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Home My WebLink AboutC06-170 0 -I .- DEPARTMENT OR AGENCY NAME I COLORADO DEPARTMENT OF PUBLIC HEAL TH AL~D ENVIRONMENT I I DEP AR TMENT OR AGENCY 'NuMBER , FLA CONTRACT ROUTING NUMBER 07-FLA-00058 TASK ORDER Familv Planninl! Services Prol!ram This Task Order is made this 17th day of April, 2006, by and between: the state of Colorado, acting by and through the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal place of business is 4300 CHERRY CREEK DRIVE SOUTH, DENVER, COLORADO 80246, hereinafter referred to as "the State"; and the BOARD OF COUNTY COMMISSIONERS OF EAGLE COUNTY (a political subdivision of the state of Colorado), whose address or principal place of business is PO Box 850, Eal!le, Colorado 81631, for the use and benefit of the EAGLE COUNTY HEALTH AND HUMAN SERVICES whose address or principal place of business is PO Box 660, EalZle, Colorado 81631, hereinafter referred to as "the Contractor" . FACTUAL RECITALS The United State Department of Health and Human Services ("DHHS"), through the Colorado General Assembly, has awarded the State federal funds to conduct a comprehensive family planning program. See, Catalog of Federal Domestic Assistance ("CFDA") number 93.217. The State has formulated a comprehensive State plan, with associated budgets, to disburse these funds throughout the state of Colorado. Under this comprehensive State plan, the State shall allocate these funds to qualified entities to provide comprehensive family planning services to the citizens of the state of Colorado on behalf of the State. Section 29-1-201, c.R.S. as amended, encourages governments to make the most efficient and effective use of their powers and responsibilities by cooperating and contracting with each other to the fullest extent possible to provide any function, service, or facility lawfully authorized to each of the cooperating or contracting entities. Section 29-1- 201, c.R.S., as amended, further states that all state of Colorado contracts with its political subdivisions are exempt from the state of Colorado's personnel rules and procurement code. The Contractor is a political subdivision of the state of Colorado. The State and the Contractor mutually agree that the most efficient and effective way to provide the above-described services is at the local level. The State and the Contractor previously entered into a Master Contract with contract routing number 05-FAA-00132. This Task Order is issued pursuant to the terms and conditions of that Master Contract. As to the State, authority exists in the Law and Funds have been budgeted, appropriated, and otherwise made available, and a sufficient uncommitted balance thereof remains available for subsequent encumbering and payment in Fund Code 100, Organizational Unit Code 7500 Appropriation Code(s) 625 & 624, Program Code 9011 Function Code(s) Flwt & Gfnd, and Grant Budget Line Code(s) JA5C under Contract encumbrance number PO FLA FPP07000058. All required approvals, clearances, and coordination have been accomplished from and with all appropriate agencies. NOW, THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree as follows: A. PERIOD OF PERFOR.1\-IAi"JCE Ai"JD TERi~INATION. The proposed effective date of this Task Order is Julv 1, 2006. However, in accordance with section 24-30-202(1), C.R.S., as amended, this Task Order is not valid until it has been approved by the State Controller, or an authorized designee thereof. The Contractor is not authorized to, and shall not, commence performance under this Task Order until this Task Page 1 of 5 Order has been approved by the State Controller. 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. If the State Controller approves this Task Order on or before its proposed effective date, then the Contractor shall commence performance under this Task Order on the proposed effective date. If the State Controller approves this Task Order after its proposed effective date, then the Contractor shall only commence performance under this Task Order on that later date. The initial term of this Task Order shall commence on the effective date of this Task Order and continue through and including June 30, 2011, unless sooner terminated by the parties pursuant to the terms and conditions of this Task Order. In accordance with section 24-103-503, C.R.S., as amended, and Colorado Procurement Rule R-24-1 03-503, the total term of this Contract, including any renewals or extensions hereof, may not exceed five (5) years. B. DUTIES AND OBLIGATIONS OF THE CONTRACTOR. The Contractor. in accordance with the terms and conditions of the Master Contract and this Task Order, shall perform and complete, in a timely and satisfactory manner, all work items described in the Statement of Work, which are incorporated herein by this reference, made a part hereof and attached hereto as "Attachment A". C. DUTIES AND OBLIGATIONS OF THE STATE. 