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Home My WebLink AboutC12-334 Colorado Immunization Program, Pertussis Response Funding EAGLE COUNTY HEALTH AND HUMAN SERVICES Colorado Department of Public Health & Environment Pertussis Response Funding Scope of Work for Eagle County Public Health Agency I. Project description: This one -time PERTUSSIS RESPONSE Immunization funding is available for EAGLE COUNTY PUBLIC HEALTH AGENCY (LPHA) to provide community outreach and education through the media and /or printed material to address the recently declared pertussis epidemic in Colorado. This project also supports case investigation, clinical operations, and personnel needed to control the spread of the pertussis disease by educating and vaccinating the at -risk people in the region. This funding period is September 24, 2012 through December 31, 2012. II. Performance Requirement/Deliverables: A. The LPHA shall use this funding to support pertussis- related projects. These projects may include, but are not limited to, holding special vaccination clinics; creating/printing /purchasing informational print materials; investigating possible pertussis cases; providing personnel for these activities. B. The LPHA shall record all immunizations given in the Colorado Immunization Information System (CIIS) within a reasonable amount of time. C. The LPHA shall follow the Standards for Child and Adolescent Immunization Practices (CDC, 2006) to assure all populations have access to appropriate immunization services. D. OFFICE VISIT FEE: Contractors receiving these 2012 Pertussis Response Immunization Funds for LPHA agree to abstain from charging an office visit fee in addition to the allowable vaccine administration fee. E. The LPHA shall submit one (1) online progress report to the State. The link to the report form is: http: / /fs9.formsite. com/ ColoradolMMprogram /PertussisReport/index.html . This progress report is due within fifteen (15) calendar days of the end of the reporting period. The progress report shall document the LPHA's progress towards completion of the activities described herein. The LPHA's payment shall not be reimbursed by the State until the requisite progress report is submitted to the State by the LPHA. Reporting period and progress report due dates are as follows: Progress Period Due Date September 24 — December 31, 2012 January 15, 2013 III. Payment/Invoicing: In consideration of those services satisfactorily and timely performed by the LPHA under this Purchase Order, the State shall cause to be paid to the LPHA a sum not to exceed FIVE THOUSAND FOUR HUNDRED SEVENTY -EIGHT DOLLARS ($5,478.00). 551 Broadway 1 P.O. Box 660 1 Eagle, CO 81631 1 970.328.8840 n �,� 3 l � -t Of the total financial obligation of the State referenced above, $5,478.00 are identified as attributable to a funding source of the United States government (CFDA #93.268), and $0.00 are identified as attributable to a funding source of the state of Colorado. To receive compensation under this Purchase Order, the Contractor shall submit a signed CDPHE Reimbursement Invoice Form. This form is accessible from the CDPHE internet website http: / /www.cdphe. state. co. us /Standardizedlnvoice /index.html . CDPHE will provide technical assistance in accessing and completing the form. The CDPHE Reimbursement Invoice Form must be submitted within fifteen (15) calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work. All Counties, Local Public Health Agencies and select intergovernmental Contractors will undergo a financial risk assessment conducted by the CDPHE Financial Risk Management System. Until such assessment is completed and the Contractor has been notified of the results, the Contractor shall provide the following documentation with the completed invoice; none. This supporting documentation shall be submitted with the completed CDPHE Reimbursement Invoice Form and sent to: Lynn McCracken Colorado Department of Public Health and Environment DCEED- A3 -IMM 4300 Cherry Creek Drive South Denver, Colorado 80246 To be considered for payment, billings for payments pursuant to this Purchase Order must be received within a reasonable time after the period for which payment is requested, but in any event no later than fifteen (15) calendar days after the relevant performance period has passed. Final billings under this Purchase Order must be received by the State within a reasonable time after the expiration or termination of this Purchase Order; but in any event no later than fifteen (15) calendar days from the effective expiration or termination date of this Purchase Order. Unless otherwise provided for in this Purchase Order, "Local Match ", if any, shall be included on all invoices as required by funding source. The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. IV. Monitoring: CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout the purchase order period by the Program's Project Manager. Methods used will include review of documentation reflective of performance to include progress reports. V. Resolution of Non - Compliance: The Contractor will be notified by e -mail and /or telephone within thirty (30) calendar of discovery of a compliance issue. Within (30) calendar of discovery, the Contractor and the State will collaborate, when appropriate, to determine the action(s) necessary to rectify the compliance issue and determine when the action(s) must be completed. The action(s) and time line for completion will be documented by e -mail and agreed to by both parties. If extenuating circumstances arise that require an extension to the time line, the Contractor must e-mail a request to the Project Manager and receive approval for a new due date. The State will oversee the completion/implementation of the action(s) to ensure time lines are met and the issue(s) is resolved. If the Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may exercise its rights under the Terms and Conditions of this Purchase Order. Statement of Work Acceptance: PERTUSSIS RESPONSE FUNDS LOCAL COUNTY HEALTH AGENCY TOTAL FOR 2012 = $5,478.00 LOCAL PUBLIC HEALTH PARTNER ACCEPTANCE OF Colorado Department of Public Health and Environment Immunization Program Pertussis Response Immunization Funds for Local Public Health Agency Statement of Work REQUIREMENTS: I, ,p,/L , on behalf of o (print) CJ hereby acknowledge the requirements for the above -named Immunization Service Purchase Order have been reviewed, and are accepted and agreed to. I further acknowledge that I have the necessary authority to sign this acceptance on behalf of the entity mentioned above. 2- ik • 1/ €/ /v /O 2_ • ;tore Title Date