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HomeMy WebLinkAboutC09-184 Task Order Waiver #154 (Rtng#10 FLA 00142)~~~ DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT , ROUTING NO. 10 FLA 00142 APPROVED TASK ORDER CONTRACT - WAIVER #154 This Task Oxder Contract is issued pursuant to Master Contract made on 01/23/2007, with routing number 08 FAA 00001G STATE: State of Colorado for the use & benefit of the Department of Public Health and Environment PSD-STEPP 4300 Cherry Creek Drive South Denver, Colorado 80127 TASK ORDER MADE DATE: 05/21/2009 PO/S~ ENCUMBR1u~1CENUMBER: PO FLA PPG1000142 TERM: This Task Order shall be effective upon approval by the State Controller, or designee, or on 07/01 /2009, whichever is later. The Task Order shall end on 06/30/2010. PRICE STRUCTURE: Cost Reimbursement PROCUREMENT METHOD: Exempt BID/RFP/LIST PRICE AGREEMENT NUMBER: Not Applicable LAW SPECIFIED VENDOR STATUTE: Not Applicable STATE REPRESENTATIVE: Chandra Hardwick Depaxtment of Public Health and Environment PSD-STEPP 4300 Cherry Creek Drive South Denver, CO 80246 SCOPE OF WORK: CONTRACTOR: Board of County Commissioners of Eagle County (a political subdivision of the State of Colorado) for the use and benefit of Eagle Counry Public Health Agency 551 Broadway Eagle, CO 81631 CONTRACTOR ENTITY TYPE: Colorado Political Subdivision BILLING STATEMENTS RECEIVED: Monthly STATUTORY AUTHORITY: Not Applicable CONTRACT PRICE NOT TO E~CEED: $52,610.00 FEDERAL FUNDING DOLLARS: $O STATE FUNDING DOLLARS: $52,(~1 O.OO MAXIMUM AMOUN i' AVAILABLE PER FISCAL YEAR: FY 10: $52,610.00 FY XX: $ FY XX: $ FY XX: $ FY XX: $ CONTRACTOR R~PRL,SFNTATIVF: Jill Hunsaker 551 Broadway Eagle, CO 81631 The Contractor will conduct activities under the project Tobacco Free Eagle County to prevent youth from using tobacco, reduce tobacco use, help people who use tobacco to quit, assist in the reduction of exposure to secondhand smoke and reduce tobacco use among groups that are disproportionately affected and/or at high risk for disease. Page 1 of 4 Rev 4/3/09 EXHIBITS: The following e~ibits 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 attachmerits if any - e.g., B-1, B-2, etc.) Exhibit C- Limited Amendment Template for Task Orders Exhibit D- Budget 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. This Task Order Contract is being entered into pursuant to the tenns 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. In accordance with section 24-30-202(1), C.R.S., as ainended, this Task Order Contract is not valid until it has been approved by the State Controller, or an authorized delegee thereo£ The Contractor is not authorized to, and shall not; conunence perfonnance 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 shali cormnence performance under this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order Contract after its praposed 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. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and inade a part hereof as if fully set forth herein. Unless othenvise 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 tenns of this Task Order Contract shall control over any conflicting terms in any of its e~ibits. In the event of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its e~ibits andJor attaclunents), or between this Task Order Contract and its e~ibits 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 e~ibits and attaclunents in the order specified in the Master Contract; 3) this Task Order Contract; 4) the Additional Provisions - Exhibit A, and its attachments if included, to this Task Order Contract; 5) the Scope/Statement of Work - Exhibit B, and its attachments if inchided, to this Task Order Contract; 6) other exhibits/attaclunents to this Task Order Contract in their order of appearance. Page 2 of 4 Rev 4/3/09 4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order Contract, shall perfonn and complete, in a tunely 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 ainount 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 Amendinent for Task Orders" that is substantially similar to the sample fonn Limited Amendinent that is incorporated herein by this reference and identified as Exhibit G To be effective, this Liinited Amendment must be signed by the State and the Contractor, and be approved by the State Controller or an authorized delegate thereo£ Upon proper execution and approval, this Limited Amendinent shall become a formal amendment to this Task Order Contract. This contract is subject to such inodifications 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 tenns of any RFP attached hereto, if applicable, establish the minimuin 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 ineet those standards of perfonnance under this Task Order Contract. STATEWIDE CONTRACT MANAGEMENT SYSTEM ~This section shall apply when the Effective Date is on or after July 1, 2009 and the maximum amount payable to Contractor hereunder is $100, 000 or higherJ By entering into this Contract, Contractor agrees to be governed, and to abide, by the provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning the monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide contract manageinent system. ~ Contractor's perfonnance shall be evaluated in accordance with the terms and conditions of this Contract, State law, including CRS ~24-103.5-101, and State Fiscal Rules, Policies and Guidance. Evahiation of Contractor's performance shall be part of the normal contract administration process and Contractor's perfonnance will be systeinatically recorded in the statewide Contract Manageinent Systein. Areas of review shall include, but shall not be limited to quality, cost and timeliness. Collection of information relevant to the perfonnance of Contractor's obligations under this Contract shall be determined by the specific requireinents of such obligations and shall include factors tailored to match the requirements of the Statement of Project of this Contract. Such perfonnance infonnation shall be entered into the statewide Contract Management System at intervals established in the Statement of Project and a final review and rating shall be rendered within 30 days of the end of the Contract tenn. Contractor shall be notified following each performance and shall address or con-ect any identified problem in a timely manner and inaintain work progress. Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the performance measures established under the Statement of Project, the Executive Director of the Colarado Department of Personnel and Administration (Executive Director), upon request by the Colorado Departinent of Public Health and Enviromnent and showing of good cause, may debar Contractor and prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result by: (i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS §24-105-102(6)), ar(ii) under CRS §24-105-102(6), exercising the debarment protest and appeal rights provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debannent and reinstateinent of Contractor, b.y the Executive Director, upon showing of good cause. Page3 of 4 Rev 4/3/09 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and aff rm that they are authorized to act on Contractor's behalf and acknowledge that the 5tate is relying on their representations to that effect. CONTRACTOR: STATE OF COLORADO: Board of Counry Commissioners of Eagle BILL RITTER, .lR. GOVERNOR County (a political subdivision of the State of Colorado) for the use and benefit of Eagle County Public Health A~ency Legal Name of Contracting Entity By For Executive Director Department of Public Health and Environment Signature of Au orized Officer ~Z~`~ ~ ~i~l~~~~ Print Name of uthorized Officer L~~~,~~~~~~~~ Print Title of Authorized Officer Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Nlscal Rules Deparhnent Program Approval: BY ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER: David J. McDermott, CPA BY. Date Page 4 of 4 Rev 4/3/09 EXHIBIT A ADDITIONAL PROVISIONS To Task Order Contract Dated 05/21/2009 - Contract Routing Number 10 FLA 00142 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 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. To receive compensation under this Contract, the Contractor shall submit a signed monthly Invoice/Cost Reiinbursement Statement. An Invoice/Cost Reimbursement Statement must be submitted within sixty (60) calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work attached hereto as Exhibit B, and with the work requirements outlined in Attachment B-1, and the Approved Budget attached hereto as Exhibit D and incorporated herein. These items may include, but are not limited to, the Contractor's actual time spent on the project based on the applicable hourly rate, fringe benefits, supplies, travel, operating, indirect costs which are allowable, and other allocable expenses related to its performance under this Contract. All expenditures must be reasonable and necessary for the performance of the grant, and must comply with The State of Colorado, specifically the Colorado Department of Public Health and Environment, fiscal guidelines and rules. Invoice/Cost Reimbursement Statements shall: 1) reference this 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) include allowable costs incurred by line item as approved in the budget; 4) include a brief description of the work performed during this perfonnance period; and, 5) show the total requested payment in a fonnat either provided or approved by the State. 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 seivices were rendered by the Contractor in accordance with the terms of this Task Order Contract. Invoice/Cost Reiinbursement Statements shall be sent to: Colorado Department of Public Health and Environment PSD-STEPP-AS 4300 Cherry Creek Drive South Denver, CO 80246 To be considered for payment, billings for payments pursuant to this Task Order Contract must be received within a reasonable tiine after the period for which payment is requested; but in no event no later than sixty (60) calendar days after the relevant perforxnance period has passed. Final billings under this Task Order Contract inust be received by the State within a reasonable tiine after the expiration or termination of this Contract; but in no event no later than sixty (60) calendar days from the effective