1. The Contractor shall be compensated for services provided in accordance with Attachment A hereto. In consideration of those services satisfactorily and timely performed by the Contractor under this Task Order the State shall cause to be paid to the Contractor a sum not to exceed FIFTY-FOUR THOUSAND ONE HUNDRED TWENTY-TWO DOLLARS, ($54,122.00) for the initial term of this Task Order. Of the total financial obligation of the State referenced above, $35,879.00 are identified as attributable to a funding source of the United States government and, $18,243.00 are identified as attributable to a funding source of the state of Colorado. 2. Payments under this Task Order shall be made either through the State's Electronic Fund Transfer system or, upon the Contractor's periodic submission of a duplicate "Task Order Reimbursement Statement". 3. Reimbursement under this Task Order, and any renewal or extension hereof, shall be made to the Contractor by the State on a monthly basis through automatic payment invoices prepared by the State. The sample invoice, attached hereto as "Attachment B", is incorporated here by reference; made a part hereof, and attached hereto, for the contract term. Accordingly, the Contractor shall be paid one twelfth (1/12) of the State's financial obligation under this Task Order each month. Upon afftrmation by the State that the Contractor has satisfactorily and timely provided the services described in this contract, the State shall pay the Contractor 1I6lh of the total amount of federal funding of $35,879.00 or $5.979.88 a month for the months of July through December, and 1I6lh of the total amount of state funding of $18,243.00 or $3,040.45 a month for the months of January through June, inclusive. 4. The State may prospectively increase or decrease the amount payable under this Task Order through a "Task Order Change Order Letter" that is substantiaIly similar to the sample Task Order Change Order Letter that is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment E". To be effective, a Task Order Change Order Letter must be: signed by the State and the Contractor; and, approved by the State Controller or an authorized designee thereof. Additionally, a Task Order Change Order Letter shall include the following information: A. Identification of the related Master Contract and this Task Order by their respective contract routing numbers and affected paragraph number(s); B. The type( s) of service( s) or program( s) increased or decreased and the new level of each service or program; Page 2 of 5 C. The amount of the increase or decrease in the level of funding for each service or program and the new total financial obligation; D. A provision stating that the Task Order Change Order Letter is effective upon approval by the State Controller, or designee, or its proposed effective date, whichever is later. Upon proper execution and approval, a Task Order Change Order Letter shall become an amendment to this Task Order. Except for the General and Special Provisions of the Master Contract, and the Additional Provisions of the Task Order, if any, the Task Order Change Order Letter shall supersede this Task Order in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the task order change order letter process may be used only for increased or decreased levels of funding, corresponding adjustments to service or program levels, and any related budget line items. Any other changes to this Task Order, other than those authorized by the task order option to renew letter process described below, shall be made by a formal amendment to this Task Order executed in accordance with the Fiscal Rules of the state of Colorado. If the Contractor agrees to and accepts a proposed Task Order Change Order Letter, then the Contractor shall execute and return that Task Order Change Order Letter to the State by the date indicated in that Task Order Change Order Letter. If the Contractor does not agree to and accept a proposed Task Order Change Order Letter, or fails to timely return a partially executed Task Order Change Order Letter by the date indicated in that Task Order Change Order Letter, then the State may, upon written notice to the Contractor, terminate this Task Order no sooner than thirty (30) calendar days after the return date indicated in the Task Order Change Order Letter has passed. This written notice shall specify the effective date of termination of that Task Order. If a Task Order is terminated under this clause, then the parties shall not be relieved of their respective duties and obligations under that Task Order until the effective date of termination has passed. Increases or decreases in the level of contractual funding made through the task order change order letter process during the initial, or renewal, term of a Task Order may only be made under the following circumstances: E. If necessary to fully utilize appropriations of the state of Colorado and/or non- appropriated federal grant awards; F. Adjustments to reflect current year expenditures; G. Supplemental appropriations, or non-appropriated federal funding changes resulting in an increase or decrease in the amounts originally budgeted and available for the purposes of a Task Order; H. Closure of programs and/or termination of related contracts or task orders; 1. Delay or difficulty in implementing new programs or services; and, J. Other special circumstances as deemed appropriate by the State. 