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HomeMy WebLinkAboutC08-186STATE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ROUTING NO. 09 FHA 00037 APPROVED TASK ORDER CONTRACT — WAIVER #154 This Task Order Contract is issued pursuant to Master Contract made on 01/23/2007, with routing number 08 FAA 00016 State of Colorado for the use & benefit of the Department of Public Health and Environment Emergency Preparedness and Response Division 4300 Cherry Creek Drive South Denver, Colorado 80246 TASK ORDER MADE DATE, May 30, 2008 PO /SC ENCUMBRANCE NUMBER. PO FHA EPI0900037 TERM: This Task Order shall be effective upon approval by the State Controller, or designee, or on 08/10/08, whichever is later. The Task Order shall end on 08/09/09. PRICE STRUCTURE Cost Reimbursement PROCUREMENT METHOD. Exempt BID /RFP /LIST PRICE AGREEMENT NUMBER: Not Applicable LAW SPECIFIED VENDOR STATUTE - Not Applicable CONTRACTOR Board of County Commissioners of Eagle County 500 Broadway Eagle, Colorado 81324, For the use and benefit of the Eagle County Health & Human Services 551 Broadway Eagle, Colorado 81631 CONTRACTOR ENTITY TYPE: Colorado BILLING STATEMENTS RECEIVED Monthly STATUTORY AUTHORITY Not Applicable Political Subdivision CONTRACT PRICE NOT TO EXCEED• $22,151.00 FEDERAL FUNDING DOLLARS: $22,151:00 STATE FUNDING DOLLARS- $ MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR- FY 09: $22,151.00 STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE. Sonia A. Gonzales Jill Hunsaker Department of Public Health and Environment Director Emergency Preparedness and Response Division 551 Broadway 4300 Cherry Creek Drive South Eagle, Colorado 81631 Denver, CO 80246 SCOPE OF WORK- Contractor shall work with and through state, regional and local partnerships to achieve the activities identified under the attached Scope of Work. Contractor shall ensure collaboration with the Colorado Department of Public Health and Environment (CDPHE), local public health agencies and regional Epidemiologist, Planner and Trainer staff members within the designated All- Hazards Region. 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 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. I. 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 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 Page 2 of 4 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. 6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope /Statement of Work - Exhibit B, establishes or creates standards of performance greater than those set forth in the RFP, then the Contractor shall also meet those standards of performance under this Task Order Contract. Page 3 of 4 IN WITNESS WHEREOF, the State has executed this Task Order Contract as of the day first above written. * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and acknowledge that the State is relying on their representations to that effect and accept personal responsibility for any and all damages the State may incur for any errors in such representation. CONTRACTOR: STATE OF COLORADO: Board of County Commissioners of Eagle BILL RITTER, JR. GOVERNOR County for the use and benefit of the Eagle County Health & Human Services Legal Name of Contracting Entity By For Executive Director w r-Y-,� -rr1tin Print Name & Title of uthonzed Officer Department of Public Health and Environment Department Program Approval: 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. By Date STATE CONTROLLER: David J. McDermott, CPA Page 4of4 EXHIBIT A ADDITIONAL PROVISIONS To Task Order Contract Dated 05/30/2008 - Contract Routing Number 09 FHA 00037 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 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 93.283 . The United State Department of Health and Human Services ( "USHHS "), through the Centers for Disease Control and Preventions ( "CDC ") has awarded federal funds under Award number U90/CCU816827, hereinafter "Award ", to develop emergency -ready public health departments by upgrading, integrating and evaluating state and local public health jurisdictions' preparedness for and response to terrorism, pandemic influenza, and other public health emergencies. 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 develop emergency -ready public health departments by upgrading, integrating and evaluating state and local public health jurisdictions' preparedness for and response to terrorism, pandemic influenza, and other public health emergencies with federal, state, local, and tribal governments, the private sector, and non - governmental organizations (NGOs) for the citizens of the state of Colorado on behalf of the State. These emergency preparedness and response efforts are intended to support the National Response Plan (NRP) and the National Incident Management System (NIMS). 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. In consideration for those services timely and satisfactorily performed by the Contractor under this Contract, the State shall cause to be paid to the Contractor a total sum not to exceed TWENTY TWO THOUSAND ONE HUNDRED FIFTY ONE DOLLARS ($22,151.00) for the initial term of this Contract from August 10, 2008, through and including August 9, 2009. Of this total amount, $22,151.00 is identified as attributable to a funding source of the federal government. This Contract is funded entirely with federal funds. Therefore, the State's liability for payment for all services rendered, or goods supplied, under this Contract is contingent upon the State's receipt of those federal funds. If the State does not receive all, or any part, of the federal funds necessary to pay its obligations under this Contract, then the State may immediately amend or terminate this Contract without further liability to the State. To be attached to CDPHE Pagel of 2 Revised: 12/19/06 Task Order v1.0 (11/05) contract template EXHIBIT A To receive compensation under this Contract, the Contractor shall submit a signed monthly Emergency Preparedness and Response Division Reimbursement Statement in accordance with the Emergency Preparedness and Response Reimbursement Requirements. A sample Emergency Preparedness and Response Division Reimbursement Statement is attached hereto as "Attachment A -Y' and incorporated herein by this reference. The Emergency Preparedness and Response Division Reimbursement Requirements is attached hereto as "Attachment A -2" and incorporated herein by this reference. An Emergency Preparedness and Response Division Reimbursement Statement must be submitted within thirty (30) calendar days of the end of the billing period for which services were rendered. Final billings under this Contract must be received by the State within a reasonable time after the expiration or termination of this Contract; but in no event no later than thirty (30) calendar days from the effective expiration or termination date of this Task Order Contract. Expenditures shall be in accordance with the Statement of Work and Budget attached hereto as Exhibit B and incorporated herein, and in accordance with the work requirements outlined in "Attachment B -1 ". Contractor shall be paid on a cost reimbursement basis only. All items requested for reimbursement must be allowable and directly related to activities identified under the Scope of Work. These items may include, but are not limited to, the Contractor's salaries, fringe benefits, supplies, travel, operating, indirect costs which are allowable, and other allocable expenses related to its performance under this Task Order Contract. The State has the option to reduce the budget and the scope of work if the Contractor fails to submit monthly invoice /cost reimbursement statements within thirty (30) calendar days. The monthly billing performance shall also be used as a basis for calculating the Contractor's future funding levels, if any. The State will notify the Contractor of the potential need to decrease the budget and scope of work. The Contractor may supply the monthly invoice, back up documentation and request a re- determination, which shall take place within fifteen (15) calendar days of the receipt of a written request. If no dispute is received by the CDPHE within fifteen (15) calendar days, the State will take action and modify the contract to reduce the budget and scope of work. Invoice /Cost Reimbursement Statements shall: 1) reference this Task Order Contract by its contract routing number, which number is located on page one of this Task Order Contract; 2) state the applicable performance dates; 3) state the names of payees; 4) include a brief description of the services performed during the relevant performance dates; 5) describe the incurred expenditures if reimbursement is allowed and requested; and, 6) show the total requested payment. Payment during the initial, and any renewal or extension, term of this Task Order Contract 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 Contract. Invoice /Cost Reimbursement Statements shall be sent to: Sonia Gonzales Emergency Preparedness and Response Division Colorado Department of Public Health and Environment EPRD A -5 4300 Cherry Creek Drive South Denver, CO 80246 Unless otherwise provided for in this Task Order Contract, "Local Match ", if any, shall be included on all billing statements as required by the funding source. The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. To be attached to CDPHE Page 2 of Revised: 12/19/06 Task Order v1.0 (11105) contract template ATTACHMENT A -1 ge$06#se WvWen Roitkbars Sta"Ont" aid g .... .. .. ....... ................... 