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HomeMy WebLinkAboutC14-156 Estoy Sano Project Amendment for Task Order #2 DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ADM-ORE DEPARTMENT OR AGENCY NUMBER FAA CONTRACT ROUTING NUMBER 15_65634 AMENDMENT FOR TASK ORDERS#2 This Amendment is made this 05 day of March 2014,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 August 31,2012,with contract encumbrance number PO FAA ADM1348409,and contract routing number 13 FAA 48409, as amended by Amendment for Task Orders#1,routing number 14 FAA 55256,referred to herein as the"Original Task Order Contract,whereby the Contractor was to provide to the State the following: Develop the;Soy 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 Seventy-Six Dollars,($215,776.00)for the renewal term of 1 year,ending on June 30,2015,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: 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 FAA 48409 as amended by Contract Amendment#1, routing number 14 FAA 55256,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 FAA 48409. This Amendment is for the renewal term of July 01, 2014,through and including June 30,2015. The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is Two-Hundred Fifteen Amendment Task_Order 083010 Page 1 of 5 Thousand,Seven-Hundred Seventy-Six Dollars,($215,776.00)for an amended total financial obligation of the State of Five-Hundred Seventy-Three Thousand,Three-Hundred Eighty DOLLARS,($573,380.00). This is an increase of Two-Hundred Fifteen Thousand,Seven- Hundred Seventy-Six Dollars,($215,776.00)of the amount payable from the previous term. The revised Additional Provisions and Statement of Work are incorporated herein by this reference and identified as"Exhibit H,"and"Exhibit I". The revised Budget is incorporated herein by this reference and identified as"Exhibit J". 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 01,2014,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. Amendment Task Order_083010 Page 2 of 5 This page left intentionally blank. Amendment_Task Order_083010 Page 3 of 5 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. CONTIIACTOR: STATE: BOARD OF COUNTY COMMISSIONERS OF STATE OF COLORADO EAGLE COUNTY(a political subdivision of the John W.Hickenlooper,Governor state of Colorado)for the use and benefit of the Eagle County Public Health Agency By: ,>ignature of n orized Officer For the Executive Director DEPARTMENT OF PUBLIC HEALTH 11 + (� A1 I AND ENVIRONMENT 'Print Name of Authorized Officer }Print Title of Authorized Officer PROGRAM APPROVAL: By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS§ 4-30-202 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 Robert Jaros,CPA,MBA,JD By: Date: Amend‘ent Task_Order 083010 Page 4 of 5 This page left intentionally blank. Amendment_Task_Order_083010 Page 5 of 5 • EXHIBIT H ADDITIONAL PROVISIONS To Task Order Contract Dated 03/05/2014- Contract Amendment Routing Number 15 FAA 65634 • These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 1. This Task Order Contract contains state funds 2. To receive compensation under the Task Order Contract,the Contractor shall submit a signed Monthly CDPHE Reimbursement Invoice Form. This form is accessible from the CDPHE internet website http://www.colorado.gov/cs/Satellite/CDPHE-Main/CBON/1251622941228 and is incorporated and made part of this Task Order Contract by reference. CDPHE will provide technical assistance in accessing and completing the form. The CDPHE Reimbursement Invoice Form and Expenditure Details page must be submitted no later than forty-five(45)calendar days after the end of the billing period for which services were rendered. Expenditures shall be in accordance with this Statement of Work and Budget. Scan the completed and signed CDPHE Reimbursement Invoice Form into an electronic document. Email the scanned invoice and Expenditure Details page to: Deanna Butler,Office of Health Equity,at deanna.butler@state.co.us Final billings under the Task Order Contract must be received by the State within a reasonable time after the expiration or termination of the Task Order Contract;but in any event no later than forty-five(45) calendar days from the effective expiration or termination date of the Task Order Contract. Unless otherwise provided for in the Task Order Contract,"Local Match",if any,shall be included on all invoices as required by funding source. The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless approved in writing by CDPHE. 3. 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. b. 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. c. 