5. The State may renew a Task Order through a "Task Order Option to Renew Letter" substantially similar to the sample Task Order Option to Renew Letter that is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment F". To be effective, a Task Order Option to Renew Letter must be: signed by the State and the Contractor; and, approved by the State Controller or an authorized designee thereof. Additionally, a Task Order Option to Renew Letter shall include the following information: A. Identification of the related Master Contract and that Task Order by their respective contract routing numbers and affected paragraph number(s); Page 3 of 5 B. The type(s) of service(s) or program(s), if any, increased or decreased and the new level of each service or program for the renewal term; C. The amount of the increase or decrease, if any, in the level of funding for each service or program and the new total financial obligation; D. A provision stating that the Task Order Option to Renew Letter is etTective upon approval by the State Controller, or designee, or its proposed effective date, whichever is later. Upon proper execution and approval, a Task Order Option to Renew Letter shall become an amendment to this Task Order. Except for the General and Special Provisions of the Master Contract, and the Additional Provisions, if any of that Task Order, a Task Order Option to Renew Letter shall supersede that Task Order in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the task order option to renew letter process may be used only to: renew a Task Order; increase or decrease levels of funding related to that renewal; make corresponding adjustments to service or program levels, and, adjust any related budget line items. Any other changes to a Task Order, other than those authorized by the task order change order letter process described above, shall be made by a formal amendment to a Task Order executed in accordance with the Fiscal Rules of the state of Colorado. If the Contractor agrees to and accepts a proposed Task Order Option to Renew Letter, then the Contractor shall execute and return that Task Order Option to Renew Letter to the State by the date indicated in that Task Order Option to Renew Letter. If the Contractor does not agree to and accept the proposed renewal term, or fails to timely return a partially executed Task Order Option to Renew Letter by the date indicated in that Task Order Option to Renew Letter, then the State may, upon written notice to the Contractor, terminate this Task Order no sooner than thirty (30) calendar days after the return date indicated in the Task Order Option to Renew Letter has passed. This written notice shall specify the effective date oftermination of that Task Order. lfa Task Order is terminated under this clause, then the parties shall not be relieved of their respective duties and obligations under that Task Order until the effective date of termination has passed. 6. All attachments or exhibits to this Task Order are incorporated herein by this reference and made a part hereof as if fully set forth herein. If a conflict or inconsistency is found to exist between the terms and conditions of this Task Order and those of any attachment or exhibit hereto, then the terms and conditions of this Task Order shall control. D. ADDITIONAL PROVISIONS. 1. The Contractor shall comply with section 100 I of the federal Act and all applicable federal regulations, as amended, contained in Title X, 42 C.F.R., Subpart A, Part 59, as well as all applicable state regulations. Page 4 of 5 IN WITNESS WHEREOF, the parties hereto have executed this Task Order as of the day first above written. CONTRACTOR: STATE: BOARD OF COUNTY COMMISSIONERS OF EAGLE COUNTY STATE OF COLORADO (a political subdivision of the state of Colorado) Bill Owens. Governor for the use and benefit of the EAGLE COUNTY HEAL TH At"JD HUMAN SERVICES '~~~ By: '~I~ \ , By: Name: - ;:." 5*,,, For the Executive Director Title: Ch4 "I"'I'Y\. J-? v" I-e,.., DEP ARTMENT OF PUBLIC HEALTH FEIN: 84-600762 C AND ENVIRONMENT Date: Date: (Seal) ATTEST: PROGRAt'\1 APPROVAL: By: By: APPROVALS: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for the goods and/or services provided. STATE CONTROLLER: Leslie M. Shenefelt By: Date: Revised: 11/5/04 Page 5 of5 Attachment A STATEMENT OF WORK FOR FAl"IILY PLAl~NING SERVICES I. The Contractor shall conduct a comprehensive tlllnily planning program ("the program") in Ealde County. This program shall comply with section 1001 of the federal Act and all applicable federal regulations, as amended, contained in Title X, 42 C.F.R., Subpart A, Part 59, as well as all applicable state regulations. (Federal funding from HHS, CFDA #93.217 FP Services). 