No preview available
HomeMy WebLinkAboutC15-245 Colorado Department of Public Health and Environment CCPD GrantDEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CMS ROUTING NO. 16 FHLA 76514 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: CONTRACTOR: State of Colorado for the use & benefit of the Board of County Commissioners of Eagle County Department of Public Health and Environment 500 Broadway, Eagle, CO 81631-0850 PSD -CCPD for the use and benefit of the 4300 Cherry Creek Drive South Eagle County Public Health Agency Denver, CO 80246 CONTRACTORDUNS: 084024447 TASK ORDER MADE DATE: 4/30/2015 CORE ENCUMBRANCE NUMBER: CT FHLA TERM: This Task Order shall be effective upon approval by the State Controller, or designee, or on 07/01/2015, whichever is later. The contract shall end on 06/30/2016. PROCUREMENT METHOD: RFA #1244 BID/RFP/LIST PRICE AGREEMENT NUMBER: N/A LAW SPECIFIED VENDOR STATUTE: N/A STATE REPRESENTATIVE: Cassidy Smith ' Colorado Department of Public Health & Environment PSD -CCPD 4300 Cherry Creek Drive South Denver, CO 80246 CONTRACTOR ENTITY TYPE: Political Subdivision BILLING STATEMENTS RECEIVED: Monthly STATUTORY AUTHORITY: C.R.S. 25-20.5-302 CLASSIFICATION: Sub -Recipient CONTRACT PRICE NOT TO EXCEED: $225,000.00 FEDERAL FUNDING DOLLARS: STATE FUNDING DOLLARS: $225,000.00 MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR: FY 16 $225,000.00 PRICE STRUCTURE: Cost Reimbursement CONTRACTOR REPRESENTATIVE: Jennifer Ludwig Eagle County Public Health and Environment PO Box 660 Eagle, CO 81631 PROJECT DESCRIPTION: This project serves to increase the number of workplaces in Eagle, Grand, Jackson, Pitkin, and Summit Counties offering comprehensive worksite wellness programs that include healthy eating, physical activity and other healthy lifestyle behaviors Contract_Template_Task_Order_012215.doc Page 1 of 6 EXHIBITS: The following exhibits are hereby incorporated: Exhibit A - Additional Provisions (and any of its Attachments; e.g., A-1, A-2, etc.) Exhibit B - Statement of Work (and any of its Attachments; e.g., B-1, B-2, etc.) Exhibit C - Budget (and any of its Attachments; e.g., C-1, C-2, etc.) 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. 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 Contract Template_Task_Order _012215.doc Page 2 of 6 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 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. 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". 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 may be 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. 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, §24-102-2063 §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 Contract_Template_Task_Order_012215.doc Page 3 of 6 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. 8. 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. Contract Template_Task_Order_012215.doc Page 4 of 6 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 for the use and benefit of the Eagle County Public Health Agency Legal Name of Contracting Entity Print Name of Authorized SignaftV of Authorized Officer QNIi� Date By: Mk C-, By: Print Title of Authorized Officer STATE OF COLORADO: JOHN W. HICKENLOOPER, GOVERNOR For Executive Director Department of Public Health and Environment Department Program Approval: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER: Robert Jaros, CPA, MBA, JD By: Date Contract_Template_Task_Order 012215.doc Page 5 of 6 This page left intentionally blank. Contract_Template_Task_Order_0122! 5.doc Page 6 of 6 EXHIBIT A ADDITIONAL PROVISIONS To Contract Dated 04/20/2015 - CMS Contract Routing Number 16 FHLA 76514 These provisions are to be read and interpreted in conjunction with the provisions of the Contract specified above. This Task Order Contract contains state funds. 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 bttp://www.colorado,gov/es/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 with the Excel workbook containing the Expenditure Details page to: Vicki Bondurant CCPD Program Contracts Coordinator, at vicki.bond urant(a 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 federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. 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. 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. Page 1 of 2 Contract Exhibit -A AdditionalProvisions 040715 EXHIBIT A 5. This award does not include funds for Research and Development. 6. If Contractor indicates full expenditure of funds under this Task Order Contract by February 28 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. CDPHE will notify the Contractor of the potential need to decrease the current or upcoming budget. If the Contractor indicates at a later date than February 28 of 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 February 28, CDPHE will reallocate unspent funds without any penalties to the Contractor. Contractor shall request prior approval in writing from CDPHE for all modifications to the Statement of Work or for a cumulative modification to the direct costs in excess of twenty-five percent (25%) of the total budget for direct costs, between 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, the Contractor must seek approval from CDPHE prior to incurring expenditures against the new budget line. Any request for modifications to the Budget in excess of twenty-five (25%) percent of the total budget for direct costs or $250,000.00, whichever is less, shall be submitted to CDPHE at least ninety (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. 8. 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. - The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be the owner of all equipment as defined by the 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 Contract, the State shall approve the disposition of all equipment. 10. 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). 11. CDPHE may increase or decrease funds available under this Task Order Contract using a Grant Funding Change Letter substantially equivalent to Attachment A-1. The Grant Funding Change Letter is not valid until it has been approved by the State Controller or designee. 