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HomeMy WebLinkAboutC07-195 CDPHEDEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ROUTING NO. 08 FLA 00060 APPROVED TASK ORDER CONTRACT — WAIVER #154 This Task Order Contract is issued pursuant to Master Contract made on 12/19/2006, with routing number 08 FAA 00016 STATE: State of Colorado for the use & benefit of the Department of Public Health and Environment Prevention Services Division Family Planning 4300 Cherry Creek Drive South Denver, Colorado 80246-1530 TASK ORDER MADE DATE: 04/20/2007 PO/SC ENCUMBRANCE NUMBER: PO FLA FHS0800060 TERM: This Task Order shall be effective upon approval by the State Controller, or designee, or on 07/01/2007, whichever is later. The Task Order shall end on 06/30/2008. PRICE STRUCTURE: Fixed Price PROCUREMENT METHOD: Exempt BID/RFP/LIST PRICE AGREEMENT NUMBER.- Not UMBERNot Applicable LAW SPECIFIED VENDOR STATUTE: Not Applicable STATE REPRESENTATIVE: Candace Grosz Department of Public Health and Environment Prevention Services Division Family Planning 4300 Cherry Creek Drive South Denver, CO 80246-1530 BOARD OF COUNTY COMMISIONERS OF EAGLE COUNTY (a political subdivision of the state of Colorado) P. O. Box 850 Eagle, Colorado 81631 for the use and benefit of Eagle County Health and Human Services P. O. Box 660 Eagle, Colorado 81631 CONTRACTOR ENTITY TYPE: Colorado Political Subdivision CONTRACTOR FEIN OR SOCIAL SECURITY NUMBER 84-6000762 C BILLING STATEMENTS RECEIVED: Monthly STATUTORY AUTHORITY: Title X, 42 C.F.R, CFDA #93.217 FP Services CONTRACT PRICE NOT TO EXCEED: $54,122.00 FEDERAL FUNDING DOLLARS: $35,879.00 STATE FUNDING DOLLARS: $18,243.00 MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR: FY 08: $54,122.00 CONTRACTOR REPRESENTATIVE: Kathleen Forinash BOARD OF COUNTY COMMISIONERS OF EAGLE COUNTY (a political subdivision of the state of Colorado) P. O. Box 850 Eagle, Colorado 81631 for the use and benefit of Eagle County Health and Human Services P. O. Box 660, Eagle, Colorado 81631 SCOPE OF WORK Shall conduct a comprehensive family planning program in accordance with Exhibit B. Page 1 of 4 EXHIBITS: 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 Budget (and its attachments if any — e.g., B-1, B-2, etc.) Exhibit C - Limited Amendment Template for Task Orders Exhibit D - Contract Automatic Reimbursement Statement Exhibit E - Expenditure/Revenue Report Exhibit F - Secure External User ID Form 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. 1. 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(1), 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 Page 2 of 4 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; 5) the Additional Provisions -_Exhibit A, and its attachments if included, to this Task Order Contract; 4) 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. 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". 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 "Limited Amendment for Task Orders" that is substantially similar to the sample form Limited Amendment that is incorporated herein by this reference and identified as Exhibit C. To be effective, this Limited Amendment must be signed by the State and the Contractor, and be approved by the State Controller or an authorized delegate thereof. Upon proper execution and approval, this Limited Amendment shall become a formal amendment to this Task Order Contract. 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. 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. Page 3 of 4 IN WITNESS WHEREOF, the State has executed this Task Order Contract as of the day first above written. CONTRACTOR: STATE OF COLORADO: BOARD OF COUNTY COMMISSIONERS OF BILL RITTER, JR. GOVERNOR EAGLE COUNTY (a political subdivision of the _ state of Colorado) for the use and benefit of Eagle County Health and Human Services Legal Name of Contracting Entity For Executive Director 84-6000762 Department of Public Health and Environment Socia,lgecuriober or FEIN (V� Department Program Approval: Signature o uthorized Officer &",e.4 - `AR -(N' Ctl� By Print Name & Title of Authorized Officer GOVERNMENTAL ENTITIES: (An attestation and seal are required) ',NLE c �:\ J O Attest (Seal) By( (Town/City/County Clerk or Equi alent) 3r qR vernment seal here) COtORNO 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 NL Shenefelt By Date 7// v0 Page 4 of t4 EXHIBIT A ADDITIONAL PROVISIONS To Task Order Contract Dated 04/20/2007 - Contract Routing Number 08 FLA 00060 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 1. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination. The State has determined that this contract does not constitute a Business Associate relationship under HIPAA. 2. This Task Order Contract contains federal funds (see Catalog of Federal Domestic Assistance (CFDA) number 93.217) 3. The United State Department of Health and Human Services ("US DHHS"), through the Colorado General Assembly has awarded federal funds, hereinafter "Award", to perform — a comprehensive family planning program. 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. If the underlying Award authorizes the State to pay all allowable and allocable expenses of a contractor as of the effective date of that Award, then the State shall reimburse the Contractor for any allowable and allocable expenses of the Contractor that have been incurred by the Contractor since the proposed effective date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable and allocable expenses of a contractor as of the effective date of that Award, then the State shall only reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by the Contractor on or after the effective date of this Task Order Contract, with such effective date being the later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the State Controller or delegee. 