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 thirty(30) calendar days,to correct the noted deficiencies. If the Contractor fails to correct such deficiencies within thirty(30)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. To be attached to CDPHE Page 1 of 3 Revised: 12/19/06 Task Order v1.0(3/12)contract template EXHIBIT H 4. Health Insurance Portability and Accountability Act(HIPAA)Business Associate Determination. The State has determined that this Task Order Contract does not constitute a Business Associate relationship under HIPAA. 5. The list of acronyms attached hereto as Attachment H-1 may be referenced to in Exhibit H,Exhibit I, Exhibit J,and all and any attachments thereof in this Task Order Contract. 6. Contractor shall request prior approval in writing from the State for all modifications to,the Statement of Work/Work Plan or for any cumulative modification to the direct costs in excess of twenty-five percent (25%)of the total budget for direct costs,between approved budget categories. Budget revisions are also required to incur expenses against a budget category with zero funds budgeted.To open a new budget category line,one must seek approval prior to incurring expenditures against the new line.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 General Provisions,Section 5,of this Task Order Contract. 7. If Contractor indicates full expenditure of funds under this Task Order Contract by January 31,2015 of each grant year and the full expenditure does not occur,CDPHE has the option to reduce current or upcoming Task Order Contract by said amount or a percent deemed reasonable by CDPHE.The State will notify the Contractor of the potential need to decrease the current or upcoming budget. If the Contractor indicates at a later date than January 31of each grant year an expectation of surplus of funds or inability to fully expend said funds for unforeseen circumstances that Contractor had not anticipated by January 31, CDPHE will reallocate unspent funds without any penalties to the Contractor. Upon receipt of timely written notice of an objection by the State for inability to fully expend funds,the Contractor shall have a reasonable period of time not to exceed ten(10)calendar days to respond to the action. If no dispute is received by the State within ten(10)calendar days,the State has the option to reduce the current budget for the current year and any upcoming budget for future contractual agreements. 8. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9,Rights in Data,Documents and Computer Software or Other Intellectual Property,unless otherwise provided for,all data collected or produced or derived exclusively from the Contractor's or subcontractor's work under this Task Order Contract shall remain the sole property of the State,whether in individual,aggregate,identified or de-identified form or any other form required by the State. To facilitate follow-up,research,surveillance and evaluation,any such data collected,used or acquired shall be made available in any form required by the State,to the State and any other entity designated by the State. Any such data collected,used or acquired shall be used solely for the purposes of this Task Order Contract. The Contractor and its subcontractors agree not to release,divulge,publish,transfer,sell,or otherwise make known any such data to unauthorized persons without the express prior written consent of the State or as otherwise required by law.This includes a prior written request by the Contractor to the State for submission of abstracts or reports to conferences,which utilize data collected under this Task Order Contract. Notwithstanding the foregoing,the Contractor shall be entitled to retain a set of any such data collected or work papers necessary to perform its duties under this Task Order Contract and in accordance with professional standards. 9. 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 To be attached to CDPHE Page 2 of 3 Revised: 12/19/06 Task Order v1.0(3/12)contract template EXHIBIT H 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. 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 lfor 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 Task Order 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 Task Order 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). 14. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding Letter substantially equivalent to Attachment 11-2.The Grant Funding Change Letter is not valid until it has been approved by the State Controller or designee. 