HomeMy WebLinkAboutC10-159 Colorado Family Planning Initiative Rtg 11-15888DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD-CFPI
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
11-15888
AMENDMENT FOR TASK ORllERS #4
This Amendment is made this 1st day of March, 2010, 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,
BOARD OF COUNTY COMMISSIONERS OF EAGLE COUNTY, whose principle place of business is 500
Broadway, Eagle, Colorado 81631 for the use and benefit of the EAGLE COUNTY PUBLIC HEALTH
AGENCY , (a political subdivision of the state of Colorado), whose address or principal place of business is 551
Broadway, Eagle, Colorado 81631, hereinafter referred to as the "Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract, dated January 23, 2007, with contract routing number 08 FLA 00016.
Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated
August 15, 2008, with contract encumbrance number PO FLA FPP0900663, and contract routing number 09-FLA-
00663, as amended by Contract Amendment #1, contract routing number 09-FLA-00854, Contract Amendment #2,
contract routing number 10-FLA-00227, Contract Amendment #3, contract routing number 10-FLA-9455 and Grant
Funding Letter #2, contract routing number 10-FLA-13357 collectively referred to herein as the "Original Task
Order Contract, whereby the Contractor was to provide to the State the following:
Contractor will provide a comprehensive family planning program with an emphasis on
increasing the total number of men and women accessing services and increasing utilization
of long acting reversible methods of contraception (LARC) among existing clients.
The State promises to pay the Contractor the sum of Sixty-One Thousand Five Hundred Dollars, ($61,500.00) 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 12 months, ending on June 30, 2011.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree
as follows:
Consideration for this Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Amendment, and promises and agreements herein set forth.
It is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order
Contract, contract routing number 09-FLA-00663, as amended by Contract Amendment #1 contract
routing number 09-FLA-00854, Contract Amendment #2, contract routing number 10-FLA-00227,
Contract Amendment #3, contract routing number 10-FLA-9455 and Grant Funding Letter #2, contract
routing number 10-FLA-13357 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 Amendment 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 modified,
altered, and changed in the following respects only:
Page 1 of 1
Rev 3/16/2010
~~~ ~~~~~
A. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified
by contract routing cumber 09 FLA 00663. This Amendment is for the renewal term of Ju1y 1,
2010, through and including June 30, 2011. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Sixty-One Thousand Five
Hundred Dollars, ($61,500.00) for an amended total financial obligation of the State of TWO
HUNDRED TWENTY-NINE THOUSAND FIVE HUNDRED SEVENTY-EIGHT
DOLLARS, ($229,578.00). This is an increase of Sixty-One Thousand Five Hundred Dollars,
($61,500.00) of the amount payable from the previous term. The revised Additional Provisions
and Statement of Work is incorporated herein by this reference and identified as "Exhibit J" and
"Exhibit K".
The Original Task Order Contract is moditied accordingly. All other terms and conditions of the Original
Task Order Contract are reaffii7ned.
4. The effective date of this Amendment is July 1, 2010, or upon approval of the State Controller, 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 Amendment and any of the ternis and provisions of
the Original Task Order Contract, the terms and provisions of this 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 2 of 2 Rev 3/16/2010
IN WITNESS WHEREOF, the parties hereto have executed this 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.
CONTRACTOR: STATE:
BOARD OF COUNTY COMMISSIONERS OF STATE OF COLORADO
EAGLE COUNTY for the use and benefit of Bill Ritter, Jr. Governor
EAGLE COUNTY PUBLIC HEALTH AGENCY
(a political subdivision of the state of Colorado)
179/(44 By:
Signature dFAuthorized Officer For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
/AO t- AND ENVIRONMENT
Print Name of Authorized Officer
C/InCam M
Print Title of Authorized Officer
PROGRAM APPROVAL:
By: I/A
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.
ATE CONTROLLER
1 , 'd J. McDer ott, ' A
B ! �
By:
Date:
Page 3 of 3 Rev 3/16/2010
EXHIBI"f .I
ADDITIONAL PROVISIONS
To Contract Dated 03/01/2010 -Contract Routing Number 11 FLA 15888
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified
above.