1.11, .. ............. To Colorado Dept of Public Health & Environment From- Address. 4300 Cherry Creek Drive South, A-3 Address Denver, CO 80246 Attn• Sonia Gonzales Fax: (303) 691-7811 Contact: Phone- Program: Public Health Office of Emergency Preparedness Date of Expenditure: From and Response To. Contract/PO. Final Invoice- Yes No FEIN 06EVOon i6fEwndituri, Retm6urseme Personnel: Salary & Fringe 't4ai­ ti'"212MI-40b litlt' me of _t of Work Reference Hours or % Please check all LPHA EPR Scope of Work categories that apply to this invoice; • Planning, Training, Ex o Regional Epidemiologist Task List • Epidemiology u ftionalPlaimer task List • Healthcare Preparedness o Regional Trainer Task List • IT and Communication o Other [Please explain]: d Laboratory z Personnel Related Expenses Sub-Total: $070 Equipment: Equipment Related Expenses Sub-Total $0.00 Travel: Travel Related Expenses Sub-Total $0.00 Operating/Supplies: Operating/Supplies Related Expenses Sub-Total $000 Indirect: Indirect Total: $0.00 TOTAL REQUESTED REIMBURSEMENT AMOUNT: $0.001 I/We affirm the claimed expenses comply with the budget provisions of the contract and are reasonable and necessary, that all relevant progress and other reports have been timely filed, and all contract milestones and/or tasks related to the billing period have been achieved. Contractor Signature: Date: FOR CDPHE APPROVAL ONLY I affirm that I or my staff have reviewed the contractor's invoice and supporting documentation (as required, progress reports and other communications with the contractor, and believe to the best of my knowledge, that the contractor is in compliance with all contract provisions. CDPHE Contractor Monitor: Date: I certify that the claimed expenses have been reviewed by me for compliance with requirements of funding source and State of Colorado's Fiscal Rules, and are charged to the appropriate funding source. CDPHE Fiscal Officer/Delegate: Date: Page 1 of 1 ATTACMENT A -2 Emergency Preparedness and Response Division 2008 - 2009 Reimbursement Requirements ExA.MPLEs OF REQUIRED EXPENDITURE DESCRIPTIONS REQUIRED AGENCY RECORDS To BE INCLUDED ON ALL REIMBURSEMENT STATEMENTS FOR SITE VISIT VERIFICATION PERSONNEL ➢ Breakout of actual amounts for salary, fringe benefits and indirect rates John Doe, 100% of Full Time Equivalent (FTE), $5,000.00 ➢ Documentation of EPR activities and Emergency Preparedness and Response (EPR) Planner, projects for employees and time periods Scope of Work (SOW) Reference listed on invoice Jane Black, 15 Hours, EPR Admin Support, $1,000.00 SOW Reference ➢ Activities must be directly related to EPR Fringe $1,236.00 ➢ All of above information is needed even if personnel time is contracted out • Invoice for actual time spent on EPR grant • Include Name, Title, SOW Reference and Percent of FTE or Hours Worked • Select all Local Public Health Agency (LPHA) /EPR Scope of Work categories that apply to this invoice (check appropriate boxes) EQUIPMENT — LIST ALL EQUIPMENT OVER $500.00 ➢ Original receipts 2 Computers $5,000.00 ➢ Actual equipment being used appropriately to 2 Pagers $1,000.00 accomplish EPR activities 3 800 MHz Radios $3,500.00 ➢ Documented check -out system if equipment 1 Fax Machine $500.00 is loaned out to other programs to track and verify location and availability of all equipment purchased with EPR funds TRAVEL ➢ Signed mileage expense forms with itemized list of travel related expenses for each traveler Jane Dough, EPR Training $1,000.00 (including applicable receipts for hotel, John Smith, Planning Conference $500.00 parking, per diem etc.) ➢ Meeting/conference (reason for travel) • List each employee who traveled separate documentation, i.e, registration confirmation, meeting minutes /attendance list etc. OPERATING /SUPPLIES ➢ Original Receipts Copies $100.00 ➢ Actual existence of supplies Office supplies Postage $23.46 $10.34 ➢ Documentation of operating expenses (phone Telephone service (Cell and Main Line) $200.00 records, rental agreements, etc.) Rent $300.00 ➢ Documented formula for expenses that are Equipment Maintenance $250.00 billed against multiple grants or programs Audio Visual Equipment Rental $40.00 Task based funding for online course $1,000.00 • Itemize by type of expense (i.e. copies, office supplies) Page 1 of 2 ATTACMENT A -2 Emergency Preparedness and Response Division 2008 - 2009 Reimbursement Requirements EXAMPLES 6F REOUIRED EXPENDITURE DESCRIPTIONS REQUIRED AGENCY RECORDS To 113E INCLUDED,0N ALL REIMBURSEMENT STATEMENTS FUR SITE VISIT VERIF WATION • * LABORTORY: Itemize separately by type of expense & item • A copy of the receipt for any single item with a value of $1,000 or greater must be submitted with the invoice INDIRECT ➢ Documentation of approved % of indirect LPHA Approved Indirect Rate 10% Specific documentation may be required and of Direct Salaries & Wages $1,243.00 will be identified on an individual basis • List approved percentage, or requested percentage if less • Indirect costs that exceed the approved contractual amount will not be reimbursed • Approved indirect rats are effect for the entire term of the contractual agreement • Per Capita is not an allowable category for expense reimbursement. • All expenses must be directly related to specific Emergency Preparedness and Response Division activities as identified in the Scope of Work. • Contractor shall be paid on a cost reimbursement basis only. • All expenses must be invoiced under the appropriate budget categories of Personal Services, Equipment, Travel, Operating/Supplies or Indirect and in accordance with the above criteria. • Cooperative agreement funds under this program may not be used to purchase vehicles or supplant any current state or local expenditures. Supplantation means using Federal funds to replace local funds. The Public Health Service Act, title I, Section 319 (c) specifically state: SUPPLEMENT NOT SUPPLANT. Funds appropriated under this section shall be used to supplement and not supplant other Federal, State, and local public funds provided for activities under this section. Therefore, the law strictly and expressly prohibits supplanting. • Department of Public Health & Environment, Emergency Preparedness and Response Division may request additional back up information including copies of receipts on any item at any time. • All Expenses must be encumbered by the grant end date, and all invoices must be submitted no later than 30 days after the grant end date. Page 2 of 2 EXHIBIT B STATEMENT OF WORK To Task Order Contract Dated 05/30/2008 - Contract Routing Number 09 FHA 00037 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 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 and Budget, which are incorporated herein by this reference, made a part hereof and attached hereto as "Attachment B -1" and incorporated herein. To be attached to CDPHE Page 1 of 1 Revised: 12/19/06 Task Order v1.0 (11105) contract template Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Contract Term: August 10, 2008 through August 9, 2009. Contract Objective: The Centers for Disease Control and Preventions (CDC) has developed Preparedness Goals designed to measure urgent public health system response performance parameters that are directly linked to health protection of the public. The Preparedness Goals are intended to measure urgent public health system response performance for terrorism and non - terrorism events including infectious disease, environmental and occupational related emergencies. For the purposes of this contractual agreement urgent response is intended to indicate non - routine public health system reaction to limit possible mortality, morbidity, loss of quality of life, or economic damage. The primary intent of this contractual agreement is to fund the active participation of the Contractor in the immediate establishment, use, and continuous improvement of a response system using the CDC Preparedness Goals to measure public health system response performance. Colorado Department of Public Health and Environment (CDPHE) shall be responsible for setting precedents for actual response to a