15. The State may require continued performance for a period of up to four years at the same rates and same terms specified in the Task Order Contract.If the State exercises the option,it will provide written notice to Contractor at least 30 days prior to the end of the current contract term in a form substantially equivalent to Attachment H-3.If exercised,the provisions of the Option Letter shall become part of and be incorporated into the original Task Order Contract.The total duration of this Task Order Contract,including the exercise of any options under this clause,shall not exceed(Note: 5 years is the maximum allowable.) To be attached to CDPHE Page 3 of 3 Revised: 12/19/06 Task Order v1.0(3/12)contract template Attachment H-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 Larimer 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 H-1 CCTCI 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 CMC 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 H-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 FIT/FOBT 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 ISHT 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 Latins 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 H-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 Practitioner 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 H-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 Q1 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 SOW Scope of Work 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 Page 5 of 6 Attachment H-1 TABS Tobacco Attitudes and Behavior Survey 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 Y @C 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 • Attachment 11-2 GRANT FUNDING CHANGE LETTER Date: I State Fiscal Year: I Grant Funding Change Letter# I 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: Lisa McGovern, Purchasing &Contracts Unit By: 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. STATE CONTROLLER Robert Jaros,CPA,MBA,JD By: Date: Page 1 of 1 Effective Date: 1/6/09-Rev 8/25/09 Attachment H-3 OPTION LETTER � Date: I State Fiscal Year: Option`Letter No. I CMS Routing# 1) OPTION : Choose all applicable options listed in§1 and in§2 and delete the rest. a.Opti n to renew only (for an additional term) b.Cha ge in the amount of goods within current term c.Cha ge in amount of goods in conjunction with renewal for additional term d.Lev I of service change within current term e. Lev I of service change in conjunction with renewal for additional term f. Opti n to initiate next phase of a contract 2) REQUIR D PROVISIONS.All Option Letters shall contain the appropriate provisions set forth below: a. For se with Options 1(a-e): In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed Institution ,and Contractor's Name, the State hereby exercises its option for an additional term beginning Insert start date and ending on Insert ending date at a cost/price specified in Section ,AND/OR an increase/decrease in the amount of goods'services at the same rate(s)as specified in Identify the Section,Schedule, Attachment, Exhibit etc. b. For Use with Option 1(f), please use the following: In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed Institution ,and Contractor's Name,the State hereby exercises its option to initiate Phase indicate which Phas :2, 3, 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price specified in Section . c. For se with all Options 1(a-f):The amount of the current Fiscal Year contract value is increaed/decreased by$amount of change to a new contract value of Insert New$Amt to as consideration for se ices/goods ordered under the contract for the current fiscal year indicate Fiscal Year.The first sentelce in Section is hereby modified accordingly. The total contract value including all previous amendments, option letters, etc. is Insert New$Amt. 3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or , whichever is later. STATE OF COLORADO Jahn W. Hickenlooper, GOVERNOR PROGRAM APPROVAL: Department of Public Health and Environment By: By: Lisa McGovern, Purchasing&Contracts Unit Director Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS§24-30- 02 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 Robert Jaros, CPA, MBA,JD By: Date: Pagelofl ' I a Effective,Date 1/6/09-Rev 8/25/09 I • X W ° o a) Y y a) O o ' o L - a V o a .ci cet y /D 0 r71 Y "0 et rl bA 0 ti .a 0 .¢ U V a o w a) M O = > o■o i. c d O U In ^0 >U C y. U O v M o X V1 a)co aq W ai ai R7 i co w sv. W ' ,..0 co. o to > Z ° a) a) •vl 03 O O aa)) cct h 0 0-, v,r. 0 •O OG N. M/� .. 