expiration or tennination date of this Contract. The Budget, which is attached hereto as Exhibit D, shall govern the expenditure of funds by the Contractor under this Task Order Contract as well as subsequent reimburseinent by the State. Failure to submit contract reiinburseinent statements in accordance with budget and the above time frames may result in a delay or denial of the reimbursement request. Time Limit For Acceptance Of Deliverables. To be attached to CDPHE Page 1 of 5 Revised: 12/19/06 Task Order vl A(11/OS) contract template EXHIBIT A a. Evaluation Period. The State shall have fifteen (15) calendar days from the date a deliverable is delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables that have a different time negotiated by the State and the Contractor. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design specifications for that particular deliverable, or is otherwise deficient, then the State shall notify the Contractor of the failure or deficiencies, in writing, within twenty (20) calendar days of: 1) the date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or deficiency at the time of delivery; or 2) the date the State becomes aware of the faih~re or deficiency. The above time frame shall apply to all deliverables except for those deliverables that have a different time negotiated by the State and the Contractor in writing pursuant to the State's fiscal rules. c. Tiine to Correct Defect. Upon receipt of timely written notice of an objection to a coinpleted deliverable, the Contractor shall have a reasonable period of time, not to exceed ten (10) calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies within ten (10) calendar days, the Contractor shall be in default of its obligations under this Task Order Contract and the State, at its option, may elect to tenninate this Task Order Contract or the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract. 4. The Contractor shall not use funds provided under this Contract for the piupose of lobbying as defined in C.R. S. 24-6-301(3.5)(a). 5. The Contractor shall support, cooperate and partner with other Tobacco Prevention, Education and Cessation Grantees. 6. The State of Colorado, specifically the Department of Public Health and Environment, shall be the owner of all equipment with a value of greater than $5,000 or a useful life of inore than one year. Disposal or transfer of equipment procured under this contract may not occur without prior, express, written consent of the State. If reqtiested by the State, the equipment shall be returned to the State upon coinpletion of the contract term. 7. If the Contractor intends to subcontract any or all of its performance under this Contract, then the Contractor shall provide to the State, a copy of any proposed subcontract between the Contractor and a subcontractor. All subcontractors are subject to all the terms and conditions of this Contract. The Contractor remains ultimately responsible for any work perfonned by a subcontractor. 8. The contractor must notify STEPP within 30 days of a staff change of those employees performing work under this contract. 9. STEPP requires a disclosure of affiliation or contractual relationships, direct and indirect, with tobacco companies, owners, affiliate, subsidiaries, holding companies ar companies involved in any way in the production, processing, distribution, promotion, sales, or use of tobacco. Companies or individuals affiliated with or receiving funds from any tobacco company or subsidiary are not eligible for funding under this proposal. Any and all subcontractors must also adhere to this policy. 10. The Contractor is required to meet all training requirements as outlined in the STEPP Capacity Building Requirements. 11. Newly hired staff of the Contractor inay begin performing work under this Contract; however, participation in orientation training conducted by the State and completion of the STEPP learning modules within six (6) months of the cormnencement date of employment must be accomplished. 12. Wark Plan specifications, attached to this Contract, may be modified by way of a contract amendment as outlined and described within paragraph 5, page 3, of the Contract. Contractor shall submit all requested changes to its approved Work Plan in writing to the State as needed during the contract term. The State To be attached to CDPHE Page 2 of 5 Revised: 12/19/06 Task Order v1.0 (11/OS) cont~act template EXHIBIT A will then develop the necessary contract amendment. Contractor must submit revisions at least thirty (30) calendar days prior to the proposed work plan modification date. However, regardless of the date subinitted Contractor understands that the revised Work Plan will not becoine effective until the associated contract ainendment has been fully approved in accordance with the State's Fiscal Rules. 13. The Contractor shall participate in state-level evaluation efforts as requested by the State to include but not be limited to quarterly reports on the iinplementation and accomplishments of its approved Work Plan, to be due 15 days after the eacfi calendar quarter. Calendar quarters shall be July-September, October- December, January-March, April-June, as applicable. Failure to submit quarterly reports in accordance with the above time frames may result in a delay or denial of the reimburseinent request for those periods. 