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HomeMy WebLinkAboutC13-192 Task Order Waiver #154 24 FHA 58481DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ROUTING NO. 14 FHA 58481 APPROVED TASK ORDER CONTRACT - WAIVER #154 This Task Order Contract is issued pursuant to Master Contract made on 01/17/2012, with routing number 13 FAA 00016 STATE-- State of Colorado for the use & benefit of the Board of County Commissioners of Eagle Department of Public Health and County Environment 500 Broadway Disease Control and Environmental Eagle, Colorado 81631 -0850 Epidemiology Division for the use and benefit of the Immunization Eagle County Public Health Agency 4300 Cherry Creek Drive South 551 Broadway Denver, Colorado 80246 Eagle, Colorado 81631 TASK ORDER MADE DATE: 06/28/2013 PO /SC ENCUMBRANCE NUMBER PO FHA EPI1458481 This Task Order shall be effective upon approval by the State Controller, or designee, or on 07/15/2013, whichever is later. The Task Order shall end on 06/30/2015. PRICE STRUCTURE: Cost Reimbursement PROCUREMENT METHOD: Exempt SID /RFP /LIST PRICE AGREEMENT NUMBER: Not Applicable LAW SPECIFIED VENDOR STATUTE: Not Applicable CONTRACTOR ENTITY TYPE: Colorado Political Subdivision BILLING STATEMENTS RECEIVED: Monthly STATUTORY AUTHORITY: N/A CONTRACT PRICE NOT TO EXCEED: $55,000.00 FEDERAL FUNDING DOLLARS: $0.00 STATE FUNDING DOLLARS: $55,000.00 MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR FY 14: $27,500.00 FY 15: $27,500.00 STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE: Teri Lindsey Rebecca Larson Department of Public Health and Environment Eagle County Public Health Agency DCEED PO Box 660 Immunization Eagle, Colorado 81631 4300 Cherry Creek Drive South Denver, CO 80246 SCOPE OF WORK: The Colorado Immunization Section (CIS) at the Colorado Department of Public Health and environment (CDPHE) will support immunization activities throughout the state through the following three projects: DTaP Winnable Battle, 317 Policy. Transition, Child Care Inspections Standards (CHINS). Page 1 of 6 Rev 6/25/09 C /f— / ?1�1 EXHIBITS: The following exhibits are hereby incorporated: Exhibit A - Additional Provisions (and its attachments if any — e.g., A -1, A -2, etc.) Exhibit B - Statement of Work (and its attachments if any — e.g., B -1, B -2, etc.) Exhibit C - Budget (and its attachments if any — e.g., C -1, C -2, etc.) Exhibit D - Grant Funding Letter GENERAL PROVISIONS The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task — Order Contract provide more specificity than these general clauses, the more specific provision shall control. 1. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including any renewals or extensions, may not exceed five (5) years. The parties intend and agree that all work shall be performed according to the standards, terms.and conditions set forth in the Master Contract, 2. In accordance with section 24 -30- 202(1), C.R.S., as amended, this Task Order Contract is not valid until it has been approved by the State Controller, or an authorized delegee thereof. The Contractor is not authorized to, and shall not; commence performance under this Task Order Contract until this Task Order Contract has been approved by the State Controller or delegee. The State shall have no financial obligation to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order Contract on or before its proposed effective date, then the Contractor shall commence performance under this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order Contract after its proposed effective date, then the Contractor shall only commence performance under this Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through and including the date specified on page one of this Task Order Contract, unless sooner terminated by the parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract. Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of the terms and conditions of this Task Order Contract. 3. The Master Contract and its exhibits and /or attachments are incorporated herein by this reference and made a part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated, the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its exhibits and/or attachments), or between this Task Order Contract and its exhibits and /or attachments, such conflicts or inconsistencies shall be resolved by reference to the documents in the following order of priority: 1) the Page 2 of 6 Rev 6/25/09 Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the Additional Provisions - _Exhibit A, and its attachments if included, to this Task Order Contract; 5) the Scope /Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other exhibits /attachments to this Task Order Contract in their order of appearance. 4. 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 work items described in the Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and attached hereto as "Exhibit B" and "Exhibit C ". 