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L) O ci d E-� -0 .0 Z ° E w - F-, k7 > r ExhibitJ Budget t r Colorado Department of Public Health and Environment '41 PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM �''a Contract Routing# 15 FAA 65634 Colorado. i, t oIPublkH- th andEn iro ent Program Contact Name Karen Koenemann,Healthy Communities Contractor Name Eagle County Manager,970-328-2610, Title"Phone and Email ,.,. A„;.; - karen.koenemann @eaglecounty.us Budget Period Fiscal Contact Name Title : Wendi Gill,Fiscal Specialist,970-328-8804, July 1,2014-June 30,2015 Phone and Email wendi.gill @eaglecounty.us ='Project Name - Estoy Sano Expenditure Categories .n 7.% �.. ; 'z' ;'t;. � a".a rl �. . # F tvqv s ° ° "^ ^. � ; n, 2,,, .evi rs s4 f .„ A* . pers n eMces ' , ," a . i , 1Ov ',r . � : '1 a ” a - , '1.,„.1„,-', s � ` t " t P ` �' 4 c u r u " r ' 0. -- A > K .` . s % : s- .ld E. - s , A� �� < ". 's s3 4. , --'1 .'• o ee ; , 4 'n € ' , ,f + -, e x ..,t.-t i, r b ' ,f d «4, .„, , : m,,w,l's�.f' =z :w,,, .,, ,. ,,„-- -a„ . $ List SOW deliverable/ primary task number(s)this Percent of Total Amount Position Title/Employee budget item Gross or Time on Requested from Name i Description of Work supports Annual Salary Fringe Project CDPHE Project Director-Karen Ms.Koenemann will provide oversight of staff, All $70,040.00 $23,928.00 10% $18,794.00 Koenemann programming and ensure fiscal responsibility of budgeting and coordinating subcontractors. (Fringe 34.163%) Project Coordinator-Lead Ms.Haas will be housed in the Eagle office and All, $49,440.00 $21,057.00 50% $35,249.00 Katie Haas 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 community partners to build networks,coordinate with community partners, provide nutrition education,coordinate with public' health programs,collect and analyze data. (Fringe= 42.591%) i - Description of fringe Fringe costs paid by Eagle County vary by employee, $0.00 depending on the individual's selection of benefits. Fringe costs cover Eagle County's expense of personnel benefits,which includes:Life Insurance, AD&D,LTD,Vision,Health and the county match on retirement. ■ $0.00 $0.00 $0.00 t $0.00 $0.00 $0.00 $0.00 �;,r� ��-� � Z $ bt e`s`�; � �`� � �. ;� &,�r -. ?t a .� :�r z .,« es urf'- �. s a ,' ' List SOW deliverable/ primary task Total#of Total Amount , Position Title/Employee number(s)this Hours on Requested from Name 1 Description of Work budget item _Hourly Wage Hourly Fringe Project CDPHE Page 1 of 7 Exhibit.1 Budget Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM °,a/ ' Contract Routing# 15 FAA 65634 Colorado Department of PublicHeald) and Envimnmcnr Program Contact Name, Karen Koenemann,Healthy Communities Contractor Name Eagle County Manager,970-328-2610, Title Phone and Email. karen.koenemann @eaglecounty.us Fiscal Contact Name,Title; Wendi Gill,Fiscal Specialist,970-328-8804, Budget Period Phone and Email wendi. ill @ea lecoun us July 1,2014-June 30,2015, g g Ty• Project Name Estoy Sano $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 --- $0.00 ---- _ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ----. $0.00 $0.00 ---- $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Supp•ies Operating Expenses 44a' '`� "e...'.. List SOW deliverable/ primary task number(s) Total Amount this budget Requested from Item Description of Item item supports Rate Quanti CDPHE Printing/Copying Colored Spanish/English posters for nutrition education/awareness,and D1,A1;D5,A2 $1.00 2250 $2,250.00 materials to promote the Cooking Show,EFNEP classes(i.e.take-away post cards),and EBT machine/SNAP at farmers markets. (stand-up signs approx.$20 each x 10=$200,posters=$1.00 each x 300=$300,post cards.50 each x 2000=$1,000,brochures.$.75 each x 1000=$750) Supplies:EFNEP Food activity,lesson materials,copies for participants D1,A2 $10.00 720 $7,200.00 $10.00/participant x 24 classes x 6 participants x 5 class locations = $7,200 Operating:La Neuva Mix La Nueva Mix Radio Nutrition Segments-weekly 5-minute airings(52 D2,A1 $30.00 52 $1,560.00 Radio Show weeks x$30=$1,560) Operating:La Neuva Mix La Nueva Mix Radio Nutrition Segments re-runs on 2 weekends per D2,A1 $20.00 22 $440.00 Radio Show month=22420=$440) Page 2of7 Exhibit J Budget k r'�,� Colorado Department of Public Health and Environment i7 PREVENTION SERVICES DIVISION BUDGET WITH JUSTIFICATION FORM • 4646" Contract Routing# 15 FAA 65634 Colorado l or of Public H th anti En vn cnt Program ContactName Karen Koenemann,Healthy Communities Contractor Name Eagle County g Title Phone and Email Manager,970 328-2610, karen.koenemann @ eaglecounty.us Fiscal Contact Name Title Wendi Gill,Fiscal Specialist,970-328-8804, Budget Period " July 1,2014-June 30,2015 Phone and Email wendi.gill @eaglecounty.us Project Name Estoy Sano Operating:Public educa ion Use local radio stations to increase public education ALL $100.00 50= $5,000.00 and program awareness on around importance of healty eating and healthy radio food donations;and increase awareness of Estoy Sano programs including:EFNEP,Cooking Show, Health Tips,Produce for Pantries.