14. Within thiriy (30) calendar days after the expiration of the term of this Contract, the Contractor shall submit a written report to the State that describes its key accomplishments in iinplementing its approved Work Plan, including qualitative and quantitative data collected about smoking prevalence and tobacco control in their communities. The report shall also describe the Contractor's achievements during the contract tenn. . 15. Unless otherwise provided for, all data collected or produced or derived exclusively.from the Contractor's or subcontractor's work under this Contract shall remain the sole property of STEPP, whether in individual, aggregate, identified or de-identified form or any other form required by STEPP. To facilitate follow-up, research, surveillance and evahiation, any such data collected, used or acquired shall be inade available in any fonn required by STEPP, to STEPP and any other contractor designated by STEPP. Any such data collected, used or acquired shall be used solely for the purposes of this Contract. The Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell, or otherwise make known any such data to unautharized persons without the express prior written consent of STEPP or as otherwise required by law. This includes a prior written request by the Contractor to STEPP for submission of abstracts or reports to conferences, which utilize data collected under this Contract. Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or work papers necessary to perform its duties under the Contract and in accordance with professional standards. 16. The State of Colorado, specifically the Department of Public Health and Environment, shall be the owner of all printed materials, graphic representations, educational materials, audio-visual products, or any other media, in whatever form, created under this Contract. All such materials created under this Contract inust be pre-approved by the STEPP Marketing Director and Contract Manager in the development phase. A ininiinum of ten (10) business days is required for the review and approval process. The State reserves the right to require the CDPHE logo, the 5TEPP logo, or other wording on any material, representation, product or other media foi7n created under this contract. Any material, representation, product or other inedia form that will use the Colorado QuitLine, Colorado QuitNet or STEPP logo or infonnation must be pre-approved by the STEPP Media Specialist. A miniinuin of ten (10) business days is required for the review and approval process. This requirement applies, but is not liinited to, any brochure, flyer, presentation, billboard, radio spot, website, banner advertisement, etc. 17. Funds provided under this Contract may not be used to: supplant funding for any existing programshnodels; develop new cessation programs/models; develop curricula for youth or adults not reviewed and approved by STEPP; pay for individual cessation aids or nicotine replacement therapy; fund capital improvements; or fund costs of enforcement of state or local laws and ordinances. 18. Funding levels within the Budget, attached to this Contract, may be inodified as follows: To be attached to CDPHE Page 3 of 5 Revised: 12/19/06 Task Order v1.0 (11/OS) contract template EXHIBIT A a. Up to ten percent (10%) of the total funds originally set forth in each major budget category (e.g., Personal Services, Operating, Travel, Contractual and Indirect) may be transferred to other major budget categories without prior approval by the State; b. Greater than ten percent (10%) of the total funds originally set forth in each major budget category can be transferred to other major budget categories only after written notice has been given to the State and the State has approved such transfer; c. Where the contract not-to-exceed amount is increased or decreased, the parties shall execute a contract amendment in accordance with paragraph 5, page 3 of this Contract prior to any such budget modification; and d. In all instances described in 18a and 18b above, the Contractor shall subinit a revised budget to the State that shows: the original amount(s), the modification(s) made, and the new amount(s) within thirty (30) calendar days of the date the modification(s) is being requested. However, with regard to paragraph 19c above, in no case shall the transfers become effective until the associated contract amendment has been fully approved in accordance with the State's Fiscal Rules. e. Any changes in excess of 10% as outlined above requiring an amendment to this agreement, shall be submitted to the state by February 28, 2010 19. The list of acronyms below could be referred to throughout the contract, work plan and budget. ACS-American Cancer Society ADA-Americans with Disabilities Act ADAD-Alcohol and Drug Abuse Division AHA-American Heart Association ALA(C)-American Lung Association (of Colorado) AMCHP-Association of Maternal Child Health Programs ANR-Americans for Non-Smokers' Rights ASSIST - American Stop Smoking Intervention Study ASTHO-Association of State and Territorial Health Office BACCHLTS-BACCHUS Peer Education Network BOH-Board of Health BRFSS-Behavioral Risk Factor Surveillance System CB - Community-based System CBO-Community-based Organization CCGGColorado Clinical Guidelines Collaborative CCPD - Cancer, Cardiovascular, and Pulmonary Disease CCIAA - Colorado Clean Indoor Air Act CDGCenters for Disease Control -~, CDE-Colorado Department of Education CDPHE-Colorado Department of Public Health and Environment CFFGColorado Foundation for Families and Children CNS-County Nursing Service COPAN-Colorado Physical Activity and Nutrition Program CPHA-Colorado Public Health Association CSAP-Colorado Student Assessment Program CTEPA-Colorado Tobacco Education and Prevention Alliance CTFK-Campaign for Tobacco-Free Kids CTRP-Colorado Tobacco Research Program CWCCI - Colorado Women's Cancer Control Initiative DASH-Division of Adolescent & School Health (CDC) DHS - Department of Human Services DOR-Department of Revenue EPA-Environmentai Protection Agency ETS-Environmental Tobacco Smoke (a.k.a._secondhand smoke) FDA - Food and Drug Administration GASO-Great American Smokeout GASP CO-Group to Alleviate Smoking Pollution of Colorado Get R!EAL (GR)-Resist! Expose Advertising Lies (Youth Empoweiment Prograan) GLBT - Gay, Lesbian, Bisexual, and Transgender LBW - Low Birth Weight LHA-Local Health Agency LHD-Local Health Department To be attached to CDPHE Page 4 of 5 Revised: 12/19/06 Task Order v1.0 (11/OS) contract teinplate EXHIBIT A LRPC-Latino/a Research and Policy Center LSTPEN - Latino Statewide Tobacco Prevention & Education MCRC-Media Campaign Resource Center - CDC MOU - Memoranduin of Understanding MPH-Master of Public Health MSA - Master Settlement Agreement NACR - Nafive American Cancer Research NAQC-North American Quitline Consortium NCI-National Cancer Institute NIDA-National Institute on Drug Abuse NIH-National Institute of Health N7H-Natioual Jewisl~ Medical and Research Center N-O-T-Not-on-Tobacco, (ALA's Youth Smoking Cessarion Program) NRT-Nicotine Replacement Therapy OSH-Office on Sinoking or Health (CDC) PSD-Prevention Services Division PIO-Public Information Officer PHN - Public Health Nurse PRAMS-Pregnancy Risk Assessment and Monitoring Survey RDAC - Regional Disparities Advisory Council TRC-Tobacco Education And Prevention and Cessation Program Review Committee RFA-Request for Applications RFP-Request For Proposais RMC-Rocky Mountain Center for Health Promotion & Education SB - School-based System SBHGSchool-Based Health Centers SES - Socio-Economic Status SEW-School Employee Wellness SGR - Surgeon General's Report SHI-School Health Index SHS-Secondhand Smoke SIDS-Sudden Infant Death Syndrome STEPP-State Tobacco Education and Prevention Partnership STW-Straight-to-Work TA-Technical Assistance TABS -Tobacco Attitudes and Behavior Survey TAG-Tecluiical Advisory Group (for evaluation & TPEG) TANF - Temporary Aid to Needy Families TCP-Tobacco Control Partners TFS-Tobacco-Free Schools TFS Law-Tobacco-Free Schools Law TDG-Tobacco Disparities Grant TGYS-Tony Grampsas Youth Services TPBG-Tobacco Program Evaluation Group TTI-Tony Grampsas Tobacco Initiative UCD-University of Colorado - Denver UCDHSC-Heath Sciences Center at UCD (sometimes abr. UCHSC) UCDHSC-University of Colorado at Denver and Health Sciences Center Well COA - Wellness Councils of America WIC - Women Infants Children YE-Youth Empowerment YRBS-Youth Risk Behavior Survey YPH-Youth Partnership for Health YTS-Youth Tobacco Suivey 5 A's - Ask, Advise, Assess, Assist, Arrange To be attached to CDPHE Page 5 of 5 Revised: 12/19/06 Task Order v1.0 (11/05) conh~act template EXHIBIT B STATEMENT OF WORK To Task Order Contract Dated 05/21/2009 - Contract Routing Number 10 FLA 00142 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 this Contract, shall perform and coinplete, in a tiinely and satisfactory manner, all iteins contained in its approved Work Plan that is attached hereto as Attachment B-1 and incorporated herein, and in accordance with the associated Budget which is attached hereta as Exhibit D and incorporated herein. 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C/~ r~ b ro -d ~ ~' ~ o' ~ N O 0 ~ N O O ~-3 o°' ~ ~ O ~ N N a ~ O C ~ ~ U ~ 0 c ~ ~~y V ~ Q~ ~' ~ ~ a~ ~ ~ ~ ~ "~ ~ td ~ ~ ~s ~ ~r R ~ 1"+ EXHIBIT C DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT. ADD DIVISION-PROGRAM ACRONYM5 DEPARTMENT OR AGENCY NUMBER *~* CONTR.ACT ROUTING NUMBER **_:~~*** EL[MINATE ALL INFORNIATION APPEAR.ING Iy RED LIMITED AMENDMENT FOR TASK ORDER5 #* This Limited Amendment is inade 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 Cherrv Creek Drive South, Denver, Colorado 80246, hereinafter referred to as the "State"; and, LEGAL NAME OF ENTITY, (le~al tvpe of entitvl, whose address or principal place of business is Street Address, Citv, State & Zip Code, hereinafter referred to as the "Contractor". FACTUAL RECITALS The parties entered into a Master Contract, dated ******** ** ****, with contract routing nuinber ** *** **'~** Pursuant to the terms apd conditions of the Master Contract, the parties entered into a Task Order