disease outbreak or emergency over the activity requirements of this contractual agreement. The Contractor shall be responsible for the accomplishment of all Local Health Agency Activities through State, Regional and Local partnerships and shall comply with Colorado Revised Statute 25 -1.5 -102. Contractor shall work with and through state, regional and local partnerships to achieve the activities identified under this Scope of Work. Contractor shall ensure collaboration with CDPHE, local public health agencies and regional Epidemiologist, Planner and Trainer staff members within the designated All- Hazards Region. Contractor shall ensure agency representation at the requested meetings, training sessions and conference calls. Contractor shall designate at least one staff member as the point of contact for Emergency Preparedness and Response activities, public information, communications, or media relations. Any Contractor receiving funding to support regional staff and accomplish the regional Epidemiologist, Planner and/or Trainer tasks, as identified and incorporated in this Scope of Work, shall ensure full collaboration with and support for all agencies within the respective All- Hazards Region. Any Contractor receiving regional funding shall be directly responsible for the accomplishment of the applicable Epidemiologist, Planner and /or Trainer tasks as designated in the budget section of this Scope of Work. Contractor shall utilize the Colorado Preparedness Reporting System (PRS) to document and monitor progress and accomplishments on a regular basis. The due dates of the progress reports are February 28, 2009 and August 8, 2009. If the Contractor has expended 25% or more of the funds prior to February 28, 2009, the Contractor must document activities and justify expenditures by entering progress data into PRS. Expenditure requests of 25% or more may be held until progress data is entered. Contractor understands and agrees that no amount of funding made available pursuant to this contractual agreement can be used for any work or project other than that specified in this Scope of Work. Contractor further understands that Contractor is not to include any work not related to the Scope of Work on any reimbursement statements to the State. If Contractor mistakenly includes any unrelated work on an reimbursement statement submitted pursuant to this contractual agreement, then Contractor hereby agrees to return this amount of money to the State immediately upon becoming or being made aware. Contractor shall ensure that all service related expenses will be completed and all goods related expenses committed by August 09, 2009. Page 1 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Contractor shall comply with all applicable Office of Management and Budget (OMB) circulars and shall be subject to performance and financial site visits as requested by CDPHE. Contractor shall provide status information periodically as requested by CDPHE and /or the CDC. The Contractor shall maintain a complete file of all records, documents, communications, and other materials that pertain to the operation of the activities under this contractual agreement. Such files shall be sufficient to properly reflect all direct and indirect costs of labor, materials, equipment, supplies and services, and other costs of whatever nature for which a reimbursement was made. These records shall be maintained according to generally accepted accounting principles and shall be easily separable from other Contractor records. Contactor's auditor shall perform audits in accordance with the requirements of the OMB Circulars A -87 (Cost Principles for State, Local, and Tribal Governments), A -122 (Cost Principles for Non - Profit Organizations) and A -133 (Audits of States, Local Governments, and Non - Profit Organizations), as applicable. Contractor shall ensure that reimbursement requests are not duplicated under any other Public Health Emergency Preparedness funding or utilized to supplant non - related activities or programs. Contractor shall ensure appropriate distribution of costs in direct relation to the activities performed. Supplantation: Cooperative agreement funds cannot supplant any current state or local expenditures. Supplantation refers to the replacement of non - federal funds with federal fund intended to support the same activities. The Public Health Service Act, Title I, Section 319 (c) specifically States: "SUPPLEMENT NOT SUPPLANT. -- Funds appropriated under this section shall be used to supplement and not supplant other federal, state, and local public funds provided for activities under this section." Therefore, the law strictly and expressly prohibits supplantation. Unallowable Costs: • Funds may not be used for research • Reimbursement of pre -award costs is not allowed • Funds under this program can not be used to purchase vehicles of any kind • Funds may not be used to purchase incentive items Page 2 of 21 Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Contract Budget: Contractor's total award shall not exceed $22,151.00. Regional Staff Positions: Contractor will notify CDPHE of Regional Emergency Preparedness and Response staff (Epi's, Planners, and Trainers) turnover. Upon notification of the vacancy the Colorado Department of Public Health and Environment (CDPHE) with support from the Local Advisory Committee (LAC) will review agency and regional circumstances and decide if the position needs to be maintained. Real Event Deployment and meetings requested by CDPHE: Regional and other associated emergency preparedness staff may be deployed to support a real emergency event, including assistance to counties, as requested by local public health agencies and CDPHE. Regional and other associated emergency preparedness staff should work with their respective agencies to arrange for emergency travel reimbursement. All meals, hotel expenses, and other associated travel costs will be eligible for reimbursement, through the current invoicing process. Agency management must approve terms of deployment for an emergency event or meeting, including timeline and location. Contractor shall ensure compliance with the Emergency Preparedness and Response Division Reimbursement Requirements and shall have the liberty to allocate funds across and in accordance with the following budget categories: Personnel: Contractor shall dedicate the necessary funds to support salary and fringe for any staff member devoting time and effort towards the accomplishment of any activities identified under this Scope of Work. Equipment: Contractor shall dedicate the necessary funds to purchase equipment, as well as maintain the working order of any existing equipment, required to meet any activity identified under this Scope of Work. This shall include, but is not limited to, personal and portable computers, communication radios, cellular telephones, facsimile machines, laboratory equipment, training equipment, public information kits, etc. Travel: Contractor shall dedicate the necessary funds to support travel related costs to ensure accomplishment of activities identified under this Scope of Work. This shall include, but is not limited to, regional planning meetings, local partner planning meetings, attendance at training sessions, conferences, agency representation at the Emergency Preparedness and Response conference calls and annual strategic planning meetings. Operating and Supplies: Contractor shall dedicate the necessary funds for operating and supply costs directly associated with any activities identified under this Scope of Work. This shall include, but is not limited to, high -speed Internet connections, notification systems, telephone and Page 3 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work communication systems, office supplies, copying, printing, postage, room rental, software purchase and upgrades, etc. Indirect: The allowable indirect rate charged to this contractual agreement may be lower but shall not exceed 10.00% of Direct Salaries & Wages, Including Fringe Benefits. This indirect rate shall be in effect for the entire term of this contractual agreement. Contractor may request a modification if a different indirect rate is negotiated within this term. Contractor must provide written documentation identifying a significant financial impact in order to justify the contractual agreement modification. All contractual agreement modifications will be reviewed on an individual basis. Contractor shall establish a process to track all obligations and expenditures related to this contractual agreement separately from other funds awarded through the Public Health Preparedness and Response Cooperative Agreement. Sustainability: Contractor shall establish and maintain a sustainability plan, detailing how emergency preparedness work is