The revised Additional Provisions are effective July 1, 2010.
1. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination. The State
has determined that this contract does not constitute a Business Associate relationship under HIPAA.
2. To receive compensation under this Task Order Contract, the Contractor shall submit a signed Monthly
Colorado Family Planning Initiative (CFPI) Cost Reimbursement Statement in a format acceptable to the
State. A CFPI Cost Reimbursement Statement is incorporated and made part hereof by reference. This
document is located at:
http://www.cdphe.state.co.us/pp/womens/FPNursin~ConsntsForms.html?colt=open. A Cost
Reimbursement Statement must be submitted within sixty (60) calendar days of the end of the billing
period for which services were rendered. CFPI Cost Reimbursement Statements must be accompanied by
detailed cost ledger to reflect all purchases being invoiced under that contract and should include date of
payment, payee name and amount, and check or voucher number, when available. Expenditures shall be in
accordance with the Statement of Work attached hereto as Exhibit K and in accordance with allocable
expenses outlined in Cost Reimbursement Guidelines attached hereto as Attachment J-1. These items
may include, but are not limited to, the Contractor's salaries, fringe benefits, supplies, travel, operating,
administrative costs which are allowable, and other allocable expenses related to its performance under this
Task Order Contract.
CFPI Cost Reimbursement Statements shall: 1) reference this Task Order Contract by its contract routing
number, which 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; and, 5) 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.
CFPI Cost Reimbursement Statements shall be sent to:
Fiscal Officer
Family Planning Program
Prevention Services Division
Colorado Department of Public Health and Environment
PSD - A4
4300 Cherry Creek Drive South
Denver, CO 80246
Final billings under this Task Order Contract must be received by the State within a reasonable time after
the expiration or termination of this Task Order Contract; but in no event no later than sixty (60) calendar
days from the effective expiration or termination date of this Task Order Contract.
The Contractor is authorized to make limited transfers of funds from one line item in its Budget to another
line item in its Budget but must notify the Program Director by email prior to the transfer. A transfer from
one line item to another line item may not exceed ten percent (10%) or One Thousand Dollars ($1000),
which ever amount is more, of the total amount of the line item from which the transfer is made unless
prior written approval is received from the Program Director. If the Contractor desires to transfer more
than ten percent (10%) or One Thousand Dollars ($1000), which ever amount is more, from one line item
in its budget to another line item in its budget then the Contractor shall request and receive prior written
approval from the Program Director by completing and submitting a Budget Revision Request Form,
To be attached to CDPHE Page 1 of 3 Revised: 4/1/04
Version 1.0 (4/04) contract template
EXHIBIT J
incorporated and made part hereof by reference. This document is located at:
http://www.cdphe.state.co.us/pt~/womens/FPNursin~?ConsntsForms.html?colt=open.
The services or activities under this Contract may be carried out by the Contractor, or through subcontracts
with other providers or, through collaborative partnerships with other community partners. The State
authorizes the Contractor to subcontract some, or all, or the services that are to be performed under this
Contract. However, a subcontractor is subject to all of the terms and conditions of this Contract.
Additionally, the contractor remains ultimately responsible for the timely and satisfactory completion of all
work performed by any subcontractor(s) under this Contract. If the Contractor desires to subcontract some,
or all, of the services that are to be performed under this Contract, the Contractor shall obtain the prior,
express, written consent of the State before entering into any subcontract. The Contractor shall maintain, at
a minimum a Memorandum of Understanding or other binding contractual agreement, and provide a copy
to the Family Planning Program Director fifteen (15) calendar days from the date the agreement is
executed. The Contractor shall maintain records of any subcontractors for a minimum of three years.
6. Contractor agrees to provide services to all Program participants and employees in a smoke-free
environment in accordance with Public Law 103-227, also known as "the Pro-Children Act of 1994", (Act).