2. The Contractor shall make its program available to men and women in their reproductive years and shall offer the following services, as appropriate: A. Outreach services and/or other program efforts designed to improve client recruitment; B. Nursing and medical services, which shall include a comprehensive health and social history and physical examination administered in accordance with all applicable Title X regulations and, all applicable nursing-medical policies or procedures which have been, or may be, established by the State's Women's Health Section ("WHS"); c. Contraceptive infonnation, education, and supplies regarding all family planning methods; D. Education and counseling services regarding family planning, family planning methods, child spacing, infertility, sterilization, nutrition, sexually transmitted diseases, HIV/AIDS, adolescent counseling and other related health issues, as outlined in the Nursing and Administrative Manual; E. Follow-up and/or referral services, as appropriate. 3. The services provided by the Contractor must be deemed acceptable, in good faith, by the WHS. For a service to be "acceptable" it must comply with all applicable: Title X regulations, WHS nursing-medical policies and procedures, and any applicable fiscal and administrative policies and procedures of the State and Federal government. All applicable Title X regulations, WHS nursing-medical policies and procedures, and all applicable fiscal or administrative policies of the State have been provided to the Contractor by the State as of the effective date of this Contract. 4. The Contractor shall provide the State's family planning program consultants and administrators with reasonable access to its operations to perform: periodic site reviews, data reviews, fiscal reviews or other evaluations of the Contractor's family planning program. Evaluations of the Contractor's program shall be based on established standards and policies of the State or the Federal government. The Contractor shall cooperate during all periodic site visits, data reviews, fiscal reviews or other evaluations conducted by the State. 5. If necessary, the Contractor shall comply with all recommendations made by the State's family planning program consultants and/or administrators after a periodic site visit, data review, fiscal review or other evaluations that are necessary to bring its program into compliance with all applicable federal and state laws, policies and regulations. The Contractor shall be in full compliance with a recommendation, if any, within three (3) months of the date a recommendation is made by the State. If the Contractor cannot obtain full compliance within this three (3) month period, then on or before the expiration date of that three (3) month period the Contractor shall present sufficient written evidence to the State: to show that continuing progress is being made towards full compliance; and, the date when full compliance shall occur. In no event, however, Attachment A - Statement of Work Page 1 of3 shall full compliance with a recommendation occur any later than six (6) months after the date that a recommendation was initially made by the State. 6. On a montWy basis, the Contractor shall collect and provide to the State, by the fifteenth calendar day of the following month, all pertinent data regarding all services ofTered, and all family planning clients served, by its program during the preceding month, submitted through the IRIS data system. This data shall be verified on a montWy basis to help assure accuracy. The Contractor must adhere to the Data Security, Use and Confidentiality Agreement attached hereto in a form substantially equivalent to Attachment D. 7. Within thirty (30) calendar days of receipt of a written request from the State, the Contractor shall submit nursing-medical chart audits to the State. 8. The Contractor shall only use program income generated from client fee collections and donations for family planning purposes that further the objectives of the legislation under which this Contract is entered into. In accordance with Title X guidelines, the Contractor shall not charge for any Title X required services provided to clients who are at or below 100% of the official poverty line as defmed by the Office of Management and Budget (OMB). A copy of this guideline has been provided to the Contractor by the State as of the effective date of this Contract. If the State receives new poverty guidelines from the OMB during the term of this Contract, then the State shall immediately forward those new poverty guidelines to the Contractor. The Contractor shall use these new poverty guidelines, if any, upon receipt thereof from the State. 9. The Contractor's charges for services to clients who are above 100% of poverty level shall be based on a sliding fee scale that takes into account a client's family size and/or individual income. These charges and the sliding fee scale shall be made available to all clients of the Contractor, the general public, and the State. This most current version of this document is available on the Family Planning website (http://www.cdohe.state.co.us/po/womens/FederaIPovertvGuidelines.htm). Charges shall be based upon the Contractor's actual costs to provide these services as detemrined by a cost analysis. The Contractor and the State shall review these costs annually. The Contractor shall insure that all clients understand that they will not be denied services because of an inability to pay any of the Contractor's sliding fee charges. 