integrated, supported, and absorbed into the public health agency and regional infrastructure. Sustainability plan must include agency provisions for program activities, staff, and equipment needed to continue operations in the event of CDC Preparedness Cooperative Agreement grant reductions. This plan should be updated and kept on file at the agency. Contract Work Plan: This Task List supports the Centers for Disease Control and Prevention (CDC) Preparedness Cooperative Agreement and the 10 Essential Public Health Services. Both resources provide a working definition for public health, and guide the framework for Colorado preparedness responsibilities and local public health systems. All activities below have been linked to the Essential Public Health Services and CDC Goals For additional information on the Essential Public Health Services or the CDC Cooperative Agreement, please go to: 1. http / /www.cdc.gov /od/ ocphp /nphpsp/EssentialPHServices.htm 2. h!Ltp://www.bt.cdc.gov/planning/coopa.greement/ ❖ Local Agency Year Three Activities = 2008 -2009 Agency Deliverables to be completed Page 4 of 21 Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work ❖ Colorado Department of Public Health and Environment (CDPHE) Measure = Deliverable criteria used to report activity progress in the Colorado Preparedness Reporting System (PRS) ❖ All agencies receiving these funds will be required to report progress to Progress Reporting System (PRS) by February 28, 2009, and August 1, 2009. Pending reimbursement requests will only be considered for agencies that have completed reports in PRS •'v All agencies receiving these funds must attach required documents to the Colorado Health Alert Network (COHAN) portal as indicated ❖ All agencies receiving these funds must sustain the security and reliability of computer and communication systems ❖ If the CDC requests further information before this reporting deadline, all agencies receiving these funds may be contacted to provide additional information ❖ Only Essential Services with applicable deliverables will be listed under the Local Agency Scope of Work for 2008- 2009 I. Essential Public Health Service #3: Inform, educate, and empower people about health issues Essential Public Health Service #4: Mobilize community partnerships to identify and solve health problems Essential Public Health Service #5: Develop policies that support individual and community health efforts CDC Goals 1, 6, 9 Local Agency Activity CDPHE Measure 1.1. Participate in at least one local medical surge tabletop 1.1 (1). Documented participation in at least one exercise by June 1, 2009. local medical surge tabletop exercise by June 1, • Utilize objectives provided by CDPHE and developed by 2009, the region, based on areas for improvement from past exercises; the medical surge target capability; and results from the 2008 Emergency Preparedness and Response (EPR) training and exercise needs assessment. • At minimum, invite public health, emergency management, hospitals, Emergency Medical Service (EMS), outpatient clinics, rural and community health, long -term care, nursing homes, and mental health. Page 5 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Local Agency Activity CDPHE Measure 1.2. Enhance collaboration with federal, state, and local 1.2 (1). Document meetings and other collaborative governmental and private agencies in the community, that efforts with federal, state, local governmental and investigate, respond, and provide support regarding issues private agencies in the community, who can respond, related to health and environmental hazards and disparities. and provide support regarding issues related to health • Develop partnerships with the local business and environmental hazards and disparities. community(s) to enlist their participation in All- Suggested documentation to be kept on file, includes: Hazards planning activities. Agenda ■ Meeting minutes 1.3 Plan and document procedures to restore health services 1.3 (1). Documented meetings with emergency and environmental safety to pre- incident levels. preparedness partners to review and establish Continue post incident recovery planning and operations protocols for restoring health services and meetings to review existing policies and processes, and environmental safety to pre- incident levels. establish additional protocols as needed. Suggested documentation to be kept on file, includes: 1.3a. Work with (at minimum) local emergency management, 6 Sign -in roster environmental health partners, and local medical professionals a Agenda to establish the following criteria: • Specifically delineate what the roles of specific 1.3a (1) Included incident recovery planning agencies are during incident recovery stages after an specifications in local Public Health Emergency emergency. Operations Plan ( PHEOP). Post PHEOP plan to • Outline specific steps to ensure external and internal COHAN in the appropriate All- Hazards Regional communications are maintained / established folder and subsequent agency folder by July 31, 2009. between public health, environmental health, medical partners, and emergency management during incident recovery stages. • Outline plans and protocols to be initiated during the incident recovery stages. 1.4 Utilize the most current Public Health Emergency 1.4 (1). Posted updated PHEOP, with all minimum Operations Plan ( PHEOP) template to update this plan and requirements using the most current up to date PHEOP the associated Emergency Support Function (ESF) #8 annex. template, to COHAN in the appropriate All- Hazards PHEOP must include at a minimum: Regional folder and subsequent agency folder by July • Disaster Behavioral Health lead identification 31, 2009. • Incident recovery planning • For each identified Alternate Care Facility (ACF) in 1.4a (1). Included COOP Annex in the PHEOP, and the county, please include: posted to COHAN in appropriate All- Hazards Regional o ACF location folder and subsequent agency folder by July 31, 2009. o ACF contact information o Identify the agency who has the authority for activation of each ACF in the county o 24/7 ACF activation protocol procedures and contact information 1.4a. Maintain, update, and exercise agency Continuity of Operations (COOP) Annex to the PHEOP by July 31, 2009. ■ UtiIize the Continuity of Operations (COOP) Annex to the PHEOP template, as provided by CDPHE, COOP Page 6 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Local Agency Activity CDPHE Measure 1.5. Work with Regional staff to update local information in 1.5 (1). Updated and maintained SNS contact partners, the Strategic National Stockpile (SNS) plan, as necessary. providing this information to the Regional Planner, as requested, by January 15, 2009. • Plan must be updated according to the Strategic National Stockpile Emergency Response Plan Template. • CDPHE will provide guidance and updates for integrating the most current Technical Assistance Review (TAR) criteria. 1.6. Continue to participate in local Healthcare Coalitions in 1.6 (1). Documented meetings with Healthcare the Region. At a minimum, the meetings should address: Coalitions in the Region. • Alternate Care Facility (ACF) planning • How staffing will be initiated and maintained at the Suggested documentation to be kept on file, includes: ACFs during activation 0 Sign -in Roster • Procedures for accessing & activation of local ff Agenda Mobile Medical Caches 1.7. Identify a local ESF #8 lead agency that is approved by 1.7 (1). Provided local ESF #8 lead agency contact the local office of emergency management for: information to the State ESF #8 lead by October 30`h, 2008. For each agency contact, please provide: (1) • Public Health (prevention & control, human illness) main telephone number, and (2) a 24/7 contact number. • Mortuary (Death certificates, victim family notification) • Environmental Health (Air, water, food, risks to humans & environment) • Medical (patient care) 1.8. (For Agencies that have been identified and approved by 1.8 (1). Documented that the local ESF #8 Lead has local emergency management). Local ESF #8 Lead must participated in HC Standard trainings & drills, as participate in Health Care (HC) Standard trainings & drills, as scheduled by CDPHE by August 9, 2009. scheduled by CDPHE by August 9h, 2009. 1.9. Participate in local Colorado Volunteer Mobilizer 1.9 (1). Identify a CVM Coordinator at the (CVM) coordination, training, and exercises. local/regional level and provide that person's contact information to the State CVM Coordinator by November 6, 2008. 1.9 (2). Documented that the local CVM coordinator has received CVM training by May 8, 2009, as documented in CO.TRAIN. 1.9 (3). Document that the local CVM has started to recruit local volunteers by August 9, 2009. (Keep on agency file). 