5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or decrease the amount payable under this Task Order Contract, or add to, delete from, and /or modify this Task Order Contract's Statement of Work through a contract amendment. To be effective, the amendment must be signed by the State and the Contractor, and be approved by the State Controller or an authorized delegate thereof. This contract is subject to such modifications as maybe required by changes in Federal or State law, or their implementing regulations. Any such required modification shall automatically be incorporated into and be part of this Task Order Contract on the effective date of such change as if fully set forth herein. 6. The conditions, provisions; and terms of any RFP attached hereto, if applicable, establish the minimum standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope /Statement of Work Exhibit B, establishes or creates standards of performance greater than those set forth in the RFP, then the Contractor shall also meet those standards of performance under this Task Order Contract. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective Date is on or after July 1, 2009 and the maximum amount payable to Contractor hereunder is $100, 000 or higher] By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the provisions of CRS §24 -102 -205, §24 -102 -206, §24- 103 -601, §24- 103.5 -101 and §24 -105 -102 concerning the monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide contract management system. Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order Contract, State law, including CRS §24 -103.5 -101, and State Fiscal Rules, Policies and Guidance. Evaluation of Contractor's performance shall be part of the normal contract administration process and Contractor's performance will be systematically recorded in the statewide Contract Management System. Areas of review shall include, but shall not be limited to quality, cost and timeliness. Collection of information relevant to the performance of Contractor's obligations under this Task Order Contract shall be determined by the specific requirements of such obligations and shall include factors tailored to match the requirements of the Statement of Project of this Task Order Contract. Such performance information shall be entered into the statewide Contract Management System at intervals established in the Statement of Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract term. Contractor shall be notified following each performance and shall address or correct any identified problem in a timely manner and maintain work progress. Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the performance measures established under the Statement of Project, the Executive Director of the Colorado Department of Personnel and Administration (Executive Director), upon request by the Colorado Department of Public Health and Environment and showing of good cause, may debar Contractor and Page 3 of 6 Rev 6/25/09 prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result by: (i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS §24- 105- 102(6)), or (ii) under CRS §24- 105 - 102(6), exercising the debarment protest and appeal rights provided in CRS § §24 -109 -106, 107, 201 or 202, which may result in the reversal of the debarment and reinstatement of Contractor, by the Executive Director, upon showing of good cause. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws, state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be amended. Without limitation, these federal laws and regulations include the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109 -282), as amended by §6062 of Public Law 110 -252, including without limitation all data reporting requirements required there under. This Act is also referred to as FFATA. Page 4 of 6 Rev 6/25/09 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * 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: Board of County Commissioners of Eagle County (a political subdivision of the state of Colorado) for the use and benefit of the Eagle County Public Health Agency Legal Name of Contracting Entity dnZL.IV-n 0.4- - - Signature of Autiforized Officer S " Print Name 6k Authorized Officer e,�t , Print Title of Authorized Officer STATE OF COLORADO: John W. Hickenlooper, GOVERNOR By For Executive Director Department of Public Health and Environment Department 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. By Date STATE CONTROLLER: Robert Jaros, CPA, MBA, JD Page 5 of 6 Rev 6/25/09 This page left intentionally blank. Page 6 of 6 Rev 6/25/09 EXHIBIT A ADDITIONAL PROVISIONS To Contract Dated 06/28/2013 - Contract Routing Number 14 FHA 58481 These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above. 