HomeMy WebLinkAboutC11-147 Nurse Home Visitor Program (12-FLA-29889) DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD-NH VP
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
12 -29889
AMENDMENT FOR TASK ORDERS #3
This Amendment is made this 20th day of April, 2011, 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, 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, CO 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 FAA 00016 .
Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated
May 25, 2007, with contract encumbrance number PO FLA FHS09000003, and contract routing number 09 -FLA-
00003, as amended by Funding Letter #1, contract routing number 09 -FLA- 00935, Contract Amendment #1,
contract routing number 10- FLA- 00003, Grant Funding Change Letter #2, contract routing number 10 -FLA- 13531,
Amendment for Task Order #2, contract routing number 11 -FLA- 15817, and Grant Funding Change Letter #3,
contract routing number 11 -FLA- 29802, collectively referred to herein as the "Original Task Order Contract,
whereby the Contractor was to provide to the State the following:
Contractor is to provide nurse home visitor services to low- income, first -time mothers in the
state of Colorado.
The State promises to pay the Contractor the sum of Three Hundred Five Thousand and Forty -Four Dollars,
($305,044.00) 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, 2012.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree
as follows:
1. 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.
2. It is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order
Contract, contract routing number 09 -FLA- 00003, as amended by Funding Letter #1, contract routing
number 09 -FLA- 00935, Contract Amendment #1, contract routing number 10 -FLA- 00003, Grant
Funding Change Letter #2, contract routing number 10- FLA - 13531, Amendment for Task Order #2,
contract routing number 11 -FLA- 15817, and Grant Funding Change Letter #3, contract routing number
11 -FLA- 29802, collectively referred to herein as the "Original Task Order 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.
Page 1 of 5 Rev 3/16/2010
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:
A. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified
by contract routing number 09 -FLA- 00003. This Amendment is for the renewal term of July 1,
2011, through and including June 30, 2012. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Three Hundred Five
Thousand and Forty-Four Dollars, ($305,044.00) for an amended total financial obligation of
the State of ONE MILLION, ONE HUNDRED FIFTY -SIX THOUSAND AND NINETY -
ONE DOLLARS, ($1,156,091.00). This is an increase of Three Hundred Five Thousand and
Forty-Four Dollars ($305,044.00) of the amount payable from the previous term. The revised
Additional Provisions is incorporated herein by this reference and identified as "Exhibit I ". The
revised Statement of Work is incorporated herein by this reference and identified as "Exhibit J ".
The revised Budget is incorporated herein by this reference and identified as "Exhibit K ".
The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original
Task Order Contract are reaffirmed.
4. The effective date of this Amendment is July 1, 2011, 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 Amendment and any of the terms 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.
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.
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Page 3 of 5 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 the John w. Hickenlooper, Governor
EAGLE COUNTY PUBLIC HEALTH AGENCY
(a political subdivision of the state of Colorado)
,'e . \� B ? v t--
Si ure of Author'' Offi For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
MIL It ■ ..i ■
Print Name of Authorized officer
CAM. i
Print Title of Authorized Officer
PROGRAM APPROVAL:
/
By: / h ...:
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 ,
vid J. McDermott, t ' A
I /
., _
By:
Date: ,S-1.)
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Page 5 of 5 Rev 3/16/2010
EXHIBIT I
ADDITIONAL PROVISIONS
To Task Order Contract Made 04/20/2011 - Contract Routing Number 12 FLA 29889
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
1. Health Insurance Portability and Accountability Act ( HIPAA) Business Associate Determination.
The State has determined that this Task Order Contract does not constitute a Business Associate
relationship under HIPAA.
2. This Task Order Contract is governed by those rules that were adopted by the state of Colorado's Board of
Health pursuant to section 25 -31 -104, C.R.S., as amended, incorporated herein by reference.
3. To receive compensation under this Task Order Contract, the Contractor shall submit a signed Monthly
Contract Reimbursement Statement in a format acceptable to the State. A sample Contract
Reimbursement Statement can be found on the website
http: / /www.cdphe. state .co.us /ps /nursehome /index.html, under the Fiscal tab, titled Contract
Reimbursement Statement, and incorporated herein by this reference. A Contract Reimbursement
Statement must be submitted within sixty (60) calendar days of the end of the billing period for which
services were rendered. Contract 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 J. 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.