1.9 (4). Participated in at least 1 CDPHE sponsored CVM drill by August 9, 2009. 1. 10. Update Local Public Health Agency Point of 1.10. (1). Posted the updated Local Public Health Distribution (POD) Plan per lessons learned from the Agency POD Plan per lessons learned from the November 2007 POD Squad exercise. November 2007 POD Squad exercise to COHAN under the appropriate All - Hazards folder by April P, 2009. 1. 11. Maintain key stakeholder information; including, but not 1.11 (1). Updated and maintained contact information limited to jurisdictional medical providers, school districts, on COHAN quarterly, especially for 240 emergency Page 7 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work emergency management and other jurisdictional partners. Information must be updated at least quarterly. contact role. Detect and correct errors. 1.12. Use statewide technology information systems for 1.12 (1). Maintained Health Alert Network (HAN) communication (such as COHAN, Dialogics, CO.TRAIN, communication protocol and capability. PRS, Colorado Electronic Data Reporting System (CEDRS), Posted protocol on COHAN in agency Outbreak Management System (OMS), Integrated Data specific folder. Ensure appropriate agency Repository, Situational Awareness Tool, secure messaging, staff is trained on the HAN communication etc.). protocol. 1.12 (2). Conducted quarterly tests and assessed 1.12a. Ensure redundant communication system response rates of fax and at least one other device infrastructure. (phone, radio, e- mail). (Keep response rates and testing information on file). 1.12a. (1). Demonstrated the possession of a back -up redundant system(s) that doesn't rely on the same infrastructure as the primary and ability for multiple methods of contact (phone, fax, radio, and e-mail) during emergency conditions (e.g. no cell phone). Page 8 of 21 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work (LABORATORY AGENCIES- ONIML) II. Attachment B -1 Essential Public Health Service #2: Diagnosis and investigate health problems and health hazards in the community Essential Public Health Service #8: Assure a competent public health and personal health care workforce CDC Goals 1.3.5. 6 Local Agency Activity CDPHE Measure 5.1. Acquire and maintain relevant laboratory capability and 5.1 (1). Documented laboratory capability through capacity for response for the identification of biological agents equipment, staff, and other resources to support in clinical (human and animal), environmental, and food laboratory identification of multi- specimens. (Keep on specimens. a ency file). 5.2. Perform testing and CDPHE - provided proficiency testing 5.2 (1). Documented the use of LRN specimen testing according to the Laboratory Response Network (LRN) methods and report results of LRN tests to LRN. (Keep protocols (not to be shared for any reason to non - approved on agency file). agencies), 5.3 Expedite the reporting (within 24 hrs) of the results of LRN 5.3 (1). Provided specimen testing result documentation testing activity to CDPHE, the LRN, and the CDC upon and progress reports, as requested by CDPHE and request, including progress reports as required. CDC. 5.4. Obtain and maintain needed permits, licenses and 5.4 (1). Provided documentation of certification, certification to allow for LRN testing. permits, and licenses. 5.5 Provide a representative to attend the Colorado Laboratory 5.5 (1). Documented staff attendance at the Colorado Forum meetings, and attend audio conferences as needed. Laboratory Forum meetings, and audio conferences. (Keep on a en ile). 5.6. Conduct testing of environmental specimens classified as 5.6 (1). Documented the classification and testing of non - credible threats by Federal Bureau of Investigation (FBI) or environmental specimens. (Keep on agency file). other qualified law enforcement authority. 5.7. Participate in exercises and assessment studies and conduct 5.7 (1). If no real events occur in the off -hours time proficiency testing. frame, sentinel laboratories documented participation in rapid response scenario(s), involving call -down procedures, communications, and laboratory response time assembly, testing and reporting. 5.8. Enter progress reports data into the Preparedness Reporting 5.8 (1). Entered progress data into PRS. System (PRS), as requested by CDPHE. 5.9. Establish lines of communications with regional partners ). Documented communication strategies with regional including CDPHE, public health, environmental health, public health, environmental health, safety, hospital, and other safety, hospitals and others as needed. (Keep on agency file). rs as needed. 5.10. Maintain LRN membership by successfully participating 5.10 (1). Documented participation in LRN proficiency in LRN proficiency test exercises. exercises. 5.11. Establish lines of communication and/or Public Health 5.11 (1). Documented PHIN- compliant information Information Network (PHIN) compliant information systems systems and/or communication strategies with regional, with regional partners including CDPHE, public health, public health, environmental health, public safety, environmental health, public safety, hospitals and others as hospitals and others as needed. needed. Page 9 of 21 Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Local Agency Activity CDPHE Measure 5.12. Accommodate inspection of Biosafety Level (BSL) -3 5.12 (1). Documented the completion of an inspection laboratory, to be completed by CDPHE staff as requested, of BSL -3 laboratory by CDPHE staff. annually. Page 10 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work For Agencies with Regional Epidemiologist ONLY ❖ Regional Epidemiologist Year Three Activities = 2008 -2009 Agency Deliverables to be completed ❖ Only Essential Services with applicable deliverables will be listed under the Epidemiologist Task List for 2008 -2009 I. Essential Public Health Service #1: Monitor health status to identify community health problems CDC Goals 1, 4, 5, 9 Regional Activity CDPHE Measure E1. Assess the timeliness and completeness of E1 (1). Submit a report regarding the assessment of timeliness and communicable disease reporting in the region/ completeness of communicable disease reporting in the jurisdiction by either reviewing semi - annual CDPHE- region/jurisdiction, problems identified, and how these were generated tabulations or some other method. addressed. E2. Participate in the pandemic surveillance and E2 (1). Provide a summary of the exercise for your region to CDPHE reporting exercise to be held in the fall of 2008. by December 12, 2008. II. Essential Public Health Service #2: Diagnosis and investigate health problems and health hazards in the community CDC Goals 1, 4, 5, 9 Regional Activity CDPHE Measure E3. Demonstrate competency in communicable disease Please complete three of the five measures listed below: outbreak investigation skills. E3 (1). Submit a formal outbreak investigation report (in most cases, providers in the region/jurisdiction, or provide the data this is different than an "after- action report"). directly to local public health agencies in the E3 (2). Incorporate National Incident Management System region/jurisdiction so they can distribute to health care (NIMS) /Incident Command System (ICS) into a multi jurisdictional providers. or large communicable disease investigation, or other large event. Document the investigation or event for which NIMS /ICS was used. E3 (3). Use the (CDPHE) Outbreak Management Systems (OMS) for a disease /outbreak investigation and submit a report, including suggestions for enhancing the OMS. E3 (4). Submit CDC Electronic Foodborne Outbreak Reporting System (eFORS) forms ( "Fork and Spoon" forms) to CDPHE within two months after the first illness onset of the outbreak. E3 (5). Conduct a presentation on a disease investigation at an epidemiological or emergency preparedness conference (within Colorado or nationally). III. Essential Public Health Service #3: Inform, educate, and empower people about health issues CDC Goals 1. 4. 