1. To receive compensation under this Task Order Contract, the Contractor shall submit a signed monthly customized CDPHE Reimbursement Invoice Form called "IMM FY 2014 -15 Combined Projects Invoice" This form is accessible from the CDPHE internet website http: / /www.colorado.gov /cs /Satellite /CDPHE- Main/CBON/1251622941228 under Customized Invoice Forms. The CDPHE will provide technical assistance in accessing and completing the form. The CDPHE Reimbursement Invoice Form must be submitted within forty rive (45) calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work attached hereto as Exhibit B and incorporated herein and the associated Budget attached hereto as Exhibit C and incorporated herein. Submit completed CDPHE Reimbursement Invoice Form to the Immunization Section email box: Cdphe.cisinvoice @state.co.us 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 any event no later than s forty five (45) 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 any event no later than forty five (45) 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. The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. 2. Time Limit For Acceptance Of Deliverables. Evaluation Period. The State shall have forty five (45) calendar days from the date a deliverable is delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables that have a different time negotiated by the State and the Contractor. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design specifications for that particular deliverable, or is otherwise deficient, then the State shall notify the Contractor of the failure or deficiencies, in writing, within forty five (45) 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 forty rive (45) calendar days, to correct the noted deficiencies. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination. The State has determined that this contract does not constitute a Business Associate relationship under HIPAA. To be attached to CDPHE Page 1 of 2 Revised: 07/17/12 Version 1.0 (3/12) contract template EXHIBIT A - 4. The State may increase or decrease funds available under this contract using a Grant Funding Letter substantially equivalent to Exhibit D. The Grant Fun_ ding Letter is not valid until it has been approved by the State Controller or designee. To be attached to CDPBE Page 2 of 2 Revised: 07/17/12 Version 1.0 (3/12) contract template EXHIBIT B STATEMENT OF WORK To Contract Dated 06/28/2013 - Contract Routing Number 14 FHA 58481 These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above. I. Project Description: Immunization Combined Projects III. Project Description: Immunization Combined Projects The Colorado Immunization Section (CIS) at the Colorado Department of Public Health and Environment ( CDPHE) will support immunization activities throughout the state through the following projects: A. DTaP Winnable Battle As one of Colorado's 10 Winnable Battles, and to reduce infectious disease that can be prevented with vaccination, Colorado will increase the percentage of children who are up to date on their diphtheria, tetanus and pertussis(DTaP) immunizations when they enter kindergarten. B. Child Care Inspections Standards (CHINS) Funding will be used to improve the quality of child care health inspections completed by local public health agencies (LPHA) through the development and implementation of sustainable systems that address improved immunization rates with infection control practices in the child care setting. C. Funding Period: July 15, 2013 through June 30, 2015 II. Definitions: CCC Child care center CCNC Child care nurse consultant CDC Center for Disease Control and Prevention CDPHE Colorado Department of Public Health and Environment CHINS Child Care Inspection Standards CHP Child Health Plan CIIS Colorado Immunization Information System CIS Colorado Immunization Section DHS Department of Human Services EH Environmental Health EHR Electronic health records DTaP Diphtheria, Tetanus and acellular Pertussis DTaP WB DTaP Winnable Battle IZ Immunization LPHA Local public health agency PHN Public health nurse RFA Request for application SOW Scope of work Tdap Tetanus, Diphtheria and acellular Pertussis VFC Vaccines for Children IV. Performance Requirements/Deliverables: 1. DTaP Winnable Battle Page 1 of 6 EXHIBIT B a) Quarterly online progress reports shall be completed, for each contract year, using this link: http: / /fs9.formsite. coin/ ColoradolMMprogram /IZCombinedProi ectsPR/index.html b) Online report due dates are: July -Sept due Oct 15 Oct -Dec due Jan 15 Jan-March due April 15 April -June due July 15 c) A mid - project progress report shall be due July 15, 2014. The link will be provided by the CIS no later than July 1, 2014. d) A final, comprehensive progress report shall be due to the CIS by July 30, 2015. The link will be provided by the CIS no later than July 1, 2015. Objective 1- Eagle County School District shall consistently enforce school immunization 1: requirements at 100% (n =17) schools. Activities to 1. Recommend to district administrative staff, a district wide policy Sept. 1, 2013 complete the and enforcement of school immunization requirements based on the objective DTaP grant 2012 -2013 assessment of compliance with school requirements per school and effectiveness of passive recall letters versus active enforcement of policy. 