Contract 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; 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. Contract Reimbursement Statements shall be sent to:
Fiscal Officer
Nurse Home Visiting Program (NHVP)
Prevention Services Division
Colorado Department of Public Health and Environment
PSD - A4
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 time after the period for which payment is requested, but in no event no later than
sixty (60) calendar days after the relevant performance period has passed. 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.
Unless otherwise provided for in this Task Order Contract, "Other Funding Sources ", if any, shall be
included on all billing statements as required by the funding source.
To be attached to CDPHE Page 1 of 3 Revised: 12/19/06
Task Order v1.0 (11/05) contract template
EXHIBIT I
The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
4. 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 Nurse Home Visitor 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), whichever is less, of the total amount of the line item from which the transfer is
made unless prior written approval is received from the Nurse Home Visitor Program Director. If the
Contractor desires to transfer more than ten percent (10 %) 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 Nurse Home
Visitor Program Director by completing and submitting a NHVP Budget Revision Request Form before
the transfer can be made. This form is located on the website
http: / /www.cdphe. state .co.us /ps /nursehome /index.html, under the Fiscal tab, and is incorporated herein by
reference,.
5. The 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, Infants 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 Task Order Contract, the Contractor certifies that the Contractor shall
comply with the requirements of the Act and shall 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
shall 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.
6. The Contractor certifies, to the best of its knowledge and belief, that no federally appropriated funds have
been paid or shall be paid by or on behalf of the Contractor, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with the awarding of this Task Order
Contract, and the extension, continuation, renewal, amendment, or modification of this Task Order
Contract, or any grant, loan, or other cooperative agreement that utilizes Federal funds. If any funds other
than federally appropriated funds have been paid or shall be paid to any person for influencing or
attempting to influence an officer or employee of any agency, Member of Congress, an officer or employee
of Congress in connection with this Task Order Contract, or any other grant, loan, or other cooperative
agreement, then the Contractor shall complete and submit Standard Form - LLL, "Disclosure Form to
Report Lobbying" in accordance with its instructions. The Contractor shall require that the language of this
certification be included in the award documents for subawards at all tiers (including subcontracts,
subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly. This certification is a material representation of fact upon which reliance
was placed when this transaction was made or entered into. This certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
7. 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
To be attached to CDPHE Page 2 of 3 Revised: 12/19/06
Task Order v1.0 (11/05) contract template
EXHIBIT I
n termination date o is Task Order Contract shall
performance, compliance or effect beyond the t i t� d t f this O d C t t all h
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.
9. The Contractor shall protect the confidentiality of all applicant or recipient records and other materials that
are maintained in accordance with this Task Order Contract. Except for purposes directly connected with
the administration of this Task Order Contract, no information about or obtained from, any applicant or
recipient shall be disclosed in a form identifiable with the applicant or recipient without the prior written
consent of the applicant or recipient, or the parent or legal guardian of a minor applicant or recipient with
the exception of information protected by Colorado statute as it applies to confidentiality for adolescent
services in which case the adolescent minor and not the parent or legal guardian must provide consent or, as
otherwise properly ordered by a court of competent jurisdiction. The Contractor shall have written policies
governing the access to, and duplication and dissemination of, all such information. The Contractor shall
advise its employees, agents, servants, and subcontractors, if any, that they are subject to these
confidentiality requirements.
10. Under this Task Order Contract, the Contractor shall refer families participating in any and all programs in
its agency such as WIC, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Immunization
Clinics, Family Planning, HCP, Prenatal Plus (PNP), etc. to appropriate enabling and direct care service
programs in the community. All pregnant women in need of resources for prenatal medical care are
provided with information about programs such as WIC, PNP, etc. as needed; provide all individuals
seeking reproductive health services with information about pregnancy planning, the consequences of
unintended pregnancies, and, referrals to comprehensive family planning services; and all children ages
birth through two years who may be eligible for early intervention services are referred to Early
Intervention Colorado.
11. 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 actively 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 shall advise such clients that an interpreter shall
be provided for them. If a client has their own interpreter, they shall be advised that the Contractor shall
provide an interpreter if the client so chooses.
12. 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 Nurse Home Visitor 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.