6 Regional Activity CDPHE Measure E4. Distribute disease surveillance data generated by E4 (1). Document dates when disease surveillance data was CDPHE or by a local public health agency to health care distributed to health care providers or local public health agencies, a providers in the region/jurisdiction, or provide the data summary of content, and the method that was used to distribute the directly to local public health agencies in the information. region/jurisdiction so they can distribute to health care providers. Page 11 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Regional Activity CDPHE Measure E5. Prepare at least one article to be included in the E5 (1). Submit one or more articles to CDPHE for inclusion in the weekly "Hot Topics in Epidemiology" update distributed "Hot Topics in Epidemiology" update. by CDPHE. preparedness activities and local communicable disease activities. IV. Essential Public Health Service #4: Mobilize community partnerships to identify and solve health problems CDC Goals 1, 6, 9 Regional Activity CDPHE Measure E6. Integrate with local and regional public health E6 (1). Submit a report documenting how the regional preparedness staff, and with local public health agency epidemiologist has integrated into local and regional public health communicable disease staff, preparedness activities and local communicable disease activities. E7. Regional epidemiologists (or an epi- trained designee E7 (1). Document assistance in a real situation ofneed/urgency, as from the regional epidemiologist's office) may be requested by CDPHE. deployed or asked to assist in a real situation of Command Posts (ICPs) and clinical labs as the CDPHE Emerging need/urgency, including assistance to counties, as Infections Program regularly does this. requested by CDPHE. E9 (1). Participated in at least 80% of the twice- monthly conference V. Essential Public Health Service #8: Assure a competent public health and personal health care workforce CDC Goals 1, 6, 9 Regional Activity CDPHE Measure E8. Educate clinical labs, hospital infection control E8 (1). Documented meetings with clinical labs, infection control practitioners, and local public health agencies in the practitioners, and local public health agencies where education was region/jurisdiction about the list of reportable diseases, provided on reportable diseases and lab testing capabilities. Note: reporting requirements, Colorado Electronic Data Denver Metro area epidemiologists (Boulder, Broomfield, Denver, Reporting System (CEDRS), and CDPHE lab testing Jefferson, Tri- County) are not required to meet with hospital Incident capabilities. Command Posts (ICPs) and clinical labs as the CDPHE Emerging Infections Program regularly does this. E9. Participate in regional epidemiologist conference E9 (1). Participated in at least 80% of the twice- monthly conference calls and regional staff meetings /trainings. calls. E9 (2). Presented or lead a discussion during one of the regional epidemiologist conference calls. E9 (3). Participated in writing the conference call minutes as assigned. E9 (4). Participated in the regional epidemiologist and regional staff meetings /trainings, including the one -day public health preparedness planning conference to be held in the spring of 2009. E10. New Regional Epidemiologists will successfully E10 (1). Completed the Public and Environmental Health Radiological complete the Public and Environmental Health CD. online Training (PEHRT), by August 9, 2009, as documented on Radiological CD. online Training (PEHRT), by August 9, CO.TRAIN. 2009. E11. Attend the Modular Emergency Response E11 (1). Documented successful completion of the Modular Radiological Transportation Training (MERRTT) Emergency Response Radiological Transportation Training course. (MERRTT) course by August 9, 2009. Page 12 of 21 Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Regional Epidemiologist Coordinator Meeting and Conference Call Calendar 2008-2009 Date Type Location/Time August 20, 2008 Regional Epi Conference Call 9:30 — 10:30 am September 3, 2008 Regional Epi Conference Call 9:30 — 10:30 am September 17, 2008 Regional Epi Conference Call 9:30 —10:30 am October 1, 2008 Regional Epi Conference Call 9:30 — 10:30 am October 15, 2008 Regional Epi Conference Call 9:30 — 10:30 am October 22 -23, 2008 Regional Staff Meeting CDPHE Denver Office November 5, 2008 Regional Epi Conference Call 9:30 — 10:30 am November 19, 2008 Regional Epi Conference Call 9:30 — 10:30 am December 3, 2008 Regional Epi Conference Call 9:30 — 10:30 am December 17, 2008 Regional Epi Conference Call 9:30 — 10:30 am January 7, 2009 Regional Epi Conference Call 9:30 —10:30 am January 21, 2009 Regional Epi Conference Call 9:30 — 10:30 am February 4, 2009 Regional Epi Conference Call 9:30 —10:30 am February 18, 2009 Regional Epi Conference Call 9:30 —10:30 am March 4, 2009 Regional Epi Conference Call 9:30 — 10:30 am March 18, 2009 Regional Epi Conference Call 9:30 —10:30 am April 1, 2009 Regional Epi Conference Call 9:30 — 10:30 am April 15, 2009 Regional Epi Conference Call 9:30 —10:30 am May (Date To be Determined) Regional Staff Meeting and Planning Conference To be Determined (TBD) May 6, 2009 Regional Epi Conference Call 9:30 —10:30 am May 20, 2009 Regional Epi Conference Call 9:30 —10:30 am June 3, 2009 Regional Epi Conference Call 9:30 —10:30 am June 17, 2009 Regional Epi Conference Call 9:30 —10:30 am July 1, 2009 Regional Epi Conference Call 9:30 — 10:30 am July 15, 2009 Regional Epi Conference Call 9:30 — 10:30 am August 5, 2009 TRegional Epi Conference Call 9:30 —10:30 am Page 13 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work For Agencies with Regional Planners ONLY ❖ Regional Planner Year Three Activities = 2008 -2009 Agency Deliverables to be completed ❖ Only Essential Services with applicable deliverables will be listed under the Planner Task List for 2008 -2009 I. Essential Public Health Service #4: Mobilize community partnerships to identify and solve health problems CDC Goals 1, 6, 9 Regional Activity CDPHE Measure P1 Update the Regional Strategic National Stockpile (SNS) plan P1 (1). Posted SNS plan to the appropriate All- Hazards and post to COHAN under appropriate All- Hazards COHAN COHAN folder by March 31, 2009. folder. • Plan must be updated according to the Strategic National *Please note: deadline for completion of SNS plans is Stockpile Emergency Response Plan Template. contingent upon date of the CDC/Division of the Strategic National Stockpile (DSNS) annual • CDPHE will provide guidance and updates for assessment. SNS plans must be completed prior to integrating the most current Technical Assistance Review assessment. (TAR) criteria. P2 Assist Local Public Health Agencies with updating local Point P2 (1). Posted the updated Local Public Health of Distribution (POD) Plans per lessons learned from the Agencies POD Plans to COHAN under the appropriate November 2007 POD Squad exercise. If no POD site was All- Hazards folder by April 3, 2009. activated during POD Squad, update local POD plans per gaps identified during a local POD event (real event or simulated exercise event). P3. Participate in Planner Meetings, The Annual Public Health P3 (1). Participated in at least 80% of the conference Emergency Preparedness Planning Conference, and Planner calls and meetings, as scheduled by CDPHE. Conference calls (including SNS), as scheduled by CDPHE. P4. Continue to participate in local Healthcare Coalitions in the P4 (1). Update Public Health Emergency Operations Region. At a minimum, the meetings should address: Plan ( PHEOP) with procedures, protocols or planning • Alternate Care Facility (ACF) planning that are outcomes of Healthcare Coalition meetings and • Address how staffing will be initiated and maintained at the ACFs during activation P4 (2). Documented meetings with Healthcare • Determine procedures for accessing & activation of local Coalitions in the Region. Assistant Secretary for Preparedness and Response (ASPR) Mobile Medical Caches. Suggested documentation to be kept on file, includes: • Sign -in roster • Agenda • Meeting minutes II. Essential Public Health Service #5: Develop policies that support individual and community health efforts CDC Goals 1. 4. 6 Regional Activity CDPHE Measure P5. Assist local public health agencies through resources and P5 (1). Posted local PHEOP, with all minimum technical assistance, in the development and or updates of the requirements using the most current up to date PHEOP Public Health Emergency Operations Plan ( PHEOP). Planners Page 14 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Regional Activity CDPHE Measure must utilize the most current version of the PHEOP template template, to COHAN in the appropriate All- Hazards posted onto COHAN. PHEOP must reference at a minimum the Regional folder and subsequent agency folder by July 31, following topics: 2009. • Disaster Behavioral health lead identification P8. 