2. Measure rate of compliance with school requirements and assess June 1 2014 effectiveness of recall reminders and enforcement of policy. 3. Report assessment of rate of compliance and make June 30, 2014 recommendations for improvement to enforcement and promotion of immunizations to school health teams, administration and other key stakeholders for the 2014 -2015 school year. 4. School district shall have a policy in place regarding the Oct. 1, 2014 enforcement of school immunization requirements and principals shall be trained on the policy. 5. Measure rates of compliance and assess effectiveness of recall June 1, 2015 reminders and enforcement of policy. 6. Report assessment of school requirements to school health teams, June 30, 2015 administration and other key stakeholders for the 2014 -2015 school ear. Reporting For conducting Education/Training sessions for principals, report the following: Requirements • Specific information included in each education or.training event. / • Results of pre and post testing for each education or training event by type of Deliverables group being trained. CIIS reminder /recall, report the following: • Number of children by age group identified as needing a DTaP immunization. • Number of recall notices returned undeliverable. • Percent of children by age group that were recalled then subsequently brought up to date for DTaP. Objective 1- Increase the rate of Eagle County School District's students compliant with school 2: immunization requirements by 2% from 90 %. Activities to 1. Provide education and training to 100% of school health staff on Sept. 15, 2013 complete the Colorado's school immunization requirements. objective 2. Provide education and training to 100 % of primary care providers in Oct. 1, 2013 Eagle County regarding school immunization requirements and appropriate documentation needed by schools. Page 2 of 6 Ti VTY-ru T D 3. Provide ongoing support to 17 schools by reviewing Kindergarten, Beginning + 6`i' grade, and new student immunization records to determine if they Sept. 1, 2013 meet immunization requirements. through May 31, 2014 4. Send recall letters, in partnership with school principals and school Beginning health staff, to students not meeting immunization requirements and Sept. 1, 2013 specifying needed vaccines. through May 31, 2014 5. Assist school health staff at 17 schools in updating CIIS with student Beginning immunization records as needed. Sept. 1, 2013 through May 31, 2014 6. Partner with school health and administrative staff to identify 2014- May 1, 2014 2015 incoming kindergartners and 6`h graders that do not meet immunization requirements. 7. Partner with school health and administrative staff to send recall and May 15, 2014 reminder letters to 2014 -2015 incoming kindergarteners and 6`'' graders regarding immunizations needed to meet school requirements. 8. Measure rate of compliance with school requirements and assess June 1, 2014 effectiveness of recall reminders and enforcement of policy. 9. Report assessment of rate of compliance and make June 30, 2014 recommendations for improvement to enforcement and promotion of immunizations to school health teams, administration and other key stakeholders for the 2014 -2015 school year. 10. Expand immunization support to Eagle County School District to Sept. 1, 2014 include 7 school - located preschools. 11. Provide education and training to 100% of school health staff on Sept. 15, 2014 Colorado's school immunization requirements. 12. Provide education and training to 100% of primary care provider Oct. 1, 2014 practices in Eagle County regarding school immunization requirements and appropriate documentation needed by schools. 13. Provide ongoing support to 17 schools by reviewing Preschool, Beginning Kindergarten, 60' grade, and new student immunization records to Sept. 1, 2014 determine if they meet immunization requirements. through May 1, 2015 14. Send recall letters, in partnership with school principals and school Beginning health staff, to students not meeting immunization requirements and Sept. 1, 2014 specifying needed vaccines. through May 132015 15. From September 1, 2014 through May 1, 2015, assist school health Beginning staff at 17 schools and 7 preschools in updating CIIS with student Sept. 1, 2014 immunization records as needed. through May 132015 16. Partner with school health and administrative staff to identify 2015- May 1, 2015 2016 incoming kindergartners and 6"' graders that do not meet immunization requirements. 