HomeMy WebLinkAboutC01-158 Contract Change Order Letter No. 3 - EPSDT Program HHS$g
` Bill Cravens, Governor
Jane E. Norton, Executive Director
Dedicated to protecting and im
4300 Cherry Creek Dr. S.
Denver, Colorado 80246 -1530
Phone (303) 692 -2000
TDD Line (303) 691 -7700
Located in Glendale, Colorado
ht(P-*#www-ccphe.state.co.us
May 10, 2001
(- 1 -1 (�� C" k_' L' I — / --,- U — C-- —
STATE OF COLORADO
7roving the health and environment of the people of Cc
Laboratory and Radiation Services Division
8100 Lowry Blvd.
Denver CO 80230 -6928
(303) 692 -3090
State Fiscal Year 2000 -2001 Contract Change Order Letter No. 3 6—(� -T `
EPSDT Prouam U v
Pursuant to paragraph C_5 of the contract with routing number 99 -0049
EPS9900499. (as amended by Contract Change Order Letter contrac_ _ /'1Xe r
1 contract routing number 00- 00022, Contract Change Order Letter 2, contract routing number 00- 01124 .and Contract
Renewal Letter 2 contract routing number _U:90176 ), hereinafter referred to as "the Original Contract" (a copy of which is
attached hereto and by this reference incorporated herein and made a part hereof) between the State of Colorado,
Department of Public Health and Environment (Family and Community Health Services Division) and The Board of
County Commissioners Eagle County, for the term from_July 1.2000 through June 30, 2001, the patties agree that the
maximum amount payable by the State for the eligible services referenced in Paragraph B of the Original Contract is
increased by ONE HUNDRED FIFTY DOLLARS ($150.00 ) for a new total financial obligation of the State of
THIRTY THREE THOUSAND ONE HUNDRED FIFTY FIVE DOLLARS ($33,155.00). This funding change is in
accordance with the revised budget, which is incorporated herein by this reference, made a part hereof, and attached hereto
as Attachment 2 -1. The first sentence in Paragraph C_l. of the Original Contract is hereby modified accordingly. All other
terms of conditions of the Original Contract are hereby reaffirmed.
This amendment to the Original Contract is intended to be effective as of June 1, 2001, However, in no event shall this
amendment be deemed valid until it shall have been approved by the State Controller or such assistant as he mav designate.
Please sign, date and return all three originals of this Contract Change Order Letter by May 28, 2001 to the attention of:
Lee Joseph, Colorado Department of Public Health and Environment Family and Community Health Services Division Mail
Code: FCHSD- ADM -A4 4300 Cherry Creek Drive South Denver, Colorado 80246 -1530. One original of this Contract
Change Order Letter will be returned to you when fully approved.
_Board of County Commissioners Eagle County
By
Print Name: --F(7
Title:--L L)?J(11-0.
FEIN: 84- 6000762
APPROVALS:
PROGRAM
52
STATE OF COLORADO:
Bill Owens, Governor
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
APPROVALS:
CONTROLLER
By:
Arthur L.Barnhart
ATTACHMENT 2 -1
Revised May 10, 2001
APPLICANT. Eagle
PROJECT: EPSDT
DETAILED BUDGET FOR THE PERIOD: July 1, 2000 to June 30, 2001
C",
Annual Number
Total
Source
of CDH
Funds
DIRECT COST Salary Months % Time
Amount
Applicant
Requested
EPSDT
Refugee
Other
Total
Rate Budget
Required
and Other
from CDH
CDH
CDH
PERSONNEL SERVICES: 0.35
Stone 29,765 12.00 10%
2,976
2,976
2,976
2,976
Ontiveros 27,290 12 10%
2,729
2,729
2,729
2,729
Grant 26,998 12 15%
4,050
4,050
4,050
4,050
Contractual /Fee for Service:
Supervising Personnel:
Sarah Schipper 55,937 12 5%
2,797
2,797
Fringe Benefits Rate =
2,313
2,313
2,313
2,313
Total Personnel Services
14,865
2,797
12,068
12,068
12,068
OPERATING EXPENSES:
(includes Building /Facility
Cost not part of Indirect)
Operating
704
704
Subtotal Operating
704
704
TRAVEL:
ADDITIONAL FUNDING IRIS TRAINING
150
150
150
150
423
423
Subtotal Travel
573
423
150
150
150
EQUIPMENT:
Subtotal Equipment
Total Direct Costs Pers. +Operatin +Travel +E ui i
16,142
3,924
12,218
12,218
12,218
Administrative /Indirect Cost
TOTAL FRWEUT CO T 16 142 3,9241 12 218
12 218
12 218
Source of Funding for "Applicant and Other
3,924
Total Applicant and Other $3,924
"This contract will pay the actual approved rate for indirect costs finalized by the Colorado Department
of Public Health and Environment and subject to the maximum rates allowed by the Family and Community
Health Services Division. The finalized rate will be retroactive to the beginning of the contract
EA L BOARD OF COUNTY COMMISS +IERS
AGENDA REQUEST & STAFF RECOMMENDATION FORM
TITLE EPSDT Change Order No. 3 - Early, Periodic, Screening, Diagnosis and
Treatment
LOCATION Eagle County Room
STAFF CONTACT /PRESENTER Kathleen Forinash
DEPARTMENT Health & Human Services
REQUESTED HEARING DATE'4; 1?- (1ST CHOICE)\ t (2 nd choice)
CHECK ONE:
CONSENT CALENDAR —X— ON THE RECORD WORK SESSION
LENGTH OF TIME REQUESTED \REQUIRED
THE DOCUMENTS TO BE SIGNEDAAV, & APPROVED BY THE
COUNTY ATTORNEY 4
County Attorney
IF THIS IS A CONTRACT OR OTHER ITEM REQUIRING AN EXPENDITURE, IS THE
FULL AMOUNT TO COVER THIS REQUEST IN THE CURRENTAPPROVED BUDGET?
Yes
PROJECT /CONTRACT DESCRIPTION_
In the third quarter of each fiscal year, the Colorado Department of Public Health and
Environment reviews the current and anticipated spending levels for the EPSDT, Early
Periodic Screening, Diagnosis and Treatment program, and makes adjustments to the
county's contract. The Eagle County contract is being adjusted upward by $150.
STAFF RECOMMENDATION To sign the Change Order Letter No. 3 for contract
00 -01188 with the State of Colorado Department of Public Health and Environment.
Jack Ingstad, County Administrator