1 Attended at least one emergency preparedness • Incident recovery planning conference for the 2008 -2009 contract year. (Attendance • For each identified Alternate Care Facility (ACF) in documentation to be kept in agency file). the county, please include: o ACF location o ACF contact information o Identify the agency who has the authority for activation of each ACF in the county 0 24/7 ACF activation protocol procedures and contact information • Update the incident- specific annex entitled `Pandemic Influenza' P5a. 1.4a. Assist local public health agencies to maintain, update, and exercise agency Continuity of Operations (COOP) Annex to the PHEOP by July 31, 2009. ■ Utilize the Continuity of Operations (COOP) Annex to the PHEOP template, as provided by CDPHE, COOP P6. Continue to coordinate and integrate All- Hazards partners P6 (1). Documented meetings with All- Hazards partners in that lead or support Emergency Support Function #8 activities the community who can respond to health and (public health, environmental health, medical, mortuary and environmental health hazards. behavioral health). P6 (2). Utilized outcomes of All- Hazards partner meetings Partners should include but aren't limited to: public health, to update plans, protocols, and procedures. hospitals, outpatient clinics, community/rural health, physician's offices, long -term care, nursing homes, behavioral health, emergency management, military, education, corrections, law enforcement, fire, Emergency Medical Services (EMS), governmental officials, Tribal Nations, non - profit, community and faith -based organizations. III Essential Public Health Service #8: Assure a competent public health and personal health care workforce fl n� !' 7.. 1 K O Regional Activity CDPHE Measure P7. New Regional Planners will successfully complete the P7 (1). Completed the Public and Environmental Health Public and Environmental Health Radiological CD /online Radiological CD /online Training (PEHRT) for new staff Training (PEHRT), by August 9, 2009. by August 9, 2009, as documented on CO.TRAIN. P8. Attend a state and/or national emergency p r epa redness P8. 1 Attended at least one emergency preparedness conference(s) of Regional Planner's choice as approved by conference for the 2008 -2009 contract year. (Attendance CDPHE. documentation to be kept in agency file). Page 15 of 21 Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Regional Activity CDPHE Measure P9. Assist CDPHE with the coordination of local agency site P9 (1). Assisted CDPHE with site visit coordination, as visits, as requested. requested. (Assistance documentation to be kept in agency • Serve as the CDPHE contact person for the site visits file). in your region. • Support the CDPHE site visit process by coordinating local agency, regional staff, dates, and times, as needed. • Regional Planner will attend site visit meetings in the region, as needed. P10. Participate in at least one Local or Regional tabletop P10 (1). Participated in at least one local medical surge exercise by June 1, 2009 where Medical Surge was a specific tabletop exercise by June 1, 2009, as documented in Target Capability tested. CO.TRAIN. • Utilize objectives provided by CDPHE, and integrate with objectives developed by the region, based on areas for improvement from past exercises; the medical surge target capability; and results from the 2008 Emergency Preparedness and Response (EPR) training and exercise needs assessment. • At minimum, invite public health, hospitals, EMS, outpatient clinics, rural and community health, long- term care, nursing homes, mental health, tribal nations and emergency management. P11. Attend the Modular Emergency Response Radiological P11 (1). Documented successful completion of the Modular Transportation Training (MERRTT) course. Emergency Response Radiological Transportation Training (MERRTT) course by August 9, 2009, P12. All Regional Staff must participate in the Public Health P12 (1). Documented successful completion of the Public 101 course developed by the regional Training Coordinators by Health 101 course developed by the regional Training August 9, 2009. Coordinators by August 9, 2009. Page 16 of 21 Attachment B-1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Regional Epidemiologist Coordinator Meeting and Conference Call Calendar 2008-2009 Date Type Location/Time August 19, 2008 Planner Conference Call 1:00 — 2:15 October 22 — 23, 2008 Regional Staff Meeting To be Determined (TBD) December 2, 2008 Planner Conference Call 1:00 — 2:15 January 2009 Planner Meeting (tentative) TBD February 10, 2009 Planner Conference Call 1:00 — 2:15 April 14, 2009 Planner Conference Call 1:00 - 2:15 May 2009 (TBD) Regional Staff Meeting (2 days) TBD June 16, 2009 Planner Conference Call 1:00 — 2:15 Page 17 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work For Agencies with Regional Trainers ONLY ❖ Regional Trainer Year Three Activities = 2008 -2009 Agency Deliverables to be completed ❖ Only Essential Services with applicable deliverables will be listed under the Trainer Task List for 2008 -2009 I. Essential Public Health Service #4: Mobilize community partnerships to identify and solve health problems CDC Goals 1, 6, 9 Regional Activity CDPHE Measure T1. Work with the regional planner to provide each agency, nursing T1 (1). Trained appropriate public health staff in service, and relevant response partners in the region, with training, each agency and nursing service in your region in information and technical assistance related to the Regional Strategic the use of the Regional SNS plan by July 30, 2009. National Stockpile (SNS) plan. PHEOP at least once during FY08 -09. T1 (2). Posted training to CO.TRAIN. All ■ Work with the regional planner to meet state participants who complete a training must be requirements and complete necessary planning and verified in CO.TRAIN no more than 30 days after training activities as related to PHEOP annexes: the event. T2. Assist local Medical Reserve Corps (MRC) Coordinators and/or T2 (1). Documented assistance to the local MRC county/regional Colorado Volunteer Mobilizer (CVM) coordinator in Coordinators and/or county/regional CVM providing at least one training for volunteers registered in the Colorado coordinator in providing at least one training for Volunteer Mobilizer System. volunteers registered in the Colorado Volunteer Mobilizer. T2 (2). Posted training to CO.TRAIN. All participants who complete a training must be verified in CO.TRAIN no more than 30 days after the event. II. Essential Public Health Service #5: Develop policies that support individual and community health efforts CDC Goals 1, 4, 6 Regional Activity CDPHE Measure T3 (1). Trained appropriate public health staff in each T3 (1). Trained appropriate public health staff in each agency agency and nursing service in your region on the Public and nursing service in your region on the changes /updates Health Emergency Operations Plans ( PHEOP) and made to PHEOP at least once during fiscal year 08 -09. associated Emergency Support Function #8 annex, the PHEOP at least once during FY08 -09. T3 (2). Posted training to CO.TRAIN. All participants who ■ Work with the regional planner to meet state complete a training must be verified in CO.TRAIN no more requirements and complete necessary planning and than 30 days after the event. training activities as related to PHEOP annexes: Pandemic Influenza, Community Containment, Mass Fatality, and Continuity of Operations Plan COOP. Page 18 of 21 Attachment B -I Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work T4. Assist Local Public Health Agencies with updating T4 (1). Trained appropriate public health staff in each agency local Point of Distribution (POD) Plans per lessons learned and nursing service in your region on POD Plan updates by from the November 2007 POD Squad exercise. May 29, 2009 T4 (2). Posted training to CO.TRAIN. All participants who complete a training must be verified in CO.TRAIN no more than 30 days after the event. III. Essential Public Health Service #8: Assure a competent public health and personal health care workforce CDC Goals 1, 6, 9 Regional Activity CDPHE Measure T5 (1) Distance learning technology location information was T5. Update distance learning contact information for updated and posted on COHAN biannually — updates to be satellite downlink, computer lab and video conferencing made in September 2008 and March 2009. sites. T6. Participate in Regional Training Coordinator (RTC) T6 (1). Documented participation in RTC meetings, Annual Planning Conference, and at least 80% of the monthly trainer Meetings and conference calls in the 2008 -2009 grant year. conference calls. (See tentative schedule provided by the state). T7. Attend at least one state and/or national emergency T7 (1). Attended at least one emergency preparedness preparedness conference of the Regional Training conference for the 2008 — 2009 grant year. (Keep in agency Coordinator's choice. file). T8. Participate in at least one local medical surge tabletop T8 (1). Participated in at least one local medical surge exercise by June 1, 2009, tabletop exercise by June 1, 2009, as documented in • Utilize objectives provided by CDPHE, and CO.TRAIN. integrate with objectives developed by the region, based on areas for improvement from past exercises; the medical surge target capability; and results from the 2008 EPR training and exercise needs assessment. • At minimum, invite public health, hospitals, EMS, outpatient clinics, rural and