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HomeMy WebLinkAboutC13-232 CDPHE Task Order #2 Amendment DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PSD-STEPP DEPARTMENT OR AGENCY NUMBER FLA CONTRACT ROUTING NUMBER 14-58645 AMENDMENT FOR TASK ORDERS#2 This Amendment is made this 24TH day of JULY,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),500 Broadway,Eagle,Colorado 81631-0850,for the use and benefit of the Eagle County Public Health Agency,whose address or principal place of business is 551 Broadway,Eagle,Colorado 81631, hereinafter referred to as the"Contractor". FACTUAL RECITALS The parties entered into a Master Contract,dated January 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 August 31,2012 with contract encumbrance number PO FLA PPG1348290 and contract routing number 13 FLA 48290,as amended by Contract Amendment#1,contract routing number 13 FLA 55276,collectively referred to herein as the"Original Task Order Contract,whereby the Contractor was to provide to the State the following: To provide tobacco cessation,reduce initiation of tobacco use,decrease tobacco prevalence among youth and decrease exposure to secondhand smoke. The State hereby exercises a"no cost"change to the budget and specifications within the Statement of Work within the current term of the Original Task Order Contract. 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 13 FLA 48290,as amended by Contract Amendment#1,contract routing number 13 FLA 55276,collectively referred to herein as the Original Contract,which is by this reference incorporated herein. All terms,conditions,and provisions thereof,unless specifically modified herein,are to apply to this Amendment as though they were expressly rewritten,incorporated,and included herein. 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 13 FLA 48290. This Amendment modifies the Statement of Work in Exhibit E of the Original Contract. The revised specifications to the Statement of Work are incorporated herein by this reference and identified as"Revised Exhibit E." Page 1 of 5 Rev 3/16/2010 G( -237 B. This Amendment also modifies the Budget in Exhibit F of the Original Contract. The revised specifications to the Budget are incorporated herein by this reference and identified as"Revised Exhibit F". 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 August 26.2013,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 ahy 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 5 Rev 3/16/2010 This page left intentionally blank. 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 John W.Hickenlooper,Governor (a political subdivision of the state of Colorado) for the use and benefit of the Eagle County Public Health Agency By::ID)F\jq 1/1 67-6111) Chita, Signatur of Authorized Officer For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Print Name of Authorized Officer M( ,(1-m c Print Title of Authorized Officer PROGRAM APPROVAL: Q r- B y: 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. 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OW fy H U cd o U O J o ab " w 15 W o �w° m r-. > o M- d- w .° 3 d o o a � Q U > 1 REVISED EXHIBIT F Colorado Department of Public Health and Environment • PREVENTION SERVICES DIVISION-BUDGET JUSTIFICATION FORM • s• To Task Order Dated 8/31/2012-Contract Routing Number 13 FLA 48290-Contract Amendment Routing Number 14 FLA 58645 Colorado Dep utrnrot of Public Health and Environment Contractor Name Eagle County Government Program Contact Name,Title,Phone Jordana Sabella,Tobacco Coordinator/970-920-5062/ and Email jordanapickman @gmail.com Budget Period July 1,2013-June 30,2014 Fiscal Contact Name,Title,Phone and Wendi Gill,Fiscal Specialist/970-328-8804/ Email wendi.gill @eaglecounty.us Project Name West Mountain Region Tobacco Program Amount Total Amount Expenditure Categories Original Budget Requested in Requested Amendment from CDPHE Gross or Annual Percent of Personal Services Sala Fringe FTE on ry Project 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 N of months budgetted. supports Ms.Rietmann will be housed in the Eagle office and facilitate programming east of Garfield County (Eagle River side of the region).She will act as lead, ensuring deliverables are met and reports are submitted in a timely,professional manner.She will work directly with Doctor's On-Call,Eagle Care,and Carly Rietmann Colorado Mountain College in Eagle County.Duties Deliverable 1-4 $50,469.00 $13,124.00 50.00% $31,797.00 $31,797 will include buildingnetworks,coordinating with BACCHUS,identifying a champion and lead contact at CMC,providing education to health care providers,coordinating with public health programs,collecting and analyzing data,and conducting research. Ms.Koenemann provides oversight of staff, Karen Koenemann programming,and ensures fiscal responsibility of Deliverable 1-4 $70,040.00 $23,928.00 20.00% $18,794.00 $18,794 the budget including subcontracts. Ms.Carey is a public health nurse who will provide tobacco education and quitline material distribution Theresa Carey when she makes her community rounds to Deliverable 1,2 $56,135.00 $21,993.00 5.00% $3,906.00 $3,906 providers,and will assist with the health systems change model. Total Personal Services (including fringe benefits) 0.75 . $54,497 $0.00 $54,497 Supplies&Operating Expenses List objective/activity number(s)this Amount Total Amount budget item Requested in Requested from Item Description of Item supports Rate Quantity Original Budget Amendment CDPHE Printing/Copying Outreach material for recruitment and education on CMC campuses Deliverable 3 (1,250 pieces per campus) $0.10 2,500 $250.00 $250 