No preview available
HomeMy WebLinkAboutC13-162 Colorado Department of Public Health and Environment - Soy Sano!c pt .DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ADM -OHD DEPARTMENT OR AGENCY NUMBER FAA CONTRACT ROUTING NUMBER 14 -55256 AMENDMENT FOR TASK ORDERS #1 This Amendment is made this 10th day of April 2013 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 (a political subdivision of the state of Colorado), whose address or principal place of business is 500 Broadway, Eagle, Colorado 81631 -0850, for the use and benefit of the Eagle County Public Health Agency, 551 Broadway, Eagle, Colorado 81631, hereinafter referred to as the "Contractor ". FACTUAL RECITALS The parties entered into a Master Contract, dated January 17, 2012, with contract routing number 13 FAA 00016 Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated Aueust 31, 2012, with contract encumbrance number PO FAA ADM1348409 and contract routing number 13 FAA 48409, referred to herein as the "Original Task Order Contract, whereby the Contractor was to provide to the State the following: Develop the lSoy Sano! Project to promote nutrition, provide access to healthy food, and reduce obesity risk factors all for the purpose of decreasing cardiovascular disease. The State promises to increase the amount of funds to be paid to the Contractor by Two Hundred Fifteen Thousand Seven Hundred and Seventy -Six Dollars, ($215,776.00) for the renewal term of one year, ending on June 30, 2014, in exchange for the promise of the Contractor to perform the revised work described herein. 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 13 FAA 48409, 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: A. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number 13 FAA 48409 This Amendment is for the renewal term of July 1, 2013 through and including June 30, 2014 The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is Two Hundred Fifteen Thousand Seven Hundred and Seventy -Six Dollars, ($215:776.00) for an amended total Pagel of 4 Rev 3/16/2010 y IN financial obligation of the State of THREE HUNDRED FIFTY -SEVEN THOUSAND SIX HUNDRED AND FOUR DOLLARS, ($357,604.00). This is an increase of Two Hundred Fifteen Thousand Seven Hundred and Seventy -Six Dollars, ($215,776.00) of the amount payable from the previous term. The revised Additional Provisions is incorporated herein by this reference and identified as "Exhibit E ", the revised Statement of Work is incorporated herein by this reference and identified as "Exhibit F ".. The revised Budget is incorporated herein by this reference and identified as "Exhibit G ". 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, 2013 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. . Page 2 of 4 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 STATE OF COLORADO OF EAGLE COUNTY (a political subdivision John W. Hickenlooper, Governor of the state of Colorado) for the use and benefit of the . Eagle County Public Health Agency By: For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PROGRAM APPROVAL: By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS §24 -30 -202 requires 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 3 of 4 Rev 3/16/2010 Print Title of Authorized Officer This page left intentionally blank. Page 4 of 4 Rev 3/16/2010 f. EXHIBIT E ADDITIONAL PROVISIONS To Task Order Contract Dated 08/31/2012 - Contract Routing Number 13 FAA 48409 — Task Order Contract Amendment Routing Number 14 FAA 55256 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. The list of acronyms attached hereto as Attachment E -1 may be referenced to in Exhibit F, Exhibit G, and all and any attachments thereof in this Task Order Contract. This Task Order Contract contains state funds. 3. To receive compensation under this Task Order Contract, the Contractor shall submit a signed monthly, CDPHE Reimbursement Invoice Form. This form is accessible from the CDPHE internet website htip: / /www.colorado.gov /cs/ Satellite /CDPHE- Main/CBON/1251622941228 and is incorporated herein by reference. CDPHE will provide technical assistance in accessing and completing the form. The CDPHE Reimbursement Invoice Form 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 F and incorporated herein and the associated Budget attached hereto as Exhibit G and incorporated herein. All other expenditures shall not be reimbursed without prior written consent of the State. All expenditures must be reasonable and necessary for the performance of this Contract, and must comply with The State of Colorado, specifically the Colorado Department of Public Health and Environment, fiscal guidelines and rules. Submit completed CDPHE Reimbursement Invoice Form to: Colorado Department of Public Health and Environment Office of Health Disparities Program Coordinator ADM -OHD -C 1 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, "Local Match ", if any, shall be included on all invoices as required by funding source. 