HomeMy WebLinkAboutC06-274
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALm AND ENVIRONMENT
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
07-00423
TASK ORDER
Tobacco Education and Prevention Prosuam
This Task Order is made this 15th day of Auost. 2006, by and between: the state of Colorado, acting by and
through the COWRADO DEPARTMENT OF PUBLIC HEALm AND ENVIRONMENT, whose address or
principal place of business is 4300 CHERRY CREEK DRIVE soum. 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 660. EAGLE. CO 81631. hereinafter referred to as "the Contractor".
FACTUAL RECITALS
Section 25-3.5-804, CRS., as amended, creates the tobacco education, prevention and cessation grant program to
provide funding for community-based and statewide tobacco education programs designed to reduce the initiation of
tobacco use by children and youth, promote cessation of tobacco use among youth and adults, and reduce exposure
to second-hand smoke.
Section 29-1-20 I, C.RS. as amended, encourages govermnents 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.RS., 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 !1M, Organi7.at1onal Unit Code 7370 Appropriation Code 775 , Program Code 9011, Function Code
XMPT, Object Code 5120, and Grant Budget Line Code 8A7G under Contract encumbrance number PO FLA
PPG0700423. 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 PERFORMANCE AND TERMINATION. The proposed effective date of this Task Order
is October 1.2006. However, in accordance with section 24-30-202(1), C.RS., 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
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,
Page 1 of6
then the Contractor shall ouly 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. 2007, unless sooner terminated by the parties pursuant to the terms and conditions of
this Task Order. In accordance with section 24-103-503, CRS., as amended, and Colorado Procurement
Rule R-24-103-503, 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 items contained in its approved Annual Action Plan, which is incorporated
herein by this reference.
1. Implement a comprehensive tobacco control program designed to prevent and reduce tobacco use.
2. The Contractor shall not use funds provided under this Task Order to: supplant fimding for any
existing programs/models; develop new cessation programs/models or curricula for youth or
adults; pay for individual cessation aids or nicotine replacement therapy; fund capital
improvements, substitute funding for events previously funded by tobacco companies, or fimd
costs of enforcement of state or local laws and ordinances.
3. If the Contractor intends to subcontract any or all of its performance under this Task Order, then
the Contractor shall provide to the State, for the State's prior review and written approval, a copy
of any proposed subcontract between the Contractor and a subcontractor. All subcontractors are
subject to all the terms and conditions of this Task Order and the related Master Contract. The
Contractor remains ultimately responsible for any work performed by a subcontractor.
4. 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.
5. Uuless otherwise provided for, all data collected or produced or derived exclusively from the
Contractor's or subcontractor's work under this Contract shall remain the sole property of STEPP,
whether in individual, aggregate, identified or de-identified form or any other form required by
STEPP. To facilitate follow-up, research, surveillance and evaluation, any such data collected,
used or acquired shall be made available in any form required by STEPP, to STEPP and any other
contractor designated by STEPP.
Any such data collected, used or acquired shall be used solely for the purposes of this Contract.
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 written consent of STEPP
or as otherwise required by law.
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 the Contract and in accordance with
professional standards.
6. The Contractor shall ensure that its staff is trained in the field of tobacco control. Newly hired
staff of the Contractor who will perform work under this Task Order shall participate in an
orientation training conducted by the State and complete the STEPP learning modules within six
(6) months of the commencement date of employment.
7. The Contractor shall participate in state-level evaluation efforts as requested by the State to
include but not be limited to quarterly reports, to be due 15 days after each calendar quarter.
Calendar quarters shall be October-December, January-March and April-June.
8. Within thirty (30) calendar days after the expiration of the term of this Task Order, the Contractor
shall submit a written report to the State which describes its key accomplishments in
Page 2 of6
implementing its Approved Annual Action Plan. The report shall also describe all measurable
objectives and the Contractor's overall achievement of it plan.
9. The Contractor shall not use funds provided under this Task Order for the purpose of lobbying as
defined in C.RS. 24-6-301(3.5)(a).
10. The Contractor IS NOT required to provide matching funds in order to be eligible to receive
funding under this Task Order.
C. DUTIES AND OBLIGATIONS OF mE STATE.
1. The Contractor shall be compensated in accordance with the budget which is incorporated herein
by this reference, made a part hereof, and attached hereto as "Attachment A", herein 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 FORTY NINE
mOUSAND SEVEN HUNDRED FIFTY FIVE DOLLARS. ($49.755.00) for the initial term
of this Task Order. Of the total financial obligation of the State referenced above, $0.00 are
identified as attributable to a funding source of the United States govermnent and, $49.755.00 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 "Task Order Reimbursement
Statement" .
3. If this Task Order requires the Contractor submit a "Task Order Reimbursement Statement", then
the Contractor shall submit a signed, monthly Task Order Reimbursement Statement within sixty
(60) calendar days of the end of the billing period for which services were rendered in a format
either provided by or approved by the State.