10. All money received by the Contractor from the State under this Contract shall be used by the Contractor to provide contraceptive services to approximately 600 tareet familv plannine clients (fertile clients receivine contraceptive services}. 11. The Contractor shall either use a cytology laboratory chosen by the State or, a laboratory proposed by the Contractor and approved by the State. 12. During the term of this Contract, the Contractor agrees to provide the State with the semi-annual Family Planning Expenditure/Revenue Reports. The required report is incorporated herein by this reference, made part hereof, and attached hereto in a form substantially equivalent to Attachment C. The first report is for the months of July through December will be due no later than February 7; the second report is for the months of January through June and will be due no later than August 7. 13. The Contractor shall protect the confidentiality of all client records and other materials that are obtained, created, or maintained by the Contractor under this contract. Except for purposes directly related to the administration of this contract, no information about, or obtained from, any client shall be disclosed by the Contractor in any form that would identify that client without the prior written consent of that client. As of the acceptance date of this contract by the Contractor, the Contractor shall have '-"Titten policies governing the access to and, the duplication and Attachment A - Statement of Work Page 2 of3 dissemination ot~ all such information. The Contractor shall advise its directors, officers, employees, agents, servants, and subcontractors, if any, that they are subject to these confidentiality requirements. Attachment A - Statement of Work Page 3 of3 Attachment A-1 07 -FLA-00057 Title X federal funding from the United States government (HHS CFDA# 93.217 FP Services) provides: $33.879 for ROUTINE FAMILY PLANNING services $0 for STERILIZATION services $ 2,000.00 for CHLAMYDIA TESTING services $ 35,879.00 Total Title X Funding ... All federal funds must be fully expended by December 31, 2006. State of Colorado funding provides: $18.243 for ROUTINE FAMILY PLANNING services $0 for STERILIZATION services $ 18,243.00 Total State of Colorado Funding .... All State funds must be fully expended by June 30, 2007. $ 54,122.00 Total Current Award Family planning services target clients: 600 Attachment A-I ~ Attachment E TASK ORDER CHANGE ORDER LETTER [Date) Task Order Change Order Letter Number .::, Contract Routing Number ** *** ***** State Fiscal Year 20** - 20**, *************** Prol!ram This Task Order Change Order Letter is issued pursuant to paragraph *. *. of the Master Contract identified as contract routing number ** *** ***** and paragraph *. *. of the Task Order identified as contract routing number ** *** ***** and contract encumbrance number ** *** **********. This Task Order Change Order Letter is between the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT and (LEGAL NAi\rlE OF CONTRACTOR1. The Task Order has been amended by Task Order Option to Renew Letter .::, contract routing number ** *** *****, and/or Task Order Change Order Letter .::, contract routing number ~ ~ifany. The Task Order, as amended, if applicable, is referred to as the "Original Task Order". This Task Order Change Order Letter is for the current term of********* **, ****, through ********* **, ****. The maximum amount payable by the State for the work to be performed by the Contractor during this current term is increased/decreased by ********** Dollars, ($*.**) for an amended total financial obligation of the State of ********** DOLLARS, ($*.**). The revised specifications to the original Scope of Work and the revised Budget are incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment *" and "Attachment *". The first sentence in paragraph *. *. of the Original Task Order is modified accordingly. All other terms and conditions of the Original Task Order are reaffirmed. This change to the Task Order shall be effective upon approval by the State controller, or designee, or on ********* **. ****, whichever is later. Please sign, date, and return aU':: originals of this Task Order Change Order Letter by ********* **, ****, to the attention of: ************ ************, Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, Mail Code ***-***-**, Denver, Colorado 80246. One original of this Task Order Change Order Letter will be returned to you when fully approved. [LEGAL NAME OF CONTRACTOR) STATE OF COLORADO (a political subdivision of the state of Colorado) Bill Owens, Governor By: By: Name: For the Executive Director Title: DEPARTMENT OF PUBLIC HEALTH FEIN: AND ENVIRONMENT PROGRAM APPROVAL: (Seal - Required) By: ATTEST (required): By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for the goods and/or services provided. STATE CONTROLLER: Leslie M. Shenefelt By: Date: COLORAD( 3PARTMENT of PUBLIC HEALTH and Er{ rONMENT - ---~-----~------- ---- - FA-MIL}' PLANNING EXPENDITURE {REVENUEREP-ORT-~- ------ -i-i- iT - ---': -C AGENCY NAME: PERIOD: COMPLETED BY: DATE: EXPENDIT1JRES Column (A) Column (B) Column (C) -- ---- ------_.._~--_._-- .