Contract, dated ******** ** ****, with contract encumbrance number PO *** **********, and contract routing nuinber ** *** *****, ~insert tl~e follawinb if ~reviaus amendment(s}, change order(s), renewal(s) have been pracessecl: as amended by] [inciude all pa•evious amendment(s), change order(s}, renewal(s) ai~d their routing numbersj, ~insert tEie folloF~ving if previaus amenclmeut(s}, change order(s}, renewat(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 Contractar rvas to do uncler the Original Task Order Contract - indent this ~a~•agra~h] Please choose one of the fc~llawing fow• options and delete the other three options not selected~ The State promises to [choose at~e ancl clelete the otl~er] increase/decrease the amount of funds to be paid to the Contractor by ********** Dollars, ($*.**) during the current tenn of the Qriginal Task Order Contract in exchange for the promise of the Contractor to perform the (ehoase one and delete the athe~•] inereased/decreased work under the Original Task Order Contract. The State proinises to pay the Contractor the sum of *********x 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 otherj increase%decrease the amount of fimds to be paid to the Contractor by **~******* Dollars, $*.** for the renewal term of **** (ci~aose a~ie and delete the ather~ years/months, ending on *X*x**** *X, ****, in exchange for the promise of the Contractor to perform the ~ehaose one and detete the otherJ increased/decreased work described herein. The State hereby exercises a"no cost" change to the [choase those that apply ~nd detete those that don't a~~ly) budget, specifications within the Statement of Work, project management/manager identification, notice address or notification personnel , or performance period within the (cItoose t-1ie and delete the oti~er~ current term of the Original Task Order Contract or renewal term of the Original Task Order Contract. Page 1 of 4 Rev 4/3/09 EXHIBIT C 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 inade pursuant to this Limited Amendment, and proinises and agreements herein set forth. 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 foltowing language here if previous an~endment(s}, clianbe order(s), re~~ew~al(s) have been pirocessedJ as amended by (include ail ~revious ~imendment(s}, chan;e order(s), renewal(s} and their routing numbers], (insert the foilowing word if previous amendinent(s}, change order(s), renetival(s} have been processed, atherwise delete "colleetive[y"jcollectively referred to herein as the Original Contract, which is by this reference incorporated herein. All tenns, conditions, and provisions thereof, unless specifically modified herein, are to apply to this Limited Amendinent as though they were expressly rewritten, incorporated, and included herein. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modifiecl, altered, and changed in the following respects only: (Please choose one of the follawiug three optians anci delete the two options not selected~ A. [Use this pn.ragraph when changes to the funtling level of the i~ri~inal Task Order Cantract accur during the current term of the Originnl Task Order Contract~ This Limited Ainendment 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 ********* ** *x**. The maximum amount payable by the State for the work to be performed by the Contractor during this current term is (ehoase one and delete the other] increased/decreased by ********** Dollars, ($*.**) for an amended total financial obligation of the State of ********** DOLLARS, ($*.**1. ~Delete ttie following sentence if not applicable in your situation1 The revised Statement of Work is incorporated herein by this reference and identified as "Attachment *". (17elete the following sentence if naf 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 Origi-~al Task Order Contract will be renewed for anatl~er term j This Liinited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing nuinber ** *** *****. This Limited Amendment is for the renewal term of ********* ** ****, through and including ********* ** ****. The maximum amount. payable by the State far the work to be performed by the Contractor during this renewal term is ********** Dollars, $( *.**1 for an amended total financial obligation of the State of ****x***** DOLLAR5, ($*.**). [Detete the f`ollowing sentence if not applicable in 3~our situationJ The revised Statement of Work is incorporated herein by this refer.ence and identified as "Attachment *". tDelete t~ze f'oilowing sentence if not applicable in your situatianJ 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 paragrapl~ when there are "na cost changes" ta the 7Budget, the speci~cations ~~vithin the original Statement af Work, allawable cantract provisians as noted, or performance periad.] This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identi~ed by contract routing number ~x *~* *X***. This Limited Amendment (cl~flose ti~.ase that apply and ctelete thase that don't] modifies the Budget 'rn [ictentify location in ca~ntr~ctJ, modifies the Stat~ment of Work in [iclentify lacafioi~ in Page 2 of 4 Rev 4/3/09 EXHIBIT C eot2tractJ, modifies the project management/manager