17. Partner with school health and administrative staff to send recall and May 15, 2015 . reminder letters to 2015 -2016 incoming kindergarteners and 6"' Page 3 of 6 EXHIRIT R 2. Child Care Inspections Standards (CHINS) a) Quarterly online progress reports shall be completed, for both contract years, using this link: htti):Hfs9. formsite. com/ ColoradoIMMr)roaram /IZCombinedProi ectsPR/index.html b) Online report due dates are: July -Sept due Oct 15 Oct -Dec due Jan 15 Jan -March due April 15 April -June due July 15 c) A mid - project progress report shall be due July 15, 2014. The link will be provided by the CIS no later than July 1, 2014. Page 4 of 6 graders regarding immunizations needed to meet school requirements. June 1, 2015 18. Measure rates of compliance and assess effectiveness of recall reminders and enforcement of policy. June 30, 2015 19. Report assessment of school requirements to school health teams, administration and other key stakeholders for the 2014 -2015 school ear. Reporting For conducting Education/Training sessions, report the following: Requirements • Specific information included in each education or training event. / • Results of pre and post testing for each education or training event by type of Deliverables group being trained. CIIS reminder /recall, report the following: • Number of children by age group identified as needing a DTaP immunization. • Number of recall notices returned undeliverable. • Percent of children by age group that were recalled then subsequently brought up to date for DTaP. Objective 1- Decrease by 10% from baseline, the number of personal exemptions due to lack of 3: - paperwork or invalid/incorrect vaccine administration practices. Activities to 1. Collect baseline data on the percent of children with personal Aug. 1, 2013 complete the exemptions. objective 2. Collect qualitative data from health assistant's on the perceived Sept.l, 2013 importance of immunizations and barriers to obtaining records and reminder /recalls of students. 3. Educate providers on the school immunization requirements and Oct. 1, 2013 common administrative errors impacting student's compliance with immunization requirements based on the 2012 -2013 DTaP grant supported assessment of student immunization rates. 4. Support school health staff at 17 schools to obtain student Beginning immunization records to minimize personal exemptions due to Sept. 1, 2013 inconvenience in collecting paperwork. through May 1, 2014 5. Assess personal exemption rates at 17 schools and measure May 1, 2014 percentage due to immunization administration errors. 6. Report2013 -2014 exemption assessment findings to health care June 30, 2014 providers and school health staff, identifying areas of improvement for vaccine administration and obtaining immunization paperwork. Reporting • Percentage of children missing the required DTaP immunization Requirements with associated exemptions. Include percentage of children with / nothing in the record indicating why they are not up to date. Deliverables 2. Child Care Inspections Standards (CHINS) a) Quarterly online progress reports shall be completed, for both contract years, using this link: htti):Hfs9. formsite. com/ ColoradoIMMr)roaram /IZCombinedProi ectsPR/index.html b) Online report due dates are: July -Sept due Oct 15 Oct -Dec due Jan 15 Jan -March due April 15 April -June due July 15 c) A mid - project progress report shall be due July 15, 2014. The link will be provided by the CIS no later than July 1, 2014. Page 4 of 6 IV: EXHIBIT B d) A final, comprehensive progress report shall be due to the CIS by July 30, 2015. The link will be provided by the CIS no later than July 1, 2015. Objective 1- 1: Increase the knowledge and skills of child care center staff regarding immunizations and infection control best practices by 20 % from baseline by implementing a public health/environmental health joint inspection model. Activities to I. Meet with Eagle County Environmental Health staff to discuss and Sept. 1, 2013 complete the identify collaborative opportunities to promote immunization and objective infection control best practices among child care centers. 2. Research existing models that combine a public health nurse and Sept. 30, 2013 environmental health team inspection process. 3. Assess the knowledge and skills of child care centers in infection Dec. 1, 2013 control processes and understanding'the child care immunization requirements, the purpose of the requirements and tracking of records to determine baseline. 4. A public health nurse shall shadow an environmental health April 1, 2014 specialist in 1 child care center inspection to increase knowledge of current process, inspection criteria, and current immunization tracking practices. 5. Develop criteria to categorize high risk facilities and frequency of May 1, 2014 inspections by joint public health/environmental health team. 6. Develop a model that combines a public health nurse and June 30, 2014 environmental health team inspection process that improves the knowledge and skills of child care staff to include immunizations and infection control. Include tools to assist child care centers in tracking of immunizations and exemptions. 