4. 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 "Exhibit D", is incorporated here by reference, made a part hereof, and attached hereto, for the contract term. Upon affirmation by the State that the Contractor has satisfactorily and timely provided the services described in this contract, the State shall pay the Contractor 1/6`h 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 1/6`h 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. 5. The Contractor 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. 6. Notwithstanding anything herein to the contrary, the parties understand and agree that all terms and conditions of this contract and the exhibits and attachments hereto which may require continued performance, compliance or effect beyond the termination date of this contract shall survive such termination date and shall be enforceable by the State as provided herein in the event of such failure to perform or comply by the Contractor. To be attached to CDPHE Page 1 of 1 Revised: 12/19/06 Task Order v1.0 (11/05) contract template EXHIBIT B STATEMENT OF WORK To Task Order Contract Dated 04/20/2007 - Contract Routing Number 08 FLA 00060 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 1. The Contractor shall conduct a comprehensive family planning program ("the program") in Eagle 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). The funding for this program will be spent in accordance with Attachment B-1 attached hereto. 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 Unit ("WH"); C. Contraceptive information, 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 Manuals; E. Follow-up and/or referral services, as appropriate. The services provided by the Contractor must be deemed acceptable, in good faith, by WH. For a service to be "acceptable" it must comply with all applicable: Title X regulations, WH 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, WH 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. 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, To be attached to CDPHE Page 1 of 2 Revised: 12/19/06 Task Order v1.0 (11/05) contract template EXHIBIT B 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 monthly 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 offered, 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 quarterly 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 Exhibit F. 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 guidelines updated periodically in the Federal Register by the U.S. Department of Health and Human Services (DHHS) under the authority of 42 U.S.C. 9902(2). 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 DHHS 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 cdphe state co us/pp/womens/FederalPoveMGuidelines.htm). Charges shall be based upon the Contractor's actual costs to provide these services as determined 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 target family planning clients (fertile clients receiving 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 Exhibit E. The fust report is for the months of July through December for this contract period and will be due no later than February 7; the second report is for the months of January through June for this contract period 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 written policies governing the access to and, the duplication and dissemination of, 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. To be attached to CDPHE Page 2 of 2 Revised: 12/19/06 Task Order v1.0 (11/05) contract template Attachment B-1 Eagle Title X federal funding from the United States government (HHS CFDA# 93.217 FP Services) provides: $ 33,879.00 for ROUTINE FAMILY PLANNING services $ - for STERILIZATION services $ 2,000.00 for CHLAMYDIA TESTING services $ 35,879.00 Total Title X Funding IN, All federal funds must be fully expended by December 31, 2007. State of Colorado funding provides: $ 18,243.00 for ROUTINE FAMILY PLANNING services $ - for STERILIZATION services $ 18,243.00 Total State of Colorado Funding All State funds must be fully expended by June 30, 2008. $ 54,122.00 Total Current Award Family planning services target clients: 600 Page I of 1 EXHIBIT C DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT (ADD PROGRAM NAME HERE) DEPARTMENT OR AGENCY NUMBER *** CONTRACT ROUTING NUMBER ELIMINATE ALL INFORMATION APPEARING IN RED LIMITED AMENDMENT FOR TASK ORDERS #* This Limited Amendment is made this * * * * day of * * * * * * * * *, 200*, by and between the State of Colorado, acting by and through the 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, LEGAL NAME OF ENTITY, (legal type of entity), whose address or principal place of business is Street Address, City, State & Zip Code, hereinafter referred to as the "Contractor". FACTUAL RECITALS The parties entered into a Master Contract, dated * * * * * * * * * *, * * * *, with contract routing number * * * * * * * * * * "the Master Contract"). Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated * * * * * * * * * *, * * * *, with contract encumbrance number PO * * * and contract routing number ** *** *****, [insert the following if previous amendment(s), change order(s), renewal(s) have been processed: as amended by] linclude all previous amendment(s), change order(s), renewal(s) and their routing numbers[, [insert the following if previous amendment(s), change order(s), renewal(s) have been processed: collectively] referred to herein as the "Original Task Order Contract, whereby the Contractor was to provide to the State the following: [Briefly describe what the Contractor was to do under the Original Task Order Contract — indent this paragraph] [Please choose one of the following four options and delete the other three options not selected] The State promises to [choose one and delete the otherl increase/decrease the amount of funds to be paid to the Contractor by * * * * * * * * * * Dollars, ($*.**) during the current term of the Original Task Order Contract in exchange for the promise of the Contractor to perform the [choose one and delete the other] increased/decreased work under the Original Task Order Contract. Page 1 of 5 The State promises to pay the Contractor the sum of * * * * * * * * * * Dollars, $ *. * * in exchange for the promise of the Contractor to continue to perform the work identified in the Original Task Order Contract for the renewal term of **** years/months, ending on ******** **, ****. The State promises to [choose one and delete the other] increase/decrease the amount of funds to be paid to the Contractor by * * * * * * * * * * Dollars, $( *. * *) for the renewal term of * * * * [choose one and delete the other] years/months, ending on ******** **, ****, in exchange for the promise of the Contractor to perform the [choose one and delete the other] increased/decreased work described herein. The State hereby exercises a "no cost" change to the [choose those that apply and delete those that don't apply] budget, specifications within the Statement of Work, project management/manager identification, notice address or notification personnel, or performance period within the [choose one and delete the other] current term of the Original Task Order Contract or renewal term of the Original Task Order Contract. NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree as follows: Consideration for this Limited Amendment to the Original Task Order Contract consists of the payments and services that shall be made pursuant to this Limited Amendment, and promises and agreements herein set forth. 2. It is expressly agreed to by the parties that this Limited Amendment is supplemental to the Original Task Order Contract, contract routing number ** *** *****, [insert the following language here if previous amendment(s), change order(s), renewal(s) have been processed] as amended by [include all previous amendment(s), change order(s), renewal(s) and their routing numbers], [insert the following word if previous amendment(s), change order(s), renewal(s) have been processed, otherwise delete "collectively"]collectively referred to herein as the Original Contract, which is by this reference incorporated herein. All terms, conditions, and provisions thereof, unless specifically modified herein, are to apply to this Limited Amendment as though they were expressly rewritten, incorporated, and included herein. 3. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified, altered, and changed in the following respects only: [Please choose one of the following three options and delete the two options not selected] A. [Use this paragraph when changes to the funding level of the Original Task Order Contract occur during the current term of the Original Task Order Contract] This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number ** *** *****. This Limited Amendment is for the current term of ********* **, Page 2 of 5 EXHIBIT C * * * *, through and including * * * * * * * * * * *, * * * *. The maximum amount payable by the State for the work to be performed by the Contractor during this current term is [choose one and delete the other] increased/decreased by ********** Dollars,$( *.**) for an amended total financial obligation of the State of ********** DOLLARS, $*.** . [Delete the following sentence if not applicable in your situation] The revised Statement of Work is incorporated herein by this reference and identified as "Attachment *". [Delete the following sentence if not applicable in your situation] The revised Budget is incorporated herein by this reference and identified as "Attachment *". The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original Task Order Contract are reaffirmed. A. [Use this paragraph when the Original Task Order Contract will be renewed for another term] This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number *****. This Limited Amendment is for the renewal term of ********* ** * * * *, through and including * * * * * * * * * * *, * * * *. The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is ********** Dollars,$( *.**) for an amended total financial obligation of the State of ********** DOLLARS, ($*.