community health, long -term care, nursing homes, mental health, tribal nations and emergency management. T9. New Regional Trainer(s) successfully complete the T9 (1). Completed the Public and Environmental Health Public and Environmental Health Radiological CD /online Radiological CD /online Training (PEHRT), by August 9, 2009, as documented in CO.TRAIN. —Training. T10. Encourage new environmental health staff to complete T10 (1). Encouraged new environmental health staff to the Public and Environmental Health Radiological complete the Public and Environmental Health Radiological CD /online Training (PEHRT), by August 7, 2009, CD /online Training (PEHRT), by August 7, 2009. T11. Attend the Modular Emergency Response T11 (1). Documented successful completion of the Modular Radiological Transportation Training ( MERRTT) course. Emergency Response Radiological Transportation Training ■ Promote MERRTT course to local public health ( MERRTT) course by August 9, 2009. and environmental agencies in the regional community. T12. Work with each local agency and nursing service in T12 (1). Using the Three -Year Training and Exercise template Page 19 of 21 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work the region to develop an emergency preparedness training calendar and matrix by October 15, 2008. At a minimum, each agency should participate in the following courses: • Medical Surge exercise • NIMS required courses as appropriate for agency positions • PHEOP Update /Orientation • Emergency communications (800 MHz radios, COHAN, and/or other devices used by the agency) • EPR 101 (Emergency Preparedness 101 online course) • SNS 101 (Strategic National Stockpile 101 online course) • Basic Principles in Personal Protective Equipment (online course) • Public Health 101 (online course when it is made available) The calendar should include the tentative courses for each agency /region that will be provided during the 2008 -09 grant year as well as the following for each course listed: • Course Name /Topic • Tentative course dates, times and locations The agency /region training calendar and training matrix should be included in the Three -Year Regional Training Plan. T13. Continue to integrate the National Incident Management System (NIMS) compliance, including assessment and training, according to the NIMS National Integration Center guidelines. • All agency staff must be trained in ICS -100 and Information System -700 (IS -700). • All supervisory staff must be trained in ICS -100, ICS -200, and IS -700. • All program managers and employees who will be expected to work in the agency's emergency operations center, and/or all personnel with a direct role in emergency preparedness must be trained in ICS -100, ICS -200, ICS -300, IS -700 and IS -800. • Agency directors, executive level staff and all staff pre - identified to perform duties as a Unified Commander, Incident Commander, Command Staff or Section Chief staff member according to the agency's ICS structure must be trained in ICS- 100, ICS -200, ICS -300, ICS -400, IS -700 and IS- 800. • Encourage regional healthcare coalition partners to take ICS and NIMS courses, by providing Attachment B -I CDPHE Measure provided by CDPHE, posted all completed Training and Exercise Plans on COHAN under appropriate All- Hazards folder by October 30, 2008. All training plan documents must be linked to the "Training Plan" category in COHAN. T12 (2) Using the format provided by CDPHE, included an appendix to the Training and Exercise Plan that contains the results of the region's training needs assessment. T12 (3). All emergency preparedness training provided to agency staff was made available for registration on CO.TRAIN prior to the event. All participants who complete a training must be verified in CO.TRAIN no more than 30 days after the event. T12 (4). Posted all public health emergency preparedness and response training and presentation materials in COHAN under the All- Hazards Resources: Training and Presentation Materials folder by September 30, 2008 and ongoing thereafter. T12 (5). Removed out -of -date training and presentation materials from the All- Hazards Resources: Training and Presentation Materials folder by November 30, 2008 and ongoing thereafter. T13 (1). Worked with the local agencies to ensure that each agency documents staff trained in Incident Command System (ICS) and NIMS using the spreadsheet provided by CDPHE. Only the Federal Emergency Management Agency (FEMA) certificate or paperwork verifying the completion of an equivalent ICS -100 or ICS -200 course can be used to confirm that an employee has been trained in ICS and NIMS. T13 (2). Ensured that each agency provides the updated NIMS and ICS training data using the provided spreadsheet to you quarterly (September, December, March and June) T13 (3). Ensured that all ICS and NIMS training data is entered into CO.TRAIN and verified quarterly (October, January, April, and July). T13 (4). Documented assistance to regional coalition healthcare partners regarding ICS and NIMS training. (Utilize the PRS comment field to describe assistance provided). Page 20 of 21 Attachment B -1 Eagle County Health & Human Services Public Health Emergency Preparedness and Response 2008 -2009 Scope Of Work Regional Activity CDPHE Measure resources and availability of training(s) in the August 20, 2008 community. 8:30 - 9:30 T14. Conduct at least one session on respiratory training T14 (1) Documented all train the trainer and/or fit testing (Train- the - trainer) and/or fit- testing for public health, rural sessions you conducted or coordinated for public health rural and community health clinics, local physicians, public and/or community health clinics, local physicians, public safety and/or other partners as requested in your region safety and/or other partners as requested in your region. before July 31, 2009. T14 (2). Posted training to CO.TRAIN. All participants who Trainer Conference Call complete a training must be verified in CO.TRAIN no more January 28 and 29, 2009 than 30 days after the event. T15. Assist in the Development of the Public Health 101 T15 (1). Assisted in the development of the Public Health 101 course for all regional staff by June 1, 2009. course by June 1, 2009 Regional Training Coordinator Meeting and Conference Call Calendar 2008 -2009 Date Type Location/Time August 20, 2008 Trainer Conference Call 8:30 - 9:30 September 10, 2008 Trainer Conference Call 8 :30 - 9:30 October 22 — 23, 2008 Regional Staff Meeting Denver (CDPHE) November 12, 2008 Trainer Conference Call 8:30 - 9:30 December 10, 2008 Trainer Conference Call 8:30 - 9:30 January 28 and 29, 2009 Regional Trainer Meeting To be Determined (TBD) (CDPHE) February 11, 2009 Trainer Conference Call 8:30 - 9:30 March 11, 2009 Trainer Conference Call 8:30 - 9:30 April 8, 2009 Trainer Conference Call 8:30 - 9:30 May 2009 (TBD) Regional Staff Meeting and Annual Planning Conference TBD June 10, 2009 Trainer Conference Call 8:30 - 9:30 July 8, 2009 Traver Conference Call 8:30 - 9:30 Page 21 of 21 0 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, Meal 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] [include 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 other] 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 otherl increased /decreased work under the Original Task Order Contract. 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 Page 1 of 4 J 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 * * * * * * * ** ** * * * *, 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 Page 2 of 4 EXH11BT C 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 contractl, 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 contractl, modifies the period of performance in [identify location in contractl 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. The effective date of this Limited Amendment is * * / * * / * * * *, or upon approval of the State Controller, or an authorized delegate thereof, whichever is later. 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. 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 3 of 4 IN WITNESS WHEREOF, the parties hereto have executed this Limited Amendment on the day first above written. * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and acknowledge that the State is relying on their representations to that effect and accept personal responsibility for any and all damages the State may incur for any errors in such representation. CONTRACTOR: STATE: [LEGAL NAME OF CONTRACTOR] STATE OF COLORADO (a political subdivision of the State of Colorado) Bill Ritter, Jr. Governor By: Name: Title: By: For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PROGRAM APPROVAL: 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. By: Date: STATE CONTROLLER David J. McDermott, CPA Page 4 of 4