4. Time Limit For Acceptance Of Deliverables. a. Evaluation Period The State shall have thirty (30) 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. To be attached to CDPHE Page 1 of 3 Revised: 12/19/06 Task Order vl.0 (3/12) contract template EXHIBIT E 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 thirty (30) 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 failure 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. Time to Correct Defect Upon receipt of timely written notice of an objection to a completed 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 terminate this Task Order Contract or the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract. Health Insdrance 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 H1PAA. Contractor shall request prior approval in writing from the State for all modifications to the Statement of Work/Work Plan or for any modification to the direct costs in excess of twenty -five percent (25 %) of the total budget for direct costs. Any request for modifications to the Budget in excess of twenty-five percent (25 %) of the total budget for direct costs or $250,000.00, whichever is less, shall be submitted to the State at least 90 days prior to the end of the contract period and may require an amendment in accordance with Section 5 of this Task Order Contract. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in Data, Documents and Computer Software or Other Intellectual Property, or Section 23.i, General Provisions, Media or Public Announcements, 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 Task Order Contract. This requirement applies, but is not limited to, any brochure, flyer, presentation, billboard, radio spot, website, banner advertisement. The State reserves the right to require logos, or other wording on any material, representation, product or other media form created under this Task Order Contract. Any material, representation, product or other media form that will use the State's or logo or information must be approved by the State prior to production and distribution. A minimum of ten (10) business days is required for the review and approval process. Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of all media and materials developed by the Contractor under this Task Order, and shall have a non - commercial non - exclusive unlimited license to use such media and materials for its internal purposes and for research and publications, subject to the prior written approval of CDPHE, which approval will not be unreasonably withheld. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in Data, Documents and Computer Software or Other Intellectual Property, or Section 23.i, General Provisions, Media or Public Announcements, 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 Task Order Contract. This requirement applies, but is not limited to, any brochure, flyer, presentation, billboard, radio spot, website, banner advertisement. The State reserves the right to require logos, or other wording on any material, representation, product or other media form created under this Task Order Contract. To be attached to CDPHE Page 2 of 3 Revised: 12/19/06 Task Order v1.0 (3/12) contract template EXHIBIT E Any material, representation, product or other media form that will use the State's or logo or information must be approved by the State prior to production and distribution. A minimum of ten (10) business days is required for the review and approval process. 9. Funds provided under this Task Order Contract may not be used to: supplant funding for any existing programs /models; develop new cessation programs /models; develop curricula for youth or adults not reviewed and approved by the State pay for individual cessation aids or nicotine replacement therapy; fund capital improvements; or fund costs of enforcement of state or local laws and ordinances. 10. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 25, Conformance with Law, the Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act of 1964, as amended, which states that "no person in the United States shall on the grounds of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program actively receiving Federal financial assistance." The Office for Civil Rights has established that it is the responsibility of any program that is a recipient of federal funds to ensure that any Limited English Proficient (LEP) person or beneficiary have meaningful access to programs, services and information. The Contractor and contract personnel shall adopt and implement policies and procedures in which reasonable steps are taken to provide language assistance in order to ensure equal access to LEP persons or beneficiaries. The Contractor and contract personnel shall advise LEP individuals that language assistance will be provided at no cost to the LEP person or beneficiary. 11. The Contractor affirms that it maintains no affiliations or contractual relationships, direct or indirect, with tobacco companies, owners, affiliate, subsidiaries, holding companies or companies involved in any way in the production, processing, distribution, promotion, sales, or use of tobacco. 12. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be the owner of all equipment as defined by Federal Accounting Standards Advisory Board (FASAB) Generally Accepted Accounting Principles (GAAP) purchased under this Task Order Contract. At the end of the term of this Task Order Contract, the State shall approve the disposition of all equipment. 13. The Contractor shall not use funds provided under this Task Order Contract for the purpose of lobbying as defined in Colorado Revised Statutes (C.R. S.) 24- 6- 301(3.5)(a). To be attached to CDPHE Page 3 of 3 Revised: 12/19/06 Task Order vl .0 (3/12) contract template Attachment E -1 Commonly Used Acronyms and Abbreviations That May Be Referenced In the Scope of Work: ACS American Cancer Society ACNS Alamosa County Nursing Service ACF Administration for Children and Families ADA Americans with Disabilities Act ADAD Alcohol and Drug Abuse Division AHA American Heart Association AIDS Acquired Immune Deficiency Syndrome ALA American Lung Association ALA(C) American Lung Association (of Colorado) AMCHP Association of Maternal Child Health Programs ANR Americans for Non-Smokers' Rights ARC Addiction Recovery Centers ARRA American Recovery and Reinvestment Act ASC Adams State College ASSIST American Stop Smoking Intervention Study ASTHO Association of State and Territorial Health Office B &G Boys & Girls BACCHUS BACCHUS Peer Education Network BAG Build a Generation BBLHC Boulder Broomfield Latino Health Coalition BC Boulder County BCCP Breast and Cervical Cancer Program BCHD Bent County Health Dept BCPH Boulder County Public Health BCPHA Baca County Public Health Agency BCDSS Baca County Dept Social Services BCTEPP Bent County Tobacco Education Prevention Partnership BGC Boys & Girls Club BGCMD Boys & Girls of Metro Denver BHS Broomfield High School BMTF Baby & Me Tobacco Free BOCES Board of Cooperative Educational Services BOH Board of Health BRFSS Behavioral Risk Factor Surveillance System BVBAG Buena Vista Build a Generation BVSD Boulder Valley School District Bx Biopsy C Choice CAD Coronary Artery Disease CASB Colorado Association of School Board CB Community-based System CBE Clinical Breast Exam CBO Community -based Organization CC Clear Creek CC Custer County CC Community Coordination/Coordinator CCAP Latimer County Child Care Assistance Program CCC Colorado Cancer Coalition CCCHE Colorado Community Coalition for health Equity CCGC Colorado Clinical Guidelines Collaborative CCIAA Colorado Clean Indoor Air Act CCMC Colorado Clinical Managed Care Network CCMC Commission for Case Manager Certification CCPD Cancer, Cardiovascular, and Pulmonary Disease Page 1 of 6 Attachment E -1 CWTCI Colorado Chew Tobacco Collaborative Initiative CCTEPP Custer County Tobacco Education Prevention Partnership CDC Centers for Disease Control and Prevention CDE Colorado Department of Education CDPHE Colorado Department of Public Health and Environment CDU Chronic Disease Unit CEC Career Education Center CEO Chief Executive Officer CFDA Catalog of Federal Domestic Assistance CFFC Colorado Foundation for Families and Children CFPI Colorado Family Planning Initiative