($100 x 50 air spots=$5,000) Operating:Public educa ion Use the Vail Daily and local radio stations to increase public education All $280.00 23: $6,440.00 and program awarenesslin around importance of healty eating and healthy food donations; local newspapers - promote Estoy Sano programs including:EFNEP,Cooking Show,Health } Tips,Produce for Pantries.(23 ad spaces x$280 each=$6440) Supplies:Cooking show` aw Raw food costs for the ECO-TV 18 Spanish Language Cooking Show; D2,A2 $115.00 12> $1,380.00 food and other supplies kitchen supplies such as cleaning,paper and cooking.($115 x 12 cooking shows) Supplies:ECO-TV airing i`' TVs to air cooking show at Eagle County Public Health offices that serve D2,A2 $2,300.00 2 $4,600.00 equipment many low-income Spanish speaking clients.(TVs and mounts at$300 each,$2,000 each in hardward and software for digital signage(iCompei Black Box)-allows for content storage and looped streaming of cooking shows and other health messaging). Supplies:Produce for Supplies to support produce for pantries as:carts,starter plants,storage D3,A2;D3,A4; $500.00 3 $1,500.00 Pantries bins,garden tools etc. Supplies:Latino Health Supplies to support the photo voice project including cameras,food for D4,Al $250.00 4 $1,000.00 Leadership Group meetings with community stakeholders,photo development,photo mounting and display for community awareness Supplies:EBT at farmer Supplies to support the Edwards Farmers Market to process SNAP DS,Al;05,A3 $2,000.00 1 $2,000.00 markets benefits(formally known as food stamps)for the purchase of food items,increasing the access to healthy foods for low-income residents in the Eagle River Valley during market months(June-October). Supplies include Electronic Benefits Transfer(EBT)machine=$1,000,tokens for vendor reimbursement=$750,other supplies i.e.table/stand for EBT machine=$250). Page 3 of 7 Exhibit 1 Budget c• . „ • Colorado Department of Public Health and Environment . 'o *I PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM •,,a,�. Contract Routing# 15 FAA 65634 Colorado Department of Public Health and Emironnicnt - Karen Koenemann,Healthy Communities Program Contact Name,, Contractor Name Eagle County Manager,970-328-2610, Title Phone and Email - karen.koenemann@eaglecounty.us Fiscal Contact Name Title, Wendi Gill,Fiscal Specialist,970-328-8804, Budget Period Phone and Email wendi.gill@eaglecounty.us July 1,-2014-June 30,2015 lecounty.us g g Project Name Estoy Sano Operating:double value Double Value Coupons(DVC)for SNAP recipients(up to$20 per visit)at 135,A3 $20.00 350 $7,000.00 coupon subsidy Farmers Markets-produce is generally more expensive at farmers markets,so shopping there would normally be cost prohibitive for SNAP recipients. Allows SNAP recipients to be able to afford produce at farmers markets that would otherwise be cost prohibitive. Edwards Farmers Market is located in a town without an affordable grocer option so this will increase access to healthy foods for SNAP recipients. DVCs will be tracked through weekly report on all transactions with SNAP and DVCs provided by the Edwards Farmers Market Organizer.(Estimated 25 SNAP recipients per market x$20 DVC x 14 market days). In order to track distribution of DVCs,SNAP recipients will sign their name upon receipt of the DVC token. The number/value of tokens will be cross- checked with Edwards Farmers Market financial report of the amount of tokens disbursed/spent. . $0.00 $0.00 $0.00 . $0$0.00 $0.0 $0.00 00 0 $0.00 $0.00 . „ "- '' •. .i rc ,-. 40.379O0s r � �r T " "x ii} r , Y t a p r . " � Travel 4 - H,¥ r . s€ ra List SOW deliverable/ primary task number(s) Total Amount this budget Requested from Item Descri.tion of Item item su••oils Rate s uantit CDPHE Mileage-in state Trips required for meetings and coordination among community D3,Al $0.51 3,200 $1,632.00 partners,and reimbursement for food donation pick ups for the Produce for Pantries program-an estimated miles 266.66 miles per month x 12 months,reimbursed at$0.51 per mile. $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 _ Page 4 of 7 Exhibit 1 Budget Colorado Department of Public Health and Environment t? },' PREVENTION SERVICES DIVISION-BUDGET WITH JUSTIFICATION FORM &' Contract Routing# 15 FAA 65634 Colorado s . nr of Public H-th andEmiro .ent • Karen Koenemann,Healthy Communities xl -4 Program Contacf.Name ' Y Contractor Name Eagle County Manager,970-328-2610, e t -,`x Title Phone and Email ,,Q,; • .. , -*-. Q: ,y i4 . ,.