Public Law 103-227 requires that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or regularly for the provision of health, day care,
early childhood development services, education or library services to children under the age of 18, if the
services are funded by Federal programs either directly or through State or local governments, by Federal
grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in
indoor facilities that are constructed, operated, or maintained with such Federal funds. The law does not
apply to children's services provided in private residences; portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or
Medicaid; or facilities where Women Infant and Children (WIC) coupons are redeemed. Failure to comply
with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty of up to
$1,000 for each violation and/or the imposition of an administrative compliance order on the responsible
entity. By signing this Contract, the Contractor certifies that the Contractor will comply with the
requirements of the Act and will not allow smoking within any portion of any indoor facility used for the
provision of services for children as defined by the Act. The Contractor agrees that it will require that the
language of the Act be included in any subcontracts which contain provisions for children's services and
that all contractors shall sign and agree accordingly.
Contractor shall ensure that the provisions of Section 601 of Title VI of the Civil Rights Act of 1964 are
carried out. That Act states that "no person in the United States shall on the ground of race, color, or
national origin, be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Federal financial assistance." The Office of Civil
Rights has concluded that it is the responsibility of any program which is a recipient of funds from the
Department of Health and Human Services to ensure that clients who do not speak or understand English
well, be provided interpretation services to ensure that the service provider and the client can communicate
effectively. The Contractor shall have policies and procedures to ensure that interpretation services are
available for clients with Limited English Proficiency and will advise such clients that an interpreter will be
provided for them. If a client has their own interpreter, they shall be advised that the Contractor will
provide an interpreter if the client so chooses.
8. The State may require forms attached to this contract and incorporated herein by reference by updated
during the term of this contract. The Contractor will be informed of the new forms as they are developed.
Forms may be sent to contractors or will be available on the Family Planning Administrative Manual
website: http://www.cdphe.state.co.tis/pp/womens/famplan.html.
9. Notwithstanding anything herein to the contrary, the parties understand and agree that all terms and
conditions of this Task Order Contract and the exhibits and attachments hereto which may require
continued performance, compliance or effect beyond the termination date of this Task Order Contract shall
survive such termination date and shall be enforceable by the State as provided herein in the event of such
failure to perform or comply by the Contractor.
To be attached to CDPHE Page 2 of 3 Revised: 4/1/04
Version 1.0 (4/04) contract template
EXFI I131T .J
Funding adjustments may be made during the term of this contract. The State makes funding adjustments
on this contract using a Funding Letter substantially equivalent to Exhibit D of Original Contract and
bearing the approval of the State Controller or his designee; the fimding letter shall not be deemed valid
until the State Controller or his designee has approved it.
To be attached to CDPHE Page 3 of 3 Revised: 4/1/04
Version 1.0 (4/04) contract template
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EXHIBIT K
STATEMENT OF WORK
To Contract Dated 03/01/2010 -Contract Routing Number 11 FLA 15888
1) The Contractor, in accordance with the terms and conditions of this contract, shall perform and complete, in a
timely and satisfactory manner, all activities described in this approved Statement of Work and incorporated in
accordance with the associated COLORADO FAMILY PLANNING INIATIVE BUDGET and
COLORADO FAMILY PLANNING INIATIVE BUDGET NARRATIVE, which is attached hereto as
Attachment K-1 and Attachment K-2.
2) The Contractor shall continue to conduct a comprehensive family planning program ("the program"). This
program shall comply with section 1001 of the federal Act and all applicable federal regulations, as amended,
contained in Title X, 42 C.F.R., Subpart A, Part 59, as well as all applicable state regulations. (Federal funding
from HHS, CFDA #93.217 FP Services). The program shall offer the following under the Title X family
planning program:
A. Outreach services and/or other program efforts designed to improve client recruitment.
B. Nursing and medical services, which shall include a comprehensive health and social history and
physical examination administered in accordance with all applicable Title X regulations and, all
applicable nursing-medical policies or procedures which have been, or may be, established by the
State's Women's Health Unit (WHU).