To be attached to CDPHE Page 3 of 3 Revised: 12/19/06
Task Order v1.0 (11/05) contract template
EXHIBIT J
•
STATEMENT OF WORK
To Task Order Contract Made 04/20/11 - Contract Routing Number 12 FLA 29889
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above.
Introduction
In order to implement the Nurse Home Visitor Program (NHVP) efficiently and effectively and to promote the
successful partnerships between state public entities and the private sector, responsibility for the program is
divided between the Colorado Department of Public Health and Environment, which is responsible for financial
administration of the program, and the University of Colorado at Denver Anschutz Medical Campus (the Health
Sciences Facility) which is responsible for programmatic and clinical support, evaluation, and monitoring for
the program.
Contractor responsibilities to CDPHE:
1. 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 activities and
services related to the fiscal management of the Colorado Nurse Home Visitor Program. The fiscal
management provided by the contractor for the program must be deemed by the state to be acceptable
and in good faith. For fiscal management to be "acceptable" it must comply with all, but not limited
to, the items listed below, which are incorporated and made part hereof by reference. These
documents are located at: http: / /www.cdphe. state .co.us /ps /nursehome /index.html
• Colorado Nurse Home Visitor Program Act, as described in § 25 -31 -101, C.R.S.
• Senate Bill 10 -073
• NHVP Grantee Fiscal Requirements
• Rules Concerning the Nurse Home Visitor Program
• Medicaid Reimbursement Guidelines
2. The Contractor shall submit the following reports, when requested and by the indicated due dates,
incorporated by reference. These documents are located at:
http://www.cdphe.state.co.us/ps/nursehome/index.html
• Expenditure Year -to -Date / Mid -Year Projections Report
• Final Expenditure Report
3. The Contractor shall complete in a satisfactory manner and by the indicated date, all activities stated
in the "Areas Requiring Performance Improvement Plan or Funding Conditions" in the NHVP
Application Review Summary letter which is incorporated and made part hereof by reference.
4. The Contractor shall participate in meetings or trainings as requested by the State, and the Contractor
must cover all costs as applicable.
5. The Contractor shall provide the nurse home visitor services in accordance with the Application
Review Summary and the FY2012 Proposed Budget, Exhibit K.
6. Funding adjustments may be made during the term of this contract. Grant awards are made using
NHVP funding and Medicaid reimbursement estimates. The total amount of funding for the term of
this contract may not exceed the Total Amount Requested from the CDPHE as provided in the FY2012
Proposed Budget, Exhibit K. If the contractor draws more Medicaid funding, the state will reduce the
NHVP funding. Unless otherwise approved, overages of Medicaid funding in one fiscal year are
reconciled in the subsequent fiscal year. If the contractor draws less Medicaid funding the state may
increase the NHVP funding, if funding is available, during the Mid -Year Budget Projections process.
Page 1 of 2
EXHIBIT J
7. The State may increase or decrease funds available under this Contract using a Grant Funding Change
Letter substantially equivalent to Exhibit E of the original Contract. The Grant Funding Letter is not
valid until it has been approved by the State Controller or designee.
8. The Contractor shall submit Medicaid reimbursement requests for all eligible clients. Department of
Health Care Policy and Financing (HCPF) oversees the submission of Medicaid reimbursement
requests for compliance with HCPF procedures and the Medicaid Billing Manual. The Medicaid
Billing Manual can be accessed at http: / /www.cdphe. state .co.us /ps /nursehome /index.html
9. CDPHE will monitor the contract through documentation reviews, fiscal site visits, reports from the
Health Sciences Facility, and meetings with the contractor as necessary to ensure compliance with
fiscal requirements. The contractor shall provide reasonable access to financial documents and staff as
requested.
10. If the State believes in good faith that a fiscal activity or service fails to meet the standard for that
particular activity or service, or is otherwise deficient, then the State shall notify the Contractor of the
failure or deficiencies in writing. Corrective action shall be addressed through a Fiscal Action Plan or
some other method defined by the State. Due dates for completion of activities listed in an Fiscal
Action Plan will be negotiated on a case by case basis.