CHIN Community Health Information Network CICP Colorado Indigent Care Program CJD Colorado Judicial Department CM Case Management CIVIC Colorado Mountain College CMS Contract Management System CMS Creative Media Solutions CNCC Colorado Northwestern Community College CNS . County Nursing Service CO Colorado COD Colorado Donated Dental Services Program COPAN Colorado Physical Activity and Nutrition Program COV Colorado Van Program CPCF. Colorado Parent and Child Foundation CPHA Colorado Public Health Association CPT Current Procedural Technology CRC Colorectal Cancer CRCCP Colorectal Cancer Screening Program CRUE Culturally Responsive Urban Education CSAP Colorado Student Assessment Program CSH Coordinated School Health CSU Colorado State University CSU -P Colorado State University- Pueblo's CTC Connect to Care CTEPA Colorado Tobacco Education and Prevention Alliance CTFK Campaign for Tobacco -Free Kids CTRP Colorado Tobacco Research Program CTP Crossroads Turning Point CU University of Colorado, Boulder CWCCI Colorado Women's Cancer Control Initiative CY Contract Year DAISI Denver At -home Intervention Service Initiative DASH Division of Adolescent & School Health (CDC) DCMH Delta County Memorial Hospital DH Denver Health DHHA Denver Health and Hospital Authority DHS Department of Human Services DHHS Unites States Department of Health and Human Services , DOR Department of Revenue DOS Delta Opportunity School DSS Department of Social Services E &I Education and Information EAP Employee Assistance Program EBHV Evidence -Based Home Visiting to Prevent Child Maltreatment Grant Program ECC Early childhood council ECC Electrocardiogram ECCLC Early Childhood Council of Larimer County Page 2 of 6 Attachment E -1 ECLC Early Childhood Leadership Council/Commission E.D. Executive Director EHR Electronic Health Record EHS Early Head Start EMR Electronic Medical Record EMT Emergency Medical Technicians EPA Environmental Protection Agency EPE Epidemiology Planning and Evaluation ESL English as a Second Language ETS Environmental Tobacco Smoke (a.k.a. secondhand smoke) FIRC Family and Intercultural Resource Center FICA The Federal Insurance Contribution Act FDA Food and Drug Administration FITIFOBT Fecal Immunochemical Test(Fecal Occult Blood Test FNA Final Needle Aspiration FPP Family Planning Program FPL Federal Poverty Level FRCC Front Range Community College FTE Full Time Equivalent FTP File Transfer Protocol FY Fiscal Year FYI Family Youth Initiatives GASO Great American Smoke -out GED General Education Development GASP CO Group to Alleviate Smoking Pollution of Colorado Get R! EAL (GR) Resist! Expose Advertising Lies (Youth Empowerment Program) GLBT Gay, Lesbian, Bisexual, and Transgender GYN Gynecological HCP Health Care Program For Children with Special Needs HCYS Huerfano County Youth Services HHS Health and Human Services HIPPA Health Insurance Portability and Accountability Act of 1996 HIPPY Home Instruction for Parents of Preschool Youngster HIT Health Improvement Team HIV Human Immunodeficiency Virus HPV Human Papillomamavirus HR Human Resources hr hour HRSA Health Resources and Services Administration HSL High School Leadership ID Identification IIK Invest in Kids 1SHT Interagency School Health Team IT Information Technology JAC Juvenile Assessment Center KIS Keeping in STEPP KMH Keefe Memorial Hospital KPC Kevin Patrick Caleum LAHCDHD Las Animas Huerfano Counties District Health Department LBW Low Birth Weight LC Learning Community LGBT Lesbian, Gay, Bisexual, Transgender LEM Latinas en Movimiento LHA Local Health Agency LHD Local Health Department LLC Limited Liability Company LRCC Latino Regional Community Coalition LRPC Latino a Research and Policy Center Page 3 of 6 Attachment E -1 LST Life Skills Training LSTPEN Latino Statewide Tobacco Prevention and Education Netw LWB Live Well Broomfield MCHA Montezuma Housing Authority MCHD Montezuma County Health Department MCHS Montezuma - Cortez High School MCPN Metro Community Provider Network MCRC Media Campaign Resource Center— CDC MD Medical Doctor MHCBBC Mental Health Center Serving Boulder and Broomfield Counties MIECHV Maternal, Infant and Early Childhood Home Visiting Program MO Month MOB Medical Office Building MOU Memorandum of Understanding MPA Master of Public Administration in Health and Human Services MPH Master of Public Health MRI Magnetic Resonance Imaging Scan MS Master of Science MSA Master Settlement