The Budget, which is included in the Scope of Work, shall govern the expenditure offunds by the
Contractor under this Task Order as well as subsequent reimbursement by the State. The
Contractor may transfer fimds between specific line items within a major budget category without
prior approval. Up to ten percent (10010) of the total funds originally set forth in each major budget
category (personal Services, Operating, Travel, Contractual and Indirect) may be transferred to
other categories without prior approval by the State. Proposed transfers that exceed ten (10%) of
the original amount budgeted in a category mnst be approved in writing by the State prior to the
transfer. In all instances, the Contractor shall submit a revised budget to the State that shows: the
original amount(s), the modification(s) made, and the new amount(s) within thirty (30) calendar
days of the modification(s).
Each Task Order Reimbursement Statement shall reference the related Master Contract by its
contract routing number and this Task Order by their respective contract routing numbers. The
contract routing numbers are located on page one of these documents. Each Task Order
Reimbursement Statement shall also indicate the applicable performance dates, the names of
payees; a brief description of the services performed during the relevant performance dates; all
expenditures incurred; and, the total reimbursement requested. Reimbursement during the initial,
or any renewal, term of this Task Order shall be conditioned upon affirmation by the State that all
services were rendered by the Contractor in accordance with the terms of this Task Order. Each
Task Order Reimbursement Statement shall be sent to:
Prevention Services Division
Colorado Department of Public Health and Environment
PSD-STEPP-AS
4300 Cherry Creek Drive South
Denver, CO 80246
Page 3 of6
4. The State may prospectively increase or decrease the amount payable under this Task Order
through a "Task Order Change Order Letter" that is substantially 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 B". 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;
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
ouly 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, tenninate 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 fimding made through the task order change
order letter process during the initial, or renewal, term of a Task Order may ouly 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 tennination of related contracts or task orders;
I. Delay or difficulty in implementing new programs or services; and,
Page 4 of6
1. 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 C". 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 Optiou 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);
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 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 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 ouly 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 anthorized 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 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.
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. ADDmONAL PROVISIONS.
1. The Contractor shall provide services to all Program participants and employees in a smoke-free
environment in accordance with Public Law 103-227, also known as "the Pro-Children Act of
1994", Public Law 103-227, ("Act").
Page 5 of6
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
(a political subdivision of the state of Colorado)
By:
Name:
Title: (' \r,cA-A..JIvY,C, ~~
FEIN: 846000762
Date: q . ~ OLf
STATE OF COWRADO
Bill Owens, Governor
By.~L
For the Executive Director
DEPARTMENT OF PUBLIC REALm
AND ENVIRONMENT
Date:
(Seal) ATTEST:
By: k
City, City and C ty, County,
Special District, or Town Clerk or Equivalent
APPROVALS:
ALL CONTRACTS MUST BE APPROVED BY mE STATE CONTROLLER
CRS 24-30-202 requires that tbe 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. H performance begins prior to the date
below, the State of Colorado may uot be obligated to pay for the goods and/or services provided.
STATE CONTROLLER:
Leslie M. Shenefelt
By:
Date:
Revised: 11/5104
Page 6 of6
STATE TOBACCO EDUCATION AND PREVENTION PARTNERSHIP
APPLICATION BUDGET AND/OR EXPENDITURE REPORT FORM - Nine Month Continuation
FOR THE PERIOD: October 1, 2006 - June 30, 2007
AGENCY: Eagle County Health and Human Services
Nine Month
PERSONAL SERVICES:
HHS Staff
(includes fringe @ 50%)
Total Personal Services
DIRECTOPERATltJG EXPENSES
f'rinting/Copying u
Postage/"hipping
RenVUtilities _
_ _ Telephone, Fax, Internet Access
Office Supplies
Office Equil'ment _
__C()mputer Equip_men!
_ MEleting Expense _ _
Media Expense (Program Costt _
Staff [)evelopment - _ R_egistrations_
Staff Deve_lopment - Memberships/Subscriptions __
Educational Materials (Program Costt
Miscellaneous Expense _
Total 0 eratin
TRAVEL
_In-State
Out of State
Total Travel
CONTRACTUAL
Consultant Costs
Contract Trainers/Speakers
Data Collection
Salary
Rate
HE/
Fringe/
Ind
Pct
61,316_00 50.00%
Total Direct Costs
ADMINISTRATIVE INDIRECT COSTS
Indirect Percentage (applied to all direct costs)
Indirect Percentage (applied to salary and fringe costs only)
Indirect Percenta e a lied to sala costs onl
Total Indirect Costs
TOTAL PROJECT COST
"'Other" Funding Sources (Matching Funds). Funds supplementing the STEPP award.