-----.--..--.-- ._---_._---~-_.- --~------- Family Planning CDPHE-WHS Program - (Non- Funding CDPHE funding) Combined Total Personal Services . Salary $ - $ - $ . ------- Fringe (aJ % #D!V/O! - : . - -- Subtotal Personal Services $ - $ - $ - __.__~___~_~___e~~__~'_,,'~'n~~__',,___'__~'_"'_'_'~__~-__'_"__'_~___ ..._.,'__ - _._____..,~______'__.__~______.'_.____.___~_~~___.~.__._..__.____....___~._..___._._... Contractual Services Clinician $ - : $ - $ - Lab & X-ray - - ! - Other - ! - - r ' Services $ - $ .. : !_:: $ : \ - $ -!$ -is - - - - Other - ; - I _ Travel _ i _ ! _ --- ! _ i _ ! _ Subtotal Operating Expenses $ - $ - $ - ----- - ---.- --,--_.~--~,-_.~_._,- T.otal.Direct Costs $ - $ - ! $ - Indirect Costs @, % $ - ! $ - $ - TOTAL EXPENDITURES S($! /$: - Inkind $ _ i $ _ , $ _ -- TOTAL COSTS S -S ... ",($I! - > . _l\..I!;l' rW.\l .' i Family Planning CDPHE-WHS Program - (Non- i Funding CDPHE funding) Combined Total 1----- .. _ : CDPHE - Women's Health HlIIlllY contracts . $ - $ - $ - Patient Fees! - ! - - Patient Donations - - - Medicaid _ T _ ! _ State Children's Health Ins (CHP+) - - - . Local government-County and City grants and contracts - . . - c----------- ---- Inkind (Other Donations) '.' - - Other public health insurance (TRICARE/CHAMPUS, CHAMPV A) - ! - - Private Health Insurance - - - Temporary Assistance for Needy Families (TANF) -.- Other (specify private grants, fundrai~ing, MCH,_ Social Service Block grant, Medicare, - - . - TOTAL $ - $ - $ - . rn~npnt Funds - This Period $ - $ . $ ----::- . fMnf>nt Funds - Prior Periods - - - Balance Funds $ - $ - S - J:\FiscallcontraclsIFY06\Attachmenl C - Family Planning Expendendilure-Revenue Report.xls Maggie Leiman 303-692-2485 Attachment F TASK ORDER OPTION TO RENEW LETTER {Date} Task Order Option to Renew Letter Number ~, Contract Routing Number ** *** ***** State Fiscal Year 20** - 20** *************** Prol!ram This Task Order Option to Renew Letter is issued pursuant to paragraph *. *. of the Master Contract identified by contract routing number ** *** ***** and paragraph *. *. of the Task Order identified by contract routing number ** *** ***** and contract encumbrance number ** *** **********. This Task Order Option to Renew Letter is between the COLORADO DEPARTMENT OF PUBLIC HEALTH At,,(D ENVIRONMENT and fLEGAL NAL'1E OF CONTRACTOR1- The Task Order has been amended by Task Order Change Order Letter ~ contract routing number ** *** *****, and/or Task Order Option to Renew Letter ~, contract routing number ~ ~, if any. The Task Order, as amended, if applicable, is referred to as the "Original Task Order". This Task Order Option to Renew Letter is for the renewal term of********* **, ****, through ********* **, ****. The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is ********** Dollars, (*. **) for an amended total financial obligation of the State of ********** DOLLARS, This is an increase/decrease of ($*. **) of the amount payable from the previous term. The Budget for this renewal term is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment *". The first sentence in paragraph *. *. of the Original Task Order is modified accordingly. All other terms and conditions of the Original Task Order are reaffirmed. This Task Order Option to Renew Letter is effective upon approval by the State Controller, or designee, or on ********* **, ****, whichever is later. Please sign, date, and return all ~ originals of this Task Order Option to Renew Letter by ********* **, ****, to the attention of: ************ ************, Colorado Department of Public Health and Environment, Mail Code ***-***-**,4300 Cherry Creek Drive South, Denver, Colorado 80246. One original of this Task Order Option to Renew Letter will be returned to you when fully approved. {LEGAL NAME OF CONTRACTOR] STATE OF COLORADO (a political subdivision of the state of Colorado) Bill Owens, Governor By: By: Name: For the Executive Director Title: DEPARTMENT OF PUBLIC HEALTH FEIN: AND ENVIRONMENT PROGRAM APPROVAL: (Seal - required) By: ATTEST (required): By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for the goods and/or services provided. STATE CONTROLLER: Leslie M. Shenefelt By: Date: Colorado Department of Public Health and Environment Family Planning Program Contract Automatic Reimbursement Statement To: Family Planning Program ATTACHMENT B PSD-Women's Health Section-AS WHS main phone # 303-692-2480 4300 Cherry Creek Drive South Denver, CO 80246-1530 Attn: Maggie Leiman 07- FLA- Agency Tax ID Number Contract Number Month I Year Amount requested for: $ Federal- Title X Family Planning Services Dollars (July - December 2006) $ State Family Planning Services Dollars (January - June 2007) $ Other Total amount requested: $ - This is to certify that these services were provided per above referenced contract and reimbursement is requested for same. Signature (automatic payment - per contract) Date I hereby certify that all contract requirements have been met and the amounts billed are correct. Payment is authorized. (CDPHE Authorized Designee) Date J:\FiscaIlContracts\FY06 FPPlAtlachment B Family Planning Auto Reimbursemenl.xls Maggie Leiman 303-692-2485