<.,,' karen.koenemann@eaglecounty.us :`, Fiscal Contact Name Title Wendi Gill,Fiscal Specialist,970-328 8804,' Budget Period ,-„--,,21..v•:-0,1--, ,,,"$-::-,-', v, , a q ; •i i'= July 1,2014-June 30,2015 one and_Emal - wendi.gill @eaglecounty.us Project Name Estoy Sano $0.00 $0.00 $0.00 14 � ...?„.. ��&;:-...., x...�a..''""i:14.„:.-i . ;r ?-Yri+.f :: " `' r •,e D " 7 ::I1,.12QQ ii 0 o,--k x�; 1+«' , ,""z ' .,,, yr1 :tr a.t a rn fix` - ^ e tfr ;ti ., w '� .b' s4` "' °of s ";:s 9 ,, a-,, o, f 2 k ,I,. . ,i cContractual z s k t �� .z� -- y ��+f List SOW ideliverable/ primary task 1 number(s) 4:,. . Total Amount this budget Requested from Subcontractor Nam Description of Item item supports Rate Quanti o-, . CDPHE ECO-TV Cooking Hosts The ECO-TV 18 Cooking Hosts are a bilingual chef and a nutritionist.They D2,A2 $80.00 60 $4,800.00 were selected based on their expertise and skill.They will be the face of the Cooking Show,demonstrating proper cooking techniques and health and nutrition tips while cooking.(2 hosts x$40.00/hr x 60 hrs= $4,800.00). Hispanidad Hispanidad was selected through a County bidding process.Hispanidad D2,A1;D2,A2; $100.00 330, $33,000.00 will create Estoy Sano Project materials(i.e.nutrition education and D4,A2 awareness),help translate TV and radio scripts,and assure cultural relevancy of programming.Deliverables include English and Spanish Estoy Sano Project brand colateral,TV and radio scripts,and attendance of at least two Latino Health Leaders Group meetings. Venturoni Surveys and Venturoni Surveys was selected though a county bidding process. All $80.00 150 $12,000.00 Research,Inc Venteroni Surveys was hired to create evaluation tools,collect and analyze data annually and create a final evaluation report.Deliverables will include evaluation tools,collection and analyzation of data annually for all programs and a final project report at the end of the 3-year funding cycle. Estoy Sano Program The Estoy Sano Program Contractor will serve as the primary liasion with All $45.00 1,040 $46,800.00 Contractor Communit4 the Latino community for program outreach and provide capacity to Liaison complete program deliverables. CSU Extension Agent The Family and Consumer Science Extention Agent was selected based D1,A2;D2,A2 $36.21 250 $9,053.00 on their cooking and nutrition knowledge.They act as the technical advisor for the cooking show,collecting recipes and techniques to demonstrate for the show. They also are assisting with the EFNEP evaluation data collection.Deliverables include taped and aired cooking shows. UC Denver UC Denver will employ a train-the-trainer model to train the Estoy Sano D4,Al $ 125.00 8 $1,000.00 Program Contractor on how to facilitate a photo voice series as part of the Latino Health Leadership Group to foster community engagement and allow the community to be empowered to share about barriers to healthy eating and active living in Eagle County. I Page 5 of 7 Exhibit.'Budget Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM 6`y Contract Routing# 15 FAA 65634 Colorado Department of Public Health and Environment PT rogram Contact Name Karen Koem , mmunities Contractor Name Eagle County ' Manager neann,970-328-261Co0, itle,Phone and,Email ka ren.koeneman n @eaHealthy l gecounty.0 s Budget Period Fiscal Contact Name Title; Wendi Gill,Fiscal Specialist,970-328-8804, July 1,2014-June 30,2015 Phone and Email wendi.gill @eaglecounty.us Project Name Estoy Sano $0.00 $0.00 '$0.00 $0.00 $0.00 --- $0.00 --- _. $0.00 $0.00 $0.00 --- $0.00 $0.00 $0.00 --_ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 - �: # .fe .ter ..d�..l ontr 9 i 3� 4-K SUB TOTAL BEFORE INDIRECT l2 -- 0 $202,698.00 Page 6 of 7 Exhibit 1 Budget '"? "Colorado Department of Public Health and Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM 187. Contract Routing# 15 FAA 65634 Colorado I ,,, ant ofPublicH-th andEnvim -t 4 Karen Koenemann,Healthy Communities Program Contact Name Contractor Name Eagle County Manager,970:328-2610, ' Title Phone and Email ,:;4 ��;3qi karen.koenemann @eaglecounty,us ' # Fiscal Contact Name Title Wendi Gill,Fiscal Specialist,970-328-8804, Budget,Penod `'n.." ,,,�4 r w. July 1,2014-June 30,2015 phone and Email ` wendi.gill @eaglecounty.us ., Project Name Estoy Sano ` � t t r„, - �s" i f 9 ' r f 0 *4-Ve fi W Ae f Aw t r x II Total Amount . , Requested from Item Description of Item � = CDPHE Negotiated Indirect cost Eagle County negotiated indirect rate is 24.2%based on salaries and fringe($54,043*24.2%=$13,078) $13,078.00 rate(Federal,State,or • CDPHE) Indirect rate(other): Indirect(modified or additional base)F °ai »- ` t x s:t aa -€ , r i s s ;'k *! ;17 a F,,y ",-. x'.tte :t*a..":� -. i, , `. 5 n iz z,.yr. k` ,', ' ''°-' ,40 '.y, r, ` ' .: V--:-° s r. , Zt a VVZa: Wax '•t`_.., , 4. ,* ' tTOTAL;IIAATCH ORIN KIND Y