**). [Delete the following sentence if not applicable in your situation] The revised Statement of Work is incorporated herein by this reference and identified as "Attachment *". [Delete the following sentence if not applicable in your situation] The revised Budget is incorporated herein by this reference and identified as "Attachment The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original Task Order Contract are reaffirmed. A. (Use this paragraph when there are "no cost changes" to the Budget, the specifications within the original Statement of Work, allowable contract provisions as noted, or performance period.] This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number ** *** *****. This Limited Amendment [choose those that apply and delete those that don't] modifies the Budget in [identify location in contract], modifies the Statement of Work in [identify location in contract], modifies the project management/manager identification in [identify location in contract], modifies the notice address or notification personnel in [identify location in contract], modifies the period of performance in [identify location in contract] of the Original Task Order Contract. The revised [choose those that apply and delete those that don't] Budget, Statement of Work, project management/manager identification, notice address or notification personnel, or period of performance is incorporated by this reference and identified as. All other terms and conditions of the Original Task Order Contract are reaffirmed. 4. The effective date of this Limited Amendment is **/**/****, or upon approval of the State Controller, or an authorized delegate thereof, whichever is later. Page 3 of 5 5. Except for the Special Provisions and other terms and conditions of the Master Contract and the General Provisions of the Original Task Order Contract, in the event of any conflict, inconsistency, variance, or contradiction between the terms and provisions of this Limited Amendment and any of the terms and provisions of the Original Task Order Contract, the terms and provisions of this Limited Amendment shall in all respects supersede, govern, and control. The Special Provisions and other terms and conditions of the Master Contract shall always control over other provisions of the Original Task Order Contract or any subsequent amendments thereto. The representations in the Special Provisions to the Master Contract concerning the absence of personal interest of state of Colorado employees and the certifications in the Special Provisions relating to illegal aliens are presently reaffirmed. 6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED, AND OTHERWISE MADE AVAILABLE. Page 4 of 5 EXHIBIT C IN WITNESS WHEREOF, the parties hereto have executed this Limited Amendment on the day first above written. CONTRACTOR: STATE: [LEGAL NAME OF CONTRACTOR] STATE OF COLORADO (a political subdivision of the State of Colorado) Bill Ritter, Jr. Governor By: Name: Title: FEIN: ATTEST: Because the Contractor is a governmental entity, an attestation is required By: (Seal, required) By: For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PROGRAM APPROVAL: City, City and County, County, Special District, or Town Clerk or Equivalent [Delete inapplicable language.] By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This limited amendment 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 goods and/or services provided. STATE CONTROLLER Leslie M. Shenefelt By: Date: Page 5 of 5 p 0 CD v m ,Q N X a W c) M p � U N Q o U s LL CL = c U E U) Q C N E N ccu N U) c C 2 > N C N W L c 4 fU U (D U O Q a U O L .a+ c c O a)0 E E fl' o � a o rn -p c CU c o DOc U a t6 ¢i t LL O O U cc U '> CO 0 Q e- Ti - L -Z to _ N C to U CDO c Z' 0 A �U 0 >, � U Q o c c0 M O LL (L It 0 H P LL 00 O m C O 2 N 7 Z U C O Z Q x co F- 2 h O O N N E ^ O co Q O N � N 7 N m co o Q cc N U N N f6 U) O rn Q c_ cn C Uc (6 CL a) U) E LL c x Co 0) n- LL cu N N LL (n 1 T L - (D 0 N L: N O N N 7 O o E CIOc o H Q ca Q Ili v a) N O O N C N E J+ cu CL Em Q U J:\Fiscal\contracts\FY06\Exhibit E - Family Planning Expendenditure-Revenue Report.xls Maggie leiman 303-692-2485 EXHIBIT F of C `O STATE OF COLORADO Qw== N ° DEPARTMENT OF PUBLIC HEALTH *, 1876 AND ENVIRONMENT Please fill out online and print, deliver, mail or fax Secure EXTERNAL User ID Form Instructions: A letter on agency letterhead, signed by the applicant's supervisor, must accompany this form. Make certain pages 1 and 2 are completed and signed. Complete the first lines only at the top of page 3. The department completes the gray area on page 3. The list of program(s) provided at the top of page 3 is used to determine the applicant's access. An authorizing department staff member will contact the applicant when a new ID is set up or changes to an ID are completed. Do you have a user 10 for ANY department application"? What is it? Why are you completing this form? New system access ❑ renewal ❑ change name ❑ other change ❑ Explain: password :and to reset n g passwords g g e e e d d d AicanO's ervisor. ( ) " Applicant Signature Supervisor Signature Please PRINT full address clearly. Must include a physical street C address if a P.U. Box is used to receive mail. h a n g e, d Title Title Page 1 of 4 Date Date Applicant Name: r Agency Name- Program(s) applicant requests access for (e.g., Special Needs, Communicable Disease and TB): Check (�) box if this is a change. 