7. Conduct joint child care inspections at 50% of child care centers identified as high risk per criteria. May 1, 2015 8. Re- assess the knowledge and skills of child care centers in infection control processes and understanding the child care immunization June 1, 2015 requirements, the purpose of the requirements and tracking of records. 9. Evaluate the joint inspection model by obtaining staff feedback, assessment of child care center staff and report findings and June 30, 2015 recommendations to public health nurses, environmental health, child care centers, licensing specialist, and other key stakeholders. Reporting For Collaboration, report the following: Requirements • Summary of agreed upon collaborating activities. • Summary of collaboration outcomes or successes. Deliverables Provide a summary of the evaluation of the joint inspection model. Personnel: a) Agency information: -Agency name Eagle County Public Health Agency Agency mailing address PO Box 660 Eagle, CO 81632 Phone number 970- 328 -9820 Page 5 of 6 Fax number 855- 848 -8829 Agency DUNS # 08402447 Agency FEIN # 84- 6000762 b) Agency contact person: Name Rebecca Larson Phone number 970- 328 - 9820' Email address Rebecca.larson ea lecoun .us c) CIS DTaP Winnable Battle Project Manager: Name Jennifer Yara- Zelenski Phone number 303 -692 -2661 Email address Jennifer.Yara-zelenski@state.co.us d) CIS CHINS Project Manager: Name Jamie D'Amico Phone number 303 -692 -2957 Email address Jamie.Damico@state.co.us EXHIBIT B V: Monitoring: CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout the contract period by the CIS Project Manager, Contract Monitor and /or Evaluation Coordinator. Methods used will include review of documentation reflective of performance to include progress reports and invoices. The Contractor's performance will be evaluated at set intervals and communicated to the contractor. A Final Contractor Performance Evaluation will be conducted at the end of the life of the contract. VI: Resolution of Non - Compliance: The Contractor will be notified by email within 15 days of discovery of a compliance issue. Within 30 days 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 email and agreed to by both parties. If extenuating circumstances arise that require an extension to the time line, the Contractor must email a request to the Contract or Project Monitor 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 Remedies section of the General Provisions of this contract. Page 6 of 6 EXHIBIT C BUDGET To Contract Dated 06/28/2013 - Contract Routing Number 14 FHA 58481 The Budget shall govern the Contractor's expenditure of funds for the term through and including June 30, 2014. EaLle Page 1 of 2 FXATRiT r Contractual Indirect TOTAL $7,500.00 X500 p0 Total funding for combined projects listed above: $27.500.00 Page 2 of 2 EXHIBIT D GRANT FUNDING CHANGE LETTER Date: State Fiscal Year: Grant Funding Change Letter # CMS Routing # TO: Insert Grantee's name In accordance with Section of the Original Contract routing number , [insert the following language here if previous amendment(s), renewal(s) have been processed] as amended by [include all previous amendment(s), renewal(s) and their routing numbers], [insert the following word here if previous amendment(s), renewal(s) have been processed] between the State of Colorado, Department of Public Health and Environment and Contractor's Name beginning Insert start date < insert start date of original contract> and ending on Insert ending date <insert ending date of current contract amendment >, the undersigned commits the following funds to the Grant: The amount of grant funds available and specified in Section of <insert'contract amendment number and routing number> is ❑ increased or ❑ decreased by $amount of change to a new total funds available of $ < insert new cumulative total> for the following reason: Section is hereby modified accordingly. This Grant Funding Change Letter does not constitute an order for services under this Grant. The effective date of hereof is upon approval of the State Controller or , whichever is later. STATE OF COLORADO John W. Hickenlooper, GOVERNOR Department of Public Health and Environment PROGRAM APPROVAL: By: By: Lisa Ellis, Purchasing & Contracts Unit Director Date: ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §24 -30 -202 requires the State Controller to approve all State Grants. This Grant is not valid until signed and dated below by the State Controller or delegate. Grantee is not authorized to begin performance until such time. If Grantee begins performing prior thereto, the State of Colorado is not obligated to pay Grantee for such performance or for any goods and /or services provided hereunder. By: STATE CONTROLLER David J. McDermott, CPA Date: Page 1 of 1 Effective Date: 176 /o9 -Rev 8/25/09