Kathleen Forinash - Director of EC HHS
Signature of Authorized Representative
Rev:8/15/2006
ommumlles 0 xce ence cxsprea s eels
Amount
Re uired
SOURCE OF FUNDS
Requested /
Received
OTHER" from CDPHE
Total
$30,658.00
$30 658.00
$1,500..00
$1,200.00
_ _ $400.00
$3,500.00
_ _ $150.00
$6 750.00
$1,073.00
$1,073.00
$6,750.00
$6750.00
$45231.0
$4,524.00
$4 524.00
$49 755.00
This grant does not require Matching Funds.
TOTAL
5/26/2006
Date
o onl u gel orm
$30,658.00
$30658.00
$1,50Q,00
$1,2.o0.0(j
$400.00
$3,500.00
$15.0.00
$6,750.00
~1,0730(j
$1 073.00
$6, 750,00
$6750.00
$45231.00
$4,524.00
$4524.00
$49 755.00
Eagle County Tobacco Prevention Program Budget Narrative
(October 1, 2006- June 30, 2007)
Personal Services
The nursing staff typically earns $28 per hour resulting in a 9-month compensation of $40,040.
This position provides .20 FTE public health staff to work in a county partnership with all
entities identified in the grant application towards all tobacco prevention, education, and
cessation efforts. The total for Eagle County HHS personal services = $8,008.
Direct Operating Expenses
Only 3 items are included in the 06-07 budget and are broken down as follows:
· Meeting Expenses (4) includes food, supplies, training materials at $100 per meeting =
$400
· Media Expense - paid media (including placement) of newspaper, radio, and local cable
TV at $5,000
· Staff Development - Registrations = 1 conference registration at $150 ea. = $150
The total for operating expenses = $5,550.
Travel
· Total mileage of 1000 miles includes local and state training mileage for public health
staff@ .345 cents per mile = $345
· Overnight travel to 1 state training and 1 regional training x 1 public health staff member
with 2 overnight stays =
4 hotel nights @ $125 = $500
6 days (per diem) @ $38 = $228
The total for travel expenses = $1,073
Consultant travel expenses are extracted from this section and become part of "contractual"
hourly rates
Contractual
· Technical assistance will be provided by Shelley Evans in the program goal areas of:
· Preventing and reducing tobacco use by adolescents
· Reducing tobacco use by adults
· Eliminating exposure to secondhand smoke
· Infrastructure - Revision of 5-year strategic plan for tobacco
60 hours per month @ $40 per hr. x 9 months = $21,600.
· Technical assistance will be provided by the Eagle River Youth Coalition in the program
goal areas of:
· Preventing and reducing tobacco use by adolescents
The ERYC works with the local Get!Real group and has facilitated their ongoing
connection with the Board of County Commissioners. The Get!Real parent agency is a
member of the ERYC. The ERYC holds a very positive track record of advocating for
youth tobacco use prevention and cessation; coordinates, administers, and analyzes the
Eagle County Cares survey in all public high schools; develops and places the county-
wide social norms youth media campaigns; and serves as the main contact point for all
youth serving organizations in Eagle County.
40 hours per month @ $25 per hr. x 9 months = $9,000.
The total for contractual expenses = $30,600
Agency Indirect Costs = 10% of all direct costs = $4,524
Total Project Cost = $49,755.
Attachment B
TASK ORDER CHANGE ORDER LETTER
[Date]
Task Order Change Order Letter Number :.:,
State Fiscal Year 20** - 20**,
Contract Routing Number ** *** *****
*************** Prol!ram
This Task Order Change Order Letter is issued pursuant to paragraph *. *. of the Master Contract identified as
contract routing number ** *** ***** and paragraph':':"':':'" of the Task Order identified as contract routing number
** *** ***** and contract encumbrance number ** *** **********. This Task Order Change Order Letter is
between the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT and rLEGAL
NAME OF CONTRACTOR1- The Task Order has been amended by Task Order Option to Renew Letter :.:,
contract routing number ** *** *****, and/or Task Order Change Order Letter:':, contract routing number ~
~, if any. The Task Order, as amended, if applicable, is referred to as the "Original Task Order". This Task
Order Change Order Letter is for the current term of ********* **, ****, through ********* **, ****. The
maximum amount payable by the State for the work to be performed by the Contractor during this current term is
increased/decreased by ********** Dollars, ($*.**) 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 all:': 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]
(a political subdivision of the state of Colorado)
STATE OF COLORADO
Bill Owens, Governor
By:
Name:
Title:
FEIN:
By:
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
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:
Revised: 11/5/04
Attachment C
TASK ORDER OPTION TO RENEW LETTER
[Date]
Task Order Option to Renew Letter Number **,
State Fiscal Year 20** - 20**
Contract Routing Number ** *** *****
*************** Pro2:ram
This Task Order Option to Renew Letter is issued pursuant to paragraph *. *. ofthe 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 AND ENVIRONMENT and rLEGAL
NAME OF CONTRACTOR]. 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':':"::'::'
~,ifany. 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]
(a political subdivision ofthe state of Colorado)
STATE OF COLORADO
Bill Owens, Governor
By:
Name:
Title:
FEIN:
By:
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
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:
Revised: 11/5/04
