetings 1.0,1.1,2.0 $ 200.00 4 $800 Total Supplies &Ooeratino Expenses SD $900 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 Mileage for attending review team meetings throughout Weld County (4+meetings x 50 miles=200 miles),including mileage for required • meetings in Denver(2 meetings x 100 miles=200 miles).Additional miles for additional review team meetings as needed(4 x 50 miles=200 Primary tasks Mileage miles). 1.0,1.1,2.0 $0.54 600 $324 Total Travel $0 $324 • Page 2 of 3 V.1 Jan 2013 Exhibit C Budget Colorado Department of Public Health and Environment CPREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing # 15 FLA 68349 Colorado Department of Public Health and Environment Eric Aakko,Director,Health Communication, Weld County Department of Public Health& Program Contact Name,Contractor Name Education and Planning'970-304-6470 en 2380; Environment Title,Phone and Email eaakko@weldgov.com Fiscal Contact Name, Tanya Geiser,Director,Administrative Services;970- Budget Period July 1,2014 through June 30,2015 Title,Phone and Email 304-6410 ext 2122;tgeiser@weldgov.com Project Name CFPS Phase II Contractual List SOW deliverable/ primary task Match or In- number(s) Kind(If Total Amount this budget Required by Requested from Subcontractor Name Description of Item item supports Rate Quantity REA) CDPHE Campaign related to child/infant fatality prevention initiative-TBD. Initiative will be determined by nature of preventable deaths that occur Primary task TBD in 2014 and early 2015. 1.1 $892.50 1 $893 Total Contractual $893 SUB-TOTAL BEFORE INDIRECT $13,229 Indirect Match or In- Kind Total Amount Required by Requested from Item Description of Item ores CDPHE Negotiated Indirect cost rate(Federal,State,or 2014 CDPHE contracted indirect rate=13.39%;we request that our indirect rate be changed in 2015 to our then CDPHE) contracted indirect rate which at this time is unknown. $1,771 Total IndirectSO $1,171 TOTAL MATCH OR IN KIND $0 • TOTAL - Sumo Page 3 of 3 V.1 Jan 2013 Hello