Agreement MUH Multi -user Housing MYAT Multi- Disciplinary Youth Assessment Team N/A Not Applicable NACCHO National Association of County and City Health Officials NACR Native American Cancer Research NAQC North American Quitline Consortium NASBE National Association of State Board of Education NCCRT National Colorectal Cancer Round Table NCHD Northeast Colorado Health Department NCI National Cancer Institute NE North East NFP Nurse- Family Partnership NFPNSO Nurse- Family Partnership National Service Office NHVP Nurse Home Visitor Program NIDA National Institute on Drug Abuse NIH National Institute of Health NJH National Jewish Medical and Research Center N -O -T Not -on- Tobacco, (ALA's Youth Smoking Cessation Program) NP Nurse Practi tioner NPP Nurturing Parenting Program NRT Nicotine Replacement Therapy NSBA National School Boards Association OSH Office on Smoking or Health (CDC) OTC Over the Counter PA Physician's Assistant PAC Prevention Awareness Crew PACT Partners Assessing Chew Tobacco PAT Parents as Teachers PCCHD Pueblo City- County Health Department PPC Personal Care Providers PE Presumptive Eligibility PEN Parent Engagement Network PVCHC Peak Vista Community Health Center PHN Public Health Nurse PIO Public Information Officer PM Peer Mentor PMC Parkview Medical Center PMR Planning Management Region PN Patient Navigator Page 4 of 6 Attachment E -1 PO Purchase Order PPC Policy Partner Committee PPFC Pikes Peak Family Connections PPN Prevention Policy Network PRA Policy Resource Alliance PRAMS Pregnancy Risk Assessment and Monitoring Survey PRIDE Pure Respect Initiative Direct Education PSA Public Service Announcement PSD Prevention Service Division PTEPP Pueblo Tobacco Education and Prevention Partnership PVC Prairie View Clinic Q 1 Quarter One Q2 Quarter Two Q3 Quarter Three Q4 Quarter Four QI Quality Improvement QOL Quality of Life RDAC Regional Disparities Advisory Council RFA Request for Applications RFP Request For Proposals RIE Reach, Implementation and Effectiveness RIHEL Regional Institute for Health and Environment RMC Rocky Mountain Center for Health Promotion & Education RMRH Rocky Mountain Rural Health RMYC Rocky Mountain Youth Corps RN Registered Nurse Rx Prescription RY Reconnecting Youth SafeCare SAMHSA Substance Abuse Mental Health Services Administration SB School -based System SBAG Salida Build A Generation SBHC School -Based Health Centers SCYC School Community Youth Coalition SCRHC Southern Colorado Regional Health Collaborative SD Service Delivery SECH Southeast Colorado Hospital SEMHS Southeast Mental Health Services SES Socio- Economic Status SEW School Employee Wellness SGR Surgeon General's Report SHAC Smoke -free Housing Action Committee SHI School Health Index SHS Secondhand Smoke SIDS Sudden Infant Death Syndrome SLV San Luis Valley SMART Staying Motivated at Reducing Temptations SMART OUTCOME OBJECTIVE Specific, Measurable, Achievable, Realistic, Time -Bound SMSU Self Management Service Unit SRO School Resource Officer STD Sexually Transmitted Disease STEPP State Tobacco Education and Prevention Partnership STW Straight -to -Work SVVSD St. Vrain Valley School District SWOT Strengths, Weaknesses, Opportunities, Threats SYNAR Synar Regulation TA Technical Assistance TABS - Tobacco Attitudes and Behavior Survey Page 5 of 6 Attachment E -1 TAG Technical Advisory Group (for evaluation & TPEG) TANF Temporary Aid to Needy Families TARP Tobacco Advocacy and Resource Partnership TBD To Be Determine TCP Tobacco Control Partners TDAC Tobacco Disparities Advisory Council TDG Tobacco Disparities Grant TDS Tobacco Disparities Subcommittee TEACH Teaching Equity to Advance Community Health TEFAP The Emergency Food Assistance Program TEPCGP Tobacco Education Prevention and Cessation Grant Program TEPP Tobacco Education Prevention Partnership TFCCI Tobacco -Free Colorado Communities Initiative TFLC Tobacco Free Larimer County TFS Tobacco -Free Schools TFS Law Tobacco -Free Schools Law TGYS Tony Grampsas Youth Services Title V Title V of the Social Security Act TND Project Toward No Drug Abuse TPEG Tobacco Program Evaluation Group TPI Tobacco Prevention Initiative TRC Tobacco Education and Prevention and Cessation Program Review Committee TRI Tobacco Rapid Improvement Activity TRIA Tobacco Rapid Improvement Assessment TTI Tony Grampsas Tobacco Initiative UCD University of Colorado — Denver UCDHSC Health Sciences Center at UCD (sometimes