C. Contraceptive information, education, and supplies regarding all family planning methods.
D. Education and counseling services regarding family planning, family planning methods, child
spacing, infertility, sterilization, nutrition, sexually transmitted diseases, Human immunodeficiency
virus (HIV)/ Acquired immunodeficieny syndrome (AIDS), adolescent counseling and other related
health issues, as outlined in the Nursing and Administrative Manual.
E. Follow-up and/or referral services, as appropriate.
3) All money received by the Contractor from the State under the Colorado Family Planning Initiative (CFPI) shall
be used by the Contractor to provide contraceptive services. The Contractor shall make its program available to
men and women in their reproductive years and shall offer the following services under the CFPI:
A. Utilize CFPI funding to purchase long acting reversible methods of contraception and contraceptive
rings. These are limited to Intrauterine Devices (IUD) Mirena and Paraguard, contraceptive implants and
contraceptive rings.
B. Utilize CFPI funding to provide the referral process and cover the actual costs of tubal ligation and
vasectomy procedures.
C. Utilize CFPI funding for Family Planning staff to attend reproductive health related training with
preference to those related to long acting reversible methods of contraception.
4) The services provided by the Contractor to the clients it serves shall be performed pursuant to law in accordance
with prevailing medical standard of care for the same or similar medical, nursing and professional services. The
services provided shall also comply with applicable Title X regulations, WHUnnrsing-medical policies and
procedures, and any applicable fiscal or administrative policies of the State or Federal government which can be
located at http•//www cdphe state co us/pp/womens/fvnplan htmhcol2=open. Contractor acknowledges that it
has reviewed these policies and procedures.
To be attached to CDPHE Page 1 of 3 Revised: 4/1/04
Version 1.0 (4/04) contract template
EXHIBIT K
5) The Contractor shall provide the State's family planning program consultants and administrators with
reasonable access to its operations to perform: periodic site reviews, data reviews, fiscal reviews or other
evaluations of the Contractor's family planning program. Evaluations of the Contractor's program shall be
based on established standards and policies of the State or the Federal government. The Contractor shall
cooperate during all periodic site visits, data reviews, fiscal reviews or other evaluations conducted by the State.
The established standards and policies for the Family Planning Program can be located in the Family Planning
Administrative Manual and the Family Planning Nursing Manual located on the Family Planning website at
http•//www cdphe state co us/pp/womens/famplan html.
6) If necessary, the Contractor shall comply with all reconm~endations, including development and implementation
of a Performance Improvement Plan, made by the State's family planning program consultants and/or
administrators after a periodic site visit, data review, fiscal review or other evaluations that are necessary to
bring its program into compliance with all program requirements and applicable federal and state laws, policies
and regulations. The Contractor shall be in full compliance with a recommendation, if any, within three (3)
months of the date a recommendation is made by the State. If the Contractor camiot obtain full compliance
within this three (3) month period, then on or before the expiration date of that three (3) month period the
Contractor shall present sufficient written evidence to the State: to show that continuing progress is being made
towards full compliance; and, the date when full compliance shall occur. In no event, however, shall full
compliance with a recommendation occur any later than six (6) months after the date that a recommendation
was initially made by the State. Notwithstanding the foregoing provisions, the State may disregard these cure
periods and immediately terminate the.contract without liability if it has solely determined that Contractor's
noncompliance places the health, safety or welfare of persons receiving services in jeopardy.
7) On a monthly basis, the Contractor shall collect and provide to the State, by the fifteenth calendar day of the
following month unless otherwise specified by CDPHE, all pertinent data as defined by CDPHE regarding all
services offered, and all family planning clients served, by its program during the preceding month, submitted
through the IRIS data system. This data shall be verified on a quarterly basis to help assure accuracy. The
Contractor must adhere to the Data Security, Use and Confidentiality Agreement, incorporated and made part
hereof by reference. This document is located at:
http•//www cdphe state co us/per/womens/FPNursin~ConsntsForms htmhcol2=open. Contractor also agrees to
respond to other data requests required by the program.