Page 2 of 2
Exhibit K
NHVP
FY2011 -12 Proposed Budget for the period of July 1, 2011 through June 30, 2012
EAGLE COUNTY HEALTH & HUMAN SERVICES
Project Name: Nurse Home Visitation Program
TOTAL TOTAL
CDPHE AGENCY
FY 11/12 BUDGET FY11/12 FY11/12 •
July 1, 2011 to June 30, 2012 CONTRACT NHVP
BUDGET BUDGET
Annual No. of B +C A +B +C
Salary months A. Other '," i
Sources of &a �. (A +B +C)
Rate Budget FTE Funding "1
PERSONAL SERVICES (Detail Expenses) BUDGET
Personal Services (Title and Name)
80 80
Wehrer, Jennir $ 85,010 12 0.5 $15280 $27,214.80 $42,..- #$42505
Beveridge, LEA, $ 59,363 12 1 $59383 $88 - ' $59,353
Avila, Luz - Nu $ 59,363 12 1 $59,363 859 , 1 9 83 $89,863
Vasquez, Evel• $ 34,965 12 0.25 $8,741 $814'1 + "88, 741
•
$0
Agohia, Paul. $ 41,600 12 0.3 $1 2,480: 612,48Q 0 % 0 '1' 4 - 58,
.::
Kozusko, Julia $ 3,600 12 $3,600 $3,600 $3,600
$0 $0 80
Woods, Rile -( $ 88,670 12 0.1 $8,867 $8,867 $8,867
Fringe Benefits: Rate = Approwmatley 46.9% for CDPHE funding 583,917 883,91. '$83,91
1. TOTAL PERSONAL SERVICES 2.85 $0 318,280 $263,548.:: $278,838 $278,830
OPERATING (Detail Expenses) BUDGET
Office OP al r.�.s .'T z., < : ' �� $1 134 ::.
Client Su PPOrt ;.Y9:. 811l9+r4Y1- MEMO
Printing 8 Pub! ' , : . � , J,,,, --
Postal 8 Shipp $315 5315
Corn muncato, ,., $1200 $1200
Medicel6 ppl. -
OutsideServic @': :+ $16695 --
_ - -11111111111.0
2. TOTAL OPERATING :. $18,945 : $0 - $7,774 : 87,774 ':528,719
EQUIPMENT Detail Expenses _ BUDGET
- --
- --
3. TOTAL EQUIPMENT ` S$0 80 : $0 $0 $0
TRAVEL Detail Expenses BUDGET
• -- $1 9667 ME=
Now= mom =WM
NCAST Atliiki;W:+2 - --
ClIZEMIMMTOMPIXYANOMINDSV WINNE 111111•111 1111M111101111111111111117
- --
11111111111111M111=' 1111111= Mr=
--
P" "?: t ' . " _' -- =MEMO •1111EIMIIIIME=1
LIZEIMEffrtl' 11 ∎ ∎∎ 11111•11•11
Professoonal D 1 - +=y". -- ilIONINIEDME $1000
5. TOTAL TRAINING & TECH ASSISTANCE 80. ;:. $0 - $12,142 '$12,142 $12,142
NCAST COSTS Detail NCAST Trainin• & Materials BUDGET
I -•11111111111111-EIS
$0 $0
8. TOTAL NCAST COSTS $0 $0 $0 80 $0
OTHER COSTS Detail Other Pro• ram Costs BUDGET
TOTAL DIRECT PROGRAM COSTS Add bud • et cats. or': 1111111aww:11
ADMINSTRATIVE COSTS Detail Administrative Cosh --
r,.%• f ," "Y E - ;.' 11 117tit
01111111=1 C:11 r 111111111111FAII1111111111171
Board of Heal. ; 111111111111111ET
Other Adminot ,.,;: a j r]
TOTAL ADMINISTRATIVE COSTS = $4,816 $0 $0 $0. $4,875
TOTAL PROJECT COSTS (Direct Program +A. $23,620 81090 $305,044 $320,334 $343,954
TOTAL PROGRAM COSTS
TOTAL APPROVED BUDGET
DIFFERENCE /ADJUSTMENT
Specify "OTHER SOURCES" (cash or in -kind) front the column A. above.
Eagle County Government $21,120.00
Colorado Bright Beginnings $1,250.00
The Literacy Program $1,250.00
Total Other Sources 323,620.00
'Signature of 4 Gary Haddon, MPH Dote Date
'Signature of CDPHE Program Director: Date Date
'Signature of CDPHE Fiscal Officer: Date Date
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