abr. UCHSC) UCDHSC University of Colorado at Denver and Health Sciences Center URL Uniform Resource Locator US United States of America USSTC US Smokeless Tobacco Company VP Vice President Well COA Wellness Councils of America WHU Women's Health Unit WIC Women, Infants, Children WWC Women's Wellness Connection YQC Youth at Crossroads YE Youth Empowerment YPH Youth Partnership for Health Yr Year YRBS Youth Risk Behavior Survey YSAP Youth Substance Abuse Prevention Coalition YTS Youth Tobacco Survey YVMC Yampa Valley Medical Center 5 A's Ask, Advise, Assess, Assist, Arrange 2A's R Ask, Advise, Refer Page 6 of 6 w H m Iz in N N v d a z an S O O �i A O 'b C U .Q u 4 G O t. N xo � x O� 3 H w OT 0 H ' z °° w� M ti G O z �i t a O U N H 0 b A a: O H H a d A 0. a 0 ❑ U ❑ A a a) N ro Q) :b u U O b u U �r. O C O U .d T 0 �» ro b N � U r b V L V3 G tj , O b A �0 U -0 0 ,U Q) � CU 4) ° • U a� � a D o T w y w� 6q B 4 a) Q d a a' a m U N 4 d F� x 3 O v � N N o U A w> ro O o O -E ro (1) o > O .. � EC7 °-° ° i y [O G A Q a 2 N (U O ° t�� -OO c U i > En o 1 W W W V U U ro y U O ✓ 4+ O UW R W � O w Cl. N p U Q b d > W 7 r y O � O C ° N O \ T d O n O ggqT Gq O Ui O > 0 ro ° ° > a�i o .O � o ,' v ° 2 ' t o 3 0 0 y 3 o a D ,ro n a a CC � ro a, are ° W E 'U 'ti o r-. y �=. E c.i U N O 0 0 C ? > 4. s,. N 0 •+ e+ G CL, E c P; v . � c a ca a.) ., v o ' y p� y � O Y aa) .0. U U d 0' V' t 0 ° �, a eq a 3 b N T 5 o N ca 4. o ;? 0 4. U ' ro r. b Lti C C o U O O p W O m ro C in tn ca w E T 'o cn t y a 0 O O l� N ^ cc ❑� >. o W .a 0 E o ro > ,.'A ° ° 0 Cd 3: a) a c ro vU' >¢ 'o cd ° aU —+ O 1 a� O va m a c oC7 r> � W o 9:1 > +�+ ro E >, .b On o ro ro ro o � c w A 6n o T U b v .°'• a N S W ° �a:aw �aK .°�' .° �r° y pq cn n >.. H d d4 a. Ln dv�Z �> ro x 3 O v � N N o U A w> F oa `1 Y 3 W O Ou"U N W �w> 3 0 M 0 ca oO td c OD Ei y O O ° 9b -z O chi I U oo 4. O N O O w LU 'O U 0 =s odd y q p cd O O W G7 N O O O `1 Y 3 W O Ou"U N W �w> 3 az M 0 ca y O O j•� r- O c« a� r: Q v a T a >2X a! r a >o� U U°'� W ._6 > U F ° O U W 4 + o w 0 0 on N. O O a> Y �� °' 0 4 w G 0 C') N w r ° v o O 0 w� o o y ° °O 4 i-. �, y r. O O p O y O > O O. y ti Ra Z C/] 7 v v G. F tv V] ° C* ° h � ^ v d c p, o ca v ca ca o O a o p d zz O o^ oD� O N q v . F d d O °O > N > o 0 O C ocn bq s q v es 0 o y 3 ° •5 p aN N o u R U N q .c� U p, [. O ° en GQ O 0 > O . O " O cd cd t. . O d3 Cj t3' C N CIS 1 0 0 v ° " �=3 0. • 3 � U � :3 N � O � N _C � O - 0 �O d CE 41 V V O G O. •y N A F d d�E7 'vd `1 Y 3 W O Ou"U N W �w> 3 o .. to U U •� o o� � o � c o • D U � O .4 U cII o� -° O b N C 0 N 4 N� tg O cc >> a c: 'O > �a O � o o 0 U U W .d y a� U IlG O � cc U C7 „ ._ 3 O a) F `m et V3 0 O M F �W w 6p o x M N O 04 w N Q a 'b . 0. .b 'a O U >, U 0 0 o a 4a o Q . a x 6• C u r �°= c o .d) y is on o o W U m 0 v R, U w 90 0 ` W�U . ;>, F4 WU w wa ° . y u � T O a. O v 0 0 ❑Cry 0 O • w � Q 0 T O F n w 0 T O >, E Y W O U O u Lu x cn m 04 0 o C 4 ?? a> C) N CN O W CL o a ° f3.. ° ` O m N O Q A o 0 0 y O m o � � L3. ` N 4 w0 x b k ca u 0 w o aua w •Y++ y N - a O •� F•, O O 4� a r y 'L! d) ca N a .D b O 0, N �• "y >, nTP, UcA 4T) T U 0 0 0 � •x U 4 N -0 O �O � N N E G M ��a S° 5.o ° 4) O a pti ��°a o v O E H y' a c'� p E To W CL O o i v U y C7 O U e. CL R ~ U O y O •r to + W y L d E Q dx U o .E r-i a M a y N r a O O bn N , w v W , O yy, O O N 4 V 4° cFd cc O U 1 . 3 12 M y °O N O U ° v w ° O 3' �"•. W ob p. y ar o� U • p N ~ yy,, O O N U M cC 4 p 0. y .. y 3 F+" iyr N O L_ V s :�i 4R N .a+ • d cC sa V v° '° U O u 0 3 O a) F `m et V3 0 O M F �W N x � v Q . a x w a 0 v 0 oA G d � T O O O P. 0 ❑Cry 0 O • U � Q 0 O F n w 0 T O >, E Y W e O u Lu x o 04 0 o o a ° f3.. o w OA � � d• x O ca u o aua O -� .5 d) ca N a .D b O N �• "y Y O G M CL a) E b O Cl. 4) W CL O o i U y C7 a� G CL R ~ U c d Cit •r N c c 0 A, E Q dx 3 O a) F `m et V3 0 O M F �W w x � X w Qj ,t8 cn cr rA .A� U U 0 O 0 ca ° Ei O U 0 N U i a CU R. a m o a ° U � U C1 G C U M 0 .° rn M a � cn Z M . cl -0 U 0 0 ' o o C L CO CL N N U. U .� •b U 0 O U O 10 C's 0 U N G' b = b o ti TbOAS- U 1 " O 3 , O ,-; C ' 4 O C , O M ° lu (D s» cF U U N 0) 3 0 Y O � � � N Q O • o cd b R3 ° � U N �. . bA • 0 c� O N O i N E^ U °y O +�- •° N N O O U O -0 .0 II.'� •� O. N I� N cad U a) . >,." ' . 0 V ci � O m � in °' O O ° ° o o Er- Cl, o � aU+ a) dcd r a o d I o et U � � G .fit Q Q O r n o ap T � � d a a W a o 0 o m 0 3 ° ° o c oP o 4, Ca v w U ov 0 3 n o a ° w ens ai co v a 3 � id o tb A 0 o N �° w W S o .