8) During the term of this Contract, the Contractor agrees to provide the State with the semi-annual Family
Planning Expenditure/Revenue Reports. The Expendihire/Revenue Report (ERR) is located on pages 19-21 in
the Financial Management Section of the Family Planning Administrative Manual, this information can also be
accessed online on the CDPHE Family Planning website at
httu://www.cduhe.state.co.us/pp/womens/famplan.html. The first report is for the months of October through
December will be due in February. January through June and will be due in August. Final due dates will be
specified by CDPHE.
9) The Contractor shall protect the confidentiality of all client records and other u~aterials that are obtained,
created, or maintained by the Contractor under this contract. Except for purposes directly related to the
administration of this contract, no information about, or obtained from, any client shall be disclosed by the
Contractor in any form that would identify that client without the prior written consent of that client. As of the
acceptance date of this contract by the Contractor, the Contractor shall have written policies governing the
access to and, the duplication and dissemination of, all such information. The Contractor shall advise its
directors, officers, employees, agents, servants, and subcontractors, if any, that they are subject to these
confidentiality requirements.
10) Maintenance of Effort (MOE)
Colorado Family Planning Initiative funding is expected to provide new funding for providing services to
additional family planning clients and increasing the total number of clients utilizing efficacious methods of
contraception. This is a temporary funding source, and therefore shall not be used to supplant other traditional
funding sources. Therefore, the contractor shall show Maintenance of Effort (MOE) for revenue provided by
local government as documented on the required family planning program Expenditure Revenue Reports
To be attached to CDPHE Page 2 of 3 Revised: 4/1/04
Version 1.0 (4/04) contract template
EXHIBIT K
(ERR), for the three years previous to any year in which funding from the Colorado Family Planning Initiative
is received. This revenue, provided by local government (county and city grants and contracts) shall be equal to,
or in excess of, 90% of the average of the last 3 year's Expenditure Revenue Reports.
Definition:
Maintenance of Effort (MOE) - A measure intended to preserve funding for the base program. This ensures that
fiscal resources are not supplanted and that new funding creates an expansion in the program. MOE shall be
determined by averaging the revenue provided by local government in the last 3 years' Expenditure/Revenue
Reports (ERR) for the entity's family planning program, and then multiplying by ninety percent (90%). The
result is the minimum amount that the entity must spend in order to illustrate MOE. In an instance where there
is not three years' data, MOE shall be 90% of previous two years' local government revenues from the ERR, or
95% of the last year's results, as applicable. In the case of an anomaly where local government revenue level
from the previous three years' ERR varies more than 30% in any two of the three years, an explanation of the
variance must be provided by the Contractor. The Family Planning Director shall use this information to decide
if the anomaly should be eliminated from the calculation of the MOE level.
In any year in which the Contractor will not attain MOE, according to the forniula described in the definition
the Contractor shall notify the Family Planning Director.
Should MOE not be obtained, in special hardship cases, a Maintenance of Effort Waiver to this clause may be
requested Isom the CDPHE Family Planning Director, in conjunction with the Women's Health Director,
attached hereto as Attachment B-2 of Original Contract. Should a Maintenance of Effort Waiver not be
granted, the Colorado Family Planning Initiative funding may be reduced.
11. The services provided by the Contractor must be deemed acceptable, in good faith, by WH. For a service to be
"acceptable" it must comply with all applicable: Title X regulations, WH nursing-medical policies and
procedures, and any applicable fiscal and administrative policies and procedures of the State and Federal
government. All applicable Title X regulations, WH nursing-medical policies and procedures, and all
applicable fiscal or administrative policies of the State have been provided to the Contractor by the State as of
the effective date of this Contract.
12. During the term of this Contract, the Contractor agrees to provide the State with quarterly reports to the Family
Planning Program Coordinator.
13. The Contractor shall require any new staff working on Family Planning program services to participate in Fiscal
Orientation within forty-five (45) days of employment.