identification in {ident-fy Iocatio~a ii~ cantract], modifies the notice address or notification personnel in [identify locafion in CU11tY2Ct~, modifies the period of performance in [identify (ocation in contract) of the Original Task Order Contract. The revised [choose those that apply and delete those that don'tJ . Budget, Statement of Work, project management/manager identification, notice address or notification personnel is incoiporated by this reference and identi£ed as Exhibit * or Attachment **. [if you are ctianging the performaitce period, chaose the fallowing t~~~o sentences or detete batt~ seittences) The period of performance of the [choose ane and delete the other~ current/renewal term is hereby (choose one and delete the other] extended/reduced by ***** (*) months, changing the current ending date froin ********* ** **** to ********* "* ****. The revised period of performance is ********* ** **** through and including ********* ** ****. The Original Task Order Contract is modified accordingly. All other terms and conditions of the Oxiginal Task Order Contract are reaffirmed. 4. The effective date of this Liinited Amendment is ******** *X ****, or upon approval of the State Controiler, or an authorized delegate thereof, whichever is later. 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 Amendsnent and any of the terms and provisions of the Original Task Order Contract, the terms ancl 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 3 of 4 Rev 4/3/09 EXHIBIT C IN WITNESS WHEREOF, the parties hereto have executed this Limited Ainendment 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. CONTRACTOR: [LEGAL NAME OF CONTRACTOR] (Legal type of entity) Signature of Authorized Officer Print Name of Authorized Officer Print Title of Authorized Officer STATE: STATE OF COLORADO Bill Ritter, Jr. Governor By: For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Signatory avers to the State Controller or that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules PROGRAM APPROVAL: By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve a11 State Contracts. This Contract is not valid until signed and dated below by the State Controiler or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER David J. McDermott, CPA By: Date: Page 4 of 4 Rev 4/3/09 STEPP Application 2009-2010 ~ Tobacco Free Eagle County: Eagle County Public Health Agency Exhibit D Budget Narrative PERSONAL SERVICES: Benefits were calculated at 35% of salary. Name Position Title Position Responsibilities Program Annual Costs for the position Sondra Manske, .45 FTE Program coordinator: $33,801.25 MPH, CHES Tobacco Program maintenance of system's Coordinator/Health integration strategies; local Educator policy work; management of coalition; management of budget and reports; evaluation Rebecca Larson, .OS FTE Acting Supervision of staff, program $5,443.20 MPH Supervisor/ Public and budget; consultation on Health Manager evaluation DIRECT OPERATING CO5T5: Meeting Expenses: • Coalition meetings held quarterly with approximately I S attendees x$5.00 refreshments _ $300 • Inclividual lunch meetings held to recruit coalition rnembers or talk to policy makers: $I S per attendee x 10 attendees =$I50. Total Coalition/Partner Meeting Expenses: $450 Printing: • Vail Daily (Eagle County circulation of I5, 000): 8 I/a page black and white STEPP ads plaeed at $137.00 per day. Total =$1,096 ~ Miscellaneous Printing=printing costs for coalition, state STEPP products that need fnodified for County use (example: our no smoking ordinance is 25 ft vs. 15 ft statewide), etc. Total = $500 Total Printing: $1,596 Other: , (Radio Adsj: Ads will run between the months of October and February in conjunction with Su~it County. • Ski Country Radio (Eagle, Summit, an~l Lake Counties): $I S/30 second slots X 27.5 spots/month X 2 months (national observances) =$825 • Eagle Radio (Eagle, Summit, Clear Creek, Gilpin, partial Boulder, Grancl, partial Jackson, Routt, Moffat, Rio Blanco, Garfield, Mesa, Delta, Gunnison, Chaffee, Park, Lake, and Pitkin Counties): $I S/60 second spot X 27.5 spots/month X 2 months (national observances)=$825 • La Nueva Mix (Eagle, partial Garfielcl, and partial Pitkin Counties): Hispanic target = $15/60 second spot X 45.5 spots/month X 2 months (national observances)=$1,365 Total Radio Ads: $3,015 STEPP Application 2009-2010 ~ Tobacco Free Eagle County: Eagle County Public Health Agency Exhibit D (Memberships): The Vail Va11ey Partnership is a Chamber of Commerce for the entire Vail Valley with a database of approximately 800 businesses including those that cater to disparate populations, i.e. the Latino and low SES populations. Membership includes networking and advertising opportunities among access to the business database. • Yearly membership: $550/membership + $50/administrative fee = $600 Total OtherProgram Total: $3,615 TRAVEL: In-State Travel: The current State mileage reimbursement rate is $0.53. ~ Coalition and partner meetings: 28 miles per week @$0.53 per mile =$771.68 Total Travel to STEPP trainings in Denver, for Eagle County Tobacco Program Coordinator has been calculated as follows: ~ Regional Training: (1 employee, 2 