� d•0U Qj ,t8 cn cr rA .A� U U 0 O 0 ca ° Ei O U 0 N U i a CU R. a m o a ° U � U C1 G x 0 o U er re Q 9 9 X Q C- W > .° rn cd ss ° � cn tio � U TS � -0 U 0 0 ' o o Cd CO CL N N U. � U U 0 O U O 10 C's 0 U o b = b o c ° U TbOAS- U 1 " O 3 , O O C , O a > 'S� ° lu (D O U a U O ° yam•, O 3 0 Y O 42 U rn •45 0 O • o cd b � ° � U N �. . t0 Cd y., ' U > O N -d U cH U °y O +�- •° N N O O U O -0 c a 3 Q. `*- U o ' o o = > U O � U �-+ • -� i; w ° 3 c 0 m in °' O O V3 E U dcd r a o y et U � � G .fit Q Q O r n •. U r= a a N U N o W 0 3 ° ° o r. U O U o .ca N 0 3 n o a ° w ens ai co v a bo id tb A 0 o U o 4 °o Up oU EA W U a x 0 o U er re Q 9 9 X Q C- W > Exhibit G (D Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Contract Routing # 14 FAA 55256 Colorado Department: of Poblio Flralth and Erreimnmrnt Contractor Name Eagle County Government Budget Period July 1, 2013 -June 30 2014 Project Name Estoy Sano Program Contact Name, Tide, Karen Koenemann, Healthy Communities Phone and Email Manager, 970- 328 -2610, Match or In- karen.koenemann@eaglecounty.us Fiscal Contact Name, Title, Wendl Gill, Fiscal Speciailst,970 -328 -8804, Phone and Email wendi.gill @eaglecounty.us Page 1 of 3 V. 1 Jan 2013 Total Match or In- Expenditure Categories Kind (If. Amount Requested Applicable) from CDPHE Personal Services Gross or Fringe Percent of FTE on Annual Salary List Description of Work objective /activity (for hourly employees, please Include the hourly number(s) this Position Title /Employee rate and number of hours in your description). budget item Name Include p of months bud etted. supports Ms. Koenemann will provide oversight of staff, programming and ensure fiscal responsibility of Project Director -Karen budgeting and coordinating subcontractors. Koenemann All $70,040.00 $23,928.00 20.00% $18,793.00 Ms. Hankins will be housed in the Eagle office and facilitate programming. She will act as lead, ensuring deliverables are met and reports are submitted in a timely, professional manner. She will work directly with Vail Valley Salvation Army, CSLI Extenslon,'Vail Valley Medical Center, the Eagle Valley Food Policy Group, and the Latino Health Leadership Group in Eagle County. Duties will include building networks, coordinating with community partners, identifying a champion and lead contacts at local food banks /pantries, providing nutrition education, coordinating with Project Coordinator- Lead public health programs, collecting and analyzing Katie Haas data, and conducting research. All $49,440.00 $21,057.00 50.00% $35,248.00 Vanessa Doty will be bilingual/bicultural and will act as a cultural broker to the Latino community. The specialist will be the lead for the Latina Health Leadership Group and will help implement the Go, Slow and Whoa program through the Family Project Specialist- Vanessa Leadership Training Program and will work as an Doty interpreter /translator throughout the project. All $44,368.00 $24,904.00 25.00% $17,318.00 Project Coordinator - Second T8D All $49,303.00 $21,057.00 50.00% $35180.00 Total Personal Services 1 (including fringe benefits) $213,1S1.00 $90,946.00 1 $0.00 $106,539.00 Page 1 of 3 V. 1 Jan 2013 Exhibit G M Colomdo Deparmienc. of Public Health and EnNironment Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Contract Routing # 14 FAA 55256 Contractor Name Eagle County Government Budget Period July 1, 2013 -June 30, 2014 Project Name Estoy Sano Program Contact Name, Title, Karen Koenemann, Healthy Communities Phone and Email Manager, 970- 328 -2610, List karen.koenemann@eaglecounty.us Fiscal Contact Name, Title, Wend! Gill, Fiscal Specialist,970328 -8804, Phone and Email wendi.gill @eaglecounty.us Supplies & Operating Expenses List objective /activit y number(s) this Match or in Total Amount budget item kind (if Requested from Item Description of Item supports Rate Quantity applicabl e CDPHE Colored Spanish /English posters for Plant a Row for the Hungry $1.00 450 $450.00 Printing /Copying: Campaign, Spanish /English Go, Slow, and Whoa nutritional posters and D1,A1; O1,A2; Marketing and Outreach labels, and Spanish /English advertising posters for the EFNEP program. D3,A3 Food activity, lesson materials, copies for participants $48.00 168 $8,064.00 Supplies: EFNEP $48.00 /participant x 24 classes x 7 participants = $8,064.00 DS,AZ Operating: La Neuva Mix La Nueva Mix Radio Nutrition Segments $275.00 for airings x 12 months $275.00 12 $3,300.00 Radio Show = $3,300.00 D2,A7 Operating: Marketing in Vail Daily Advertisements for EFNEP (12 ads x 222.00= $2,664), and $222.00 29 $6,438.00 Vail Daily Newspaper Plant a Row for the Hungry Campaign (17 ads x 222.00 = $3,774.00 D1,A2; D3,A3 Advertising on La Nueva Mix (Spanish) for Plant a Row for the Hungry Campaign: 300/30 sec spots x$5.00= $1,500 $5.00 600 $3,000.00 Operating: Marketing on La Advertising on KZYR (English) for Plant a Row for the Hungry Campaign: Neuva Mix and KZYR radio 300130 sec spots x $5.00= $1,500. D3,A3 Supplies: ECO-TV Cooking $100.00 12 $1,000.00 Show Raw Food Raw food costs for the ECO -TV 18Spanish Language Cooking Show. D2,A2 Supplies: ECO -TV Cooking $16.66 12 $400.00 Show kitchen supplies Kitchen supplies such as cleaning, paper and cooking. D2,A2 Supplies PAREquipment Kitchen supplies such as storage bags, collanders coolers D3,A1; D3,A2 $250.00 3 $750.00 Total Supplies & Operating Expenses $0.00 $23,402.00 Travel List Item objective /activit y number(s) this Match or In Total Amount budgetitem kind (if Requested from Description of Item supports Rate Quantity applicable) CDPHE Mileage- in state Based on 417 miles travelled x12, reimbursed at $0.51 per mile. Plus, 2 $0.51 5,004 $2,552.04 Lodging 2 ni hts lodging x 2 people x 2 trips to Denver $150=1 8 $1,200.00 Meals 12 days x 2 people x 2 trainings @ $66.00 per day 1 $66.001 $528.00 Total Travel $0.00 $4,280.04 Page 2 of 3 V.1 Jan 2013 Exhibit G ( 0- - Colorado Deparuenc ofPubficl•Iealth and Envirar ment Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Contract Routing # 14 FAA 55256 Contractor Name Eagle County Government Budget Period July 1, 2013 -June 30, 2014 Project Name Estoy Sano Program Contact Name, Title, Karen Koenemann, Healthy Communities .. Phone and Email Manager, 970 - 328 -2610, karen.koenemann @eaglecounty.us Fiscal Contact Name, Title, Wendi Gill, Fiscal Specialist,970 -328 -8804, Phone and Email wendi.gill @eaglecounty.us Contractual (payments to third parties or entities) List objective /activit Item y number(s) this Match or In Total Amount budget item kind (if Requested from Subcontractor Entity Name and/or Description of Item. supports Rate Quantity applicable) CDPHE The ECO-TV 18 Cooking Hosts are a bilugual chef and a nutritionist. They were selected based on their expertise and skill. They will be the face of $80.00 60 $4,800.00 the Cooking Show, demonstrating proper cooking techniques and health ECO -TV Cooking Hosts and nutrition tips while cooking. 2 hosts x $40.00/hr x 60 his = $4,800.00 D2,A2 Hispanidad Marketing was selected through a county bidding process. Hispanidad will create a Estoy Sano Project brand and marketing materials, help TV and Radio scripts, work with local media outlets and will begin planning Healthy Food Access Policy, and social marketing $100.00 282.25 $28,225.00 campaign with the Latino Health Leaders Group. 282.25 hours @ $100.00 = $13,255.00. Deliverables include English and Spanish Estoy SanoProject brand and marketing colateral,TV and Radio scripts, contracts with local media and attendance of two Latino Health Leaders D2,A1; D2,A2; His anidad Marketing Group meetings. D4,A2 Venturoni Surveys was selected though a county bidding process. Venteroni Surveys was hired to create evaluation tools, collect and analyze data annually and create a final evaluation report. 136 his at $85.00 136 $11,560.00 $85.00 = $11,560. Deliverables will include evaluation tools, collection Venturoni Surveys and and analyzation of data annually for all programs and a final project Research, Inc report at the end of the 3 -year funding cycle. All The Family and Consumer Science Extention Agent was selected based on their cooking and nutrition knowledge. They act as the technical advisor for the cooking show, collecting recipes and techniques to $36.21 250 $9,052.50 demonstrate for the show. They also are assisting with the EFNEP evaluation data collection. FCS extention agent: 250 hr @ $36.21 =.50 CSU Extension Agent Deliverables include taped and aired cooking shows. D1,A2; D2,A2 Total Contractual $0.00 $53,637.50 SUB -TOTAL BEFORE INDIRECT $187,858.54 Indirect Item Description of Item Negotiated Indirect cost rate Indirect (other): please list 20% $26,844.25 specific indirect costs in Indirect (other): Contractual rate, if - 2% $1,072.75 applicable Total Indirect $0.00 $27,917.00 TOTAL MATCH ORIN KIND $0.00 TOTAL $21s,n6.00 Page 3 of 3 V.1 Jan 2013