To be attached to CDPHE Page 3 of 3 Revised: 4/1/04
Version 1.0 (4/04) contract template
COLORADO FAMILY PLANNING INIATIVE BUDGET
Attachment K-~
APPLICANT: i Eagle Comity Public Health Agency
_ -_ -
- _
FOR THE BUDGET PERIOD: CFPI Jul 1, 2010 -June 30, 2011
y - - - --- __...--
Salary
'%n Time
CDPHE-WHU
CDPHE-WHU
CDPHE-WHU
NON-CDPHE
TOTALS - _
SEE ABOVF.
Family Planning ---
JIVE 30, 2010 - - - -
JUNE 30, 2010 FOR BUDGET JULY 1, 2010 - program Funding _ JUNE 30
PLEASE ROUND ALL FIGURES
JUNE 29, 2011
PERIODS BY
JUNE 30, 2(II I
JULY i
2(110 - ,
TO THE NEAREST DOLLAR
_---- FTE
-- --___ - __-- ,
.Ir^vF gin. znln 2011
FEDERAL FEDERAL & CDPHE PLUS
TITLE X STATE TITLE X CFPI NON-CDPHE NON_CDPHE
PERSONNEL EXPENSES: (include name
S title for each employee charged to CDPHE
IimJine. You do not need to list the name and title
tin employees charged only to Non-CDPHE fundutg) 5(1
Tamm ~ Brunk, FP Coordinator
$55,010
100%
$47,505
$37,505
535,010 _ _
Clinic Assistant $35,340 70% '
$_4,373 ~
S_4,373 -- -
Clinic Assistant $36,400 30% S 10,920 $10,920
Nurse Mana er $73,507 10% 57,351 $7,351
$0 --
$0
$47,505
l:V1V77G4CIUAL: (htdependent contractor for tuba) ligation, Essure, vasecromy,
physicians, nurse practitioners, etc. In CFPI portion ONLY, add referral fee in [his section.
SO
Rocky Mountain Urology- Vasectomy '24 procedures
S I (1,'1111
S 16,200 _
Essure Contractor TBD 10 procedures 526.00(1 $26,000
Medical Officer I 1 yews contract ~
$6,575
$6,575 _____
- ---
Total Contractual'Ex enses $0 $0 $42?00 56,575 $48,775
OPERATING:
$0 _
I ontracephve et me s or pornon i o a nun ee can e
.included in this line.)
$17,500
'$20,000
$37,800
Training costs -which includes registration fens, travel $ 1,50(1 $921 $2,421
Chlamydia tau (If you d° not use the state lab, please make sure this line
'.equals or exceeds the amount listed on your FY?011 Estimated Funding
worksheet for Chlamydia)
$2,000
$2,000
:Other Lab tests $7,000 $7,000
Edura[ional materials (brochures, etc)
$550
$550 _ __ _
~~Clmical supplies ' $569 $569
~Afflce opendingsu Iles ( apers, charts, pens, etc) ~ $0
Oftioe expense (rent, utilities, maunenance) $0
OTHER (Specify) $0
$0
1,5001 $117
AD~IINISTLL4TIVE (10%CFf'1 Expansion Grant. Do NOT calculate the ~
10% admin rate on one-time cxpcnes, conttaeeptive nrethods, training, or
Page 1
COLORADO FAMILY PLANNING INIATIVE BUDGET NARRATIVE
Attachment K-2
BUDGET NARRATIVE
~V11 f GPI Ao~.~,i.~,- f_r~.,* ..,;+h G't..,.,.,~;.,» !'!.-~.,+:F.,,...1;...,hl~
APPLICANT: Eagle County Public Health Agency
FOR THE PERIOD: July 1, 2010 -June 30, 2011
For Personnel category list title of
position
How is the total amount required
Relationship to project Total
For all other categories list the line calculated?
item from the budget
Rocky Mountain Urology Provide vasectomy services Contract is for 24 procedures ~ $16,200.00
Contractor TBD Provide Essure services Contract is for ] 0 procedures ~26.000.00~
Conh~aceptive Methods - LARC ~ ~ ~ $17,800.00
Training FP Coordinator training In-state training $1,500.00
TIME EXP)/1~~SES:
Page 1