days) $148.40 mileage (280 miles X 0.53) $ 125.00 hotel ($125/night) $ 60.00 food ($30/day X 2 days) $333.40 Total ~ • Regional Training: (1 employee, 2 days) $148.40 mileage (280 miles x 0.53) $125.00 hotel ($125/night) $ 60.00 food ($30/day X 2 days) $ 333.40 Total • Tobacco Control Institute: (1 employee, 3 days) $148.40 mileage (280 miles x 0.53) $250:00 hotel ($125/night X 2 nights) $ 90.00 food ($30/day X 3 days) $488.40 Total Total In-State Ti-avel = $I,926.88 STEPP Application 2009-2010 ~ Tobacco Free Eagle County: Eagle County Public Health Agency Exhibit D CONTRACTUAL: Andrew Jessen will assess community businesses to determine enforcement and education needs of smoke-free laws. Assessment and enforcement fees at $26.09/hour X 8 hours X 5 days = $1,043.60. Expected deliverables include two assessments per year and three enforcement days per year. Total Contractual Charge = $1,043.60 INDIRECT EXPENSE: Indirect expenses are charged at two percent of contractual at $1,043.60 X 0.02 =$20.87 and 10 percent of all other total direct costs at $46,832.33 X 0.10 =$4,683.23, which include executive management time, finance division time, administrative assistarit time, facility rent/lease, postage, telephone, equipment and utilities. Total Indirect Charge = $4,704.I0 APPLICATION BUDGET FORM State Tobacco Education & Prevention Grants Program 2009-2010 Check only one: p vea~ i~~~iY i, 2009 -)une 30. 2010) APPLICANT: ^ Year 2(July 1, 2010 -]une 30. 2011) Eagle Count Public Health Agency ^ Year 3(July 1, 2011 - June 30. 2012) PROJECT TITLE: SOURCE OF FUNDS Tobacco Free Eagle County Requested Other Source' Other Source' CDPHE Sourcet Source2 PERSONAL SERVICES FTE Monthly Monthly # of If applicable, If appiicable, funding funding Name Position % Eftort Salary Benefits Months source name source name Sondra Manske, MPH, Tobacco ,,, ,~~ CoordinatodHealth 0.45 $4,636.66 $1,622.83 12.0 $33,801.25 $0.00 $0.00 Acting SupervisodPublic Rebecca Larson, MPH Health Managet 0.05 Subtotal Personal Services 0.50 $39,244.45 $0.00 $0.00 ~ ~ ~ DIRECT OPERATING COSTS Unit Quantity Rate Printing/Copying Month 1.00 $ 1,596.00 $1,596.00 $0.00 $0.00 Postage/Shipping $0.00 $0.00 $0.00 Telephone, Fax, Internet Access $0.00 $0.00 $O.DO Supplies $0.00 $0.00 $0.00 Computer Equipment $O.oo $o.oo ~0.00 Staff Development $0.00 $o.oo $0.00 Meeting Expenses $450.00 $0.00 $o.oo Other Program Cost- Radio Ads $3,015 and Membership $600 $3,615.00 $0.00 $0.00 Subtotal Oueratinq Costs $5,661.00 $0.00 $0.00 TRAVEL Unit Quantity Rate Mileage Mile 2296.00 $ 0.53 $ 1,216.88 $0.00 $0.00 Lodging day 4.00 $ t25.00 $ 500.00 $0.00 $0.00 Meals day 7.00 $ 30.00 $ 210.00 $0.00 $0.00 Other Travel $ - $o.oo $0.00 Subtotal Travel Costs $1,926.88 $0.00 $0.00 CONTRACTUAL Unit Quantity Rate Consultant Hour 40.00 $ 26.09 $ 1,043.60 $0.00 $0.00 Contract TrainedSpeaker/Honorarium Day $ - $0.00 $0.00 Subcontract Hour $ - $o.oo $0.00 Subtotal Contractual Costs $1,043.60 $0.00 $0.00 OTHER COSTS Unit Quantity Rate Outreach/Educational Materials $ - $ • $0.00 $0.00 Screening $ - $o.oo $0.00 Treatment $ - $0.00 $0.00 Subtotal Other Costs $o.oo $0.00 $0.00 - ,. ~ , t. , _ . .. . . . ~. ,._ . ~ ~ ~., , _ .. ~ . ,...._ ourse . _ ~, _ ~ree~ _ . TOTAL DIRECT COSL• $47,875.93 $0.00 $0.00 t ~ a. ~ ~__ ,.. INDIRECT COSTS: 2% Of Contractual $1,043.60 $20.87 INDIRECT COSTS: 10°!o Of AllOther $46,832.33 $4,683.23 INDIRECT COSTS: 0% Other $0.00 Total Indirect Cost (Calculated on Amount Requested from CDPH E Only) $4,704.10 TOTAL AMOUNT REQUESTED FROM CDPHE $ ~ 5z,5so $0.00 $0.00 *Other: Please indicate additional funding sources 'rf applicable. ofAuthorized Representative Rev. 1 Date 2 r TERM SHEET 1) Requested hearing date: (First choice)_6/2/2009__ (Second choice) 6/9/2009 2) For Countv Manager signature: NO 3) Requestin~ department: Public Health 4) Title: Colorado Department of Public Health and Environment Tobacco, Education, Prevention and Cessation Grant Program Task Order Contract Task Order Contract - Waiver #154 pursuant to Master Contract made on O1/23/2007. Contract Routing Number 10 FLA 00142 5) Check one: Consent: X On the Record: 6) Staff submitting: Becky Larson 7) Purpose: This Task Order provides funds for Eagle County Department of Public Health's Health Educator to conduct activities under the project Tobacco Free Eagle County to prevent youth from using tobacco, reduce tobacco use, help people who use tobacco to quit, assist in the reduction of exposure to secondhand smoke and reduce tobacco use among groups that are disproportionately affected and/or at high risk for disease. 8) Schedule: The task order is for the time period July l, 2009 - June 30, 2010. 9) Financial considerations: This Task Order is for a total of $52,610 during state fiscal year 2010. A monthly invoice must be submitted to CDPHE to receive compensation under this Contract. This amount has been fully budgeted. 9) Other: RECEIVED MAY 2 6 2009 EAGLE COUN'fY ATTORNEY ~ '~~ ~~ARM By~ __~-~-°_w~.~:..~~ ~~~1e' ~~y3~~r A,~t'~:~Y's Qfflce B~ ~ ~~l~!.~~!~~~Y '~~P~~1A!l~ner's' Offlce ;~ c~ ~ ~ ~ ~~~~ ~ 1-~ ~ ~~ ~ ~ ~ ~ ~ ~ bI~ ~ ~ ~~'f Please return executed contract and copies to Kym Iglesias in HHS. 970-328-8847.