171 CDPHF. Program Use Only Print: Role: Sign: Print: Role: Sign, Print: ( ) Role: Sign: Indicate any known user ID ITS USE ONLY ITS Staff Person Completing This Set Up: Assigned User ID•' Confirmation Emailed to Authorizing Program Staff: Date: Confirmation ONLY by e-mail Signature — ITS Staff Title Notes: Exhibit F Page 2 of 4 Renewal User ID Agency Name: CAmmkOwunwom Data Security, Use and Confidentiality Agreement In consideration of my access to the Colorado Department of Public Health and Environment secure Web site and information, I agree to the following. (Initial each statement and sign below.) I understand that I am responsible for making every effort to prevent unauthorized users from gaining access to or using my user ID and password. I also agree to make every reasonable effort to prevent use of a computer for illegal or unethical purposes by all users, authorized or not. I agree to immediately report any suspected or actual unauthorized access to the Colorado Department of Public Health and Environment point of contact that manages the information. I will not share my password with any other person. I will not leave my password around my computer or where another person might easily locate it. I will change my password periodically and if I suspect it has been compromised. I will set up my passwords according to department guidelines for length and content. I understand that this is a "shared fate" environment. My fellow users and patients may be affected or confidentiality compromised by the activities of other users. Preventing such activity is the shared responsibility of all users. I agree to access only the information I need to do my job and not to access or attempt to access files that I am not authorized to use. I will not "browse" or otherwise use files or programs that exceed what is the minimum necessary to do my job. My use and disclosures of information will be consistent with those permitted by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other applicable laws and rules. I agree not to discuss confidential information or to provide copies of confidential reports, regardless of how or where acquired, to family members, friends, professional colleagues, other employees, other clients or any other person unless such person has been authorized to have access to that information. If unsure who is authorized to access the information, I will check with my supervisor or the department point of contact who manages the information. I understand that my access is granted for the purposes of public health and environmental protection. I will not use or disclose any data for any purpose or end inconsistent with the purposes of the system(s) for which access is granted. If I am unsure if any use or disclosure is permitted, I will discuss the issue with my supervisor and/or contact appropriate department program staff for further clarification. I will take precautions to protect confidential data displayed on my screen from viewing by others. This may mean re -positioning my computer screen, adding a device to limit other's view, turning off the computer when leaving the area or enabling password—protected screen savers. I will take reasonable and appropriate steps taking into account the staff and public access to my area and the nature of the data on the system. I understand that files I access may be protected from distribution by copyright or other applicable laws. The department has exclusive copyrights in all original works of authorship created by its employees or contractors. This applies to both published and unpublished works, and includes, but is not limited to, written documents, charts, graphs, imagery and maps. Other entities' copyrighted works also may be accessible on this Web site. I will not reproduce, distribute or display these works without permission from the department or another copyright owner. I understand that for audit or system security purposes, the department may monitor all my activity. I understand that the department may revoke my access at any time, with or without cause. I understand that any violation of federal, state, local or the program's confidentiality requirements or this Agreement will be considered a breach of my obligations and may result in disciplinary action, up to and including termination of employment, termination of contractual relationship and other remedies allowed by law during or after my employment or work with these data systems. For the department and other state employees, discipline will be per the State of Colorado Personnel Rules. I understand that information contained in the department's information systems is highly confidential and is protected from improper use and disclosure by applicable federal and state laws. I agree not to disclose confidential information in violation of this agreement or applicable confidentiality laws. Applicant Printed Name Applicant Signature Date Supervisor Name Signature Exhibit F Page 3 of 4 Date User Agency Letterhead Colorado Department of Public Health and Environment Program Name and Mail Code 4300 Cherry Creek Drive South Denver, CO 80246-1530 Date To Whom It May Concern: The employee(s) listed below require(s) access to the Colorado Department of Public Health data collection and reporting system indicated. As supervisor of the employee(s) I understand that if the employee(s) indicated should no longer be employed or should no longer require access to the data system indicated to conduct their job, I will request that access be disabled immediately. I also understand that if I have any questions about the status of the access, I can contact the owner of the data system indicated at the Department of Public Health and Environment at (303) 692-2000 or 1-800-886-7689 (In-state.) Sincerely Supervisor Name Title Agency ............................................................................. Employee Name: Employee Name: Employee Name: Employee Name: Please indicate which data system(s) you are requesting access to. ❑ Colorado Women's Cancer Control Initiative (CWCCI): eCaST ❑ HCP: CHIRP ❑ Family Planning: IRIS ❑ Prenatal Plus: IRIS Exhibit F Page 4 of 4