General office supplies Paper for in-house printing and purchased tobacco signage printing Deliverable 3 ($229) General office supplies(pens,notebook paper,printer cartridges,folder,etc.)estimated at$15 per month$15x12=$180). $380.00 1 $380.00 $29.00 $409 Meeting Expenses- Refreshments Deliverable 3 Food for in-person CMC training. $25.00 24 $600.00 $600 Page 1 of 3 • REVISED EXHIBIT F yf Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION-BUDGET JUSTIFICATION FORM •+01.76 To Task Order Dated 8/31/2012-Contract Routing Number 13 FLA 48290-Contract Amendment Routing Number 14 FLA 58645 Colorado Drpattment of PublicHes>)th • and Enanonmmt Program Contact Name,Title,Phone Jordana Sabella,Tobacco Coordinator/970-920-5062/ Contractor Name Eagle County Government and Email jordanapickman @gmail.com Fiscal Contact Name,Title,Phone and Wendi Gill,Fiscal Specialist/970-328-8804/ Budget Period July 1,2013-June 30,2014 Email wendi.gill @eaglecounty.us Project Name West Mountain Region Tobacco Program group inccntivcs:$25 Visa Cards for"0 focus group participants.We will lnc fie -- - -. ------ ----- - - -- -- - Deliverable-3. $26 GG 40 $17000.00 $1,000.00 Advertisements for Colorado QuitLine and other tobacco education, Advertisement-Newspapler prevention,and cessation messages in various county newspapers-3 Deliverable 1-4 $250.00 12 $3,000.00 papers x 4 ads x$250.00($3,000) $3,000 Advertisement-Buses Advertisements for Colorado QuitLine on local buses(6 buses at$3,100)Deliverable 1-4 $3,100.00 6 $18,600.00 $18,600 Advertisement for Colorado Quitline-2 weeks of radio ads($6.00/per Advertisement-Radio 30 sec spot x 140=$830.00 Deliverable 1-4 $6.00 140 $$40.00 $840 Total Supplies $24,670 -$971 $23,699 &Operating Exn ped Travel List objective/activity Item number(s)this Amount Total Amount budget item Requested in Requested from Description of Item supports Rate Quantity Original Budget Amendment CDPHE Based on 285 miles traveled per month,reimbursed at$0.51 per mile, Mileage calculated for 12 months(285 miles x.51/mile x 12 months= Deliverable 1-4 $0.51 3420 $1,744.20 $1,644.20).Miles include 2 required trips to Denver for training $1,744 2 nights lodging for a total of 2 trips to Denver(required trainings).One Lodging TC will attend each training.Nighly lodging amount based on current Deliverable 1-4 $150.00 4 $600.00 government lodging rates.2x2x$150.00=$600.00 • $600 Based on 2 days for 2 required trainings in Denver;reimbured at the Meals Federal Rate of$66 per day.One tobacco coordinator will attend each Deliverable 1-4 $66.00 4 $264.00 training=2x2x66=$264.00 $264 Total Travel $2,608 $0 $2,608 • Page 2 of 3 REVISED EXHIBIT F Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION-BUDGET JUSTIFICATION FORM �+e'e• To Task Order.Dated 8/31/2012-Contract Routing Number 13 FLA 48290-Contract Amendment Routing Number 14 FLA 58645 Colorado Department ofPublicHralth and Environment Program Contact Name,Title.Phone Jordana Sabelle,Tobacco Coordinator/970-920-5062/ Contractor Name Eagle County Government and Email jordanapickman @gmail.com Fiscal Contact Name,Title,Phone and Wendi Gill,Fiscal Specialist/970-328-8804/ Budget Period July 1,2013-June 30,2014 Email wendi.gill @eaglecounty.us Project Name West Mountain Region Tobacco Program Contractual(payments to third parties or entities) List objective/activity Item number(s)this Amount Total Amount budget Hem Requested in Requested from Subcontractor Entity Name and/or Description of Item. supports Rate Quantity Original Budget Amendment CDPHE Contract with BACCHUS Network to provide technical assistance with Objective 3:Tobacco-Free Community Colleges.BACCHUS will provide 1) Total TA-$7,925(including conference calls,webinar training development,signage development,curriculum infusion,cessation and BACCHUS enforcement consulting,and one in-person training 2)Total Material- Deliverable 3 $915.40.a.Tobacco Education Table Kits-4x$219.00=$876.00 b.Stall stories-4 x 4.35=$17.40,c.Annual Collegiate Smokeout Manual 4 x $5.50=$22.00—Rate for services is based on BACCHUS'Affiliate State Organization rate. $655.78 12 $7,869 $971 $8,840 li For Garfield County Public Health staff to provide education to Mountain Family Health Center physicians and staff,provide support and technical Garfield County Public assistance to TEPAC coordinators,educate local elected officials,and Deliverable 2 Health assist with data collection and analysis.Staff include public health director,public health nurse,and health educator $412.50 12 $4,950 $4,950 Community Health Services,Inc.in Pitkin County will provide program oversight,leadership,guidance,and technical support.One Tobacco Community Health Services,coordinator will dedicate half of their time to assist with Inc. implementation of this program initiative.50 FTE$31,800.00$1644.20 Deliverable 2 mileage(285 miles @$0.51/mile 512=$1,744.20);$600 lodging($150 x 4 nights);$264 meals($66 x 4 days);operating and supplies$530. $2,903.18 12 $34,838 $34,838 Total Contractual $47,658 $971.00 $48,628 SUB-TOTAL BEFORE INDIRECT $129,432 $0.00 $129,432 Indirect Amount Total Amount Item Description of Item Requested in Requested from Original Budget Amendment CDPHE Negotiated Indirect cost rate Indirect(other):please list Eagle County's indirect rate is 21.27%of Salaries and Fringe.21.27%of$54,495.00=$11,591.09(more than 10%of direct specific indirect costs in costs restriction per RFA). 10%of direct costs approved by CDPHE. description if no rate exists $8,177 $0 $8,177 Indirect(other):Contractual 2%of contractual • rate,if applicable $947 $0 $947 Total Indirect $9,124 so $9,124 TOTAL $138,556 $0 $138,556 Page 3 of 3