12. CDPHE may require continued performance for a period of up to two (2) years at the same rates and same terms specified in the Task Order Contract. If CDPHE exercises this option, it will provide written notice to Contractor at least thirty (30) days prior to the end of the current Task Order Contract term in a form substantially equivalent to Attachment A-2. If exercised, the provisions of the Option Letter shall become part of and be incorporated into the original Contract. The total duration of this Task Order Contract, including the exercise of any options under this clause, shall not exceed three (3) years. Page 2 of 2 Contract Exhibit -A AdditionalProvisions 040715 Attachment A -I GRANT FUNDING CHANGE LETTER Date: State Fiscal Year: Grant Funding Change CMS Routing # Letter # CORE Encumbrance # 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 routin number> is E] increased or F-1decreasedby $amount of change to a new total funds available of 9 <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 McGovern, 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 Robert Jaros, CPA, MBA, JD Date: Contract_GrantFundingChangeLetter_01-2015 Page 1 if 1 Attarhmi-nt A-7 OPTION LETTER Date: Istate Fiscal Year: Option Letter No. I CMS Routing # CORE Encumbrance # 1) OPTIONS: Choose all applicable options listed in §1 and in §2 and delete the rest. a. Option to renew only (for an additional term) b. Change in the amount of goods within current term c. Change in amount of goods in conjunction with renewal for additional term d. Level of service change within current term e. Level of service change in conjunction with renewal for additional term f. Option to initiate next phase of a contract 2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below: a. For use 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 Phase: 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 use with all Options 1(a -f): The amount of the current Fiscal Year contract value is increased/decreased by $ amount of change to a new contract value of Insert New $ Amt to as consideration for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first sentence 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 John 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 §24-30-202 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: STATE CONTROLLER Robert Jaros, CPA, MBA, JD Date: Contract_OptionLetter 01-2015 Page 1 tf 1 EXHIBIT B STATEMENT OF WORK To Original Contract Routing Number 16 FHLA 76514 These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above. I. Entity Name: Eagle County Public Health Agency Term: July 01, 2015 -June 30, 2016 II. Project Description: This project serves to increase the number of workplaces in Eagle, Grand, Jackson, Pitkin, and Summit Counties offering comprehensive worksite wellness programs that include healthy eating, physical activity and other healthy lifestyle behaviors, in order to reach at -risk populations to reduce risk factors for chronic diseases such as cancer and cardiovascular disease. Workplaces will be assisted in strengthening existing or creating new evidence -based wellness programs through Health Links. III. Definitions: 1. CCPD -Cancer, Cardiovascular and Pulmonary Disease Prevention Program 2. CDPHE-Colorado Department of Public Health and Environment 3. ECPHE — Eagle County Public Health and Environment 4. Evaluation Contractor (to be determined): Third party required by statute to conduct program evaluation. 5. NWCCOG — Northwest Colorado Council of Governments 6. NWCCOG Economic Development Region - Eagle, Grand, Jackson, Pitkin, and Summit Counties 7. RHWSP — Regional Health and Wellness Sector Partnership (serving as worksite wellness coalition) Quarter Timelines: Quarter 1: July 1 to September 30 Quarter 2: October 1 -December 31 Quarter 3: January 1 -March 31 Quarter 4: April 1 -June 30 IV. Work Plan: Goal #1: Transform communities to support health and make healthy behaviors easier and more convenient for Coloradoans. Objective #1: This project serves to increase the number of workplaces in five counties offering comprehensive worksite wellness programs that include healthy eating, physical activity and other healthy lifestyle behaviors, in order to reach at -risk populations to reduce risk factors for chronic diseases such as cancer and cardiovascular disease. Primary Activity #1 The Contractor shall formalize and grow membership in NWCCOG's RHWSP to include representation from the Economic Development Region. 1. The Contractor shall convene core group members that are representative of all five counties, private and public sector organizations, and who represent populations likely Sub -Activities #1 to be at -risk for chronic disease. 2. The Contractor shall develop common goals, schedule of meetings, and other supporting documentation for the RHWSP. 3. The Contractor shall report progress back to local public health agencies, local chambers, and other relevant stakeholders in each County. Primary Activity #2 The Contractor shall assess RHWSP members' values, relationship network, and perception of worksite wellness strategies. 1. The Contractor shall develop or adopt an effectiveness survey evaluation tool. Sub -Activities #2 2. The Contractor shall administer the evaluation tool to RHWSP members. 3. The Contractor shall analyze the results of the effectiveness survey and disseminate to RHWSP members and other stakeholders. Page 1 of Contract Statement of Work— Exhibit B January 2015 EXHIBIT B Primary Activity #3I The Contractor shall initiate an assessment of gaps and associated needs and existing resources for worksite wellness across the region. 1. The Contractor shall collect and compile existing data relevant to worksite wellness in the NWCCOG Economic Development Region, 2. The Contractor shall develop or adopt an assessment tool to gather information on worksite wellness across the region. Sub -Activities #3 3. The Contractor shall conduct an assessment to gather information on worksite wellness across the region, with a particular focus on employers of populations deemed to be at -risk for chronic disease based on gaps identified from the collection and compilation of existing data. 4. The Contractor shall summarize and analyze the results of the assessment to identify gaps and associated needs and existing resn„rrPc fnr x—Arc4o ,,,Pll Ir- ♦I,- .-e.,,,.. Page 2 of 4 Contact Statement of Work—Exhibit B January 2015 Primary Activity #4 The Contractor shall assemble a corps of Health Links Advisors for the NWCCOG Economic Development Region 1. The Contractor shall hire Health Links Advisors to be representative of the Counties in the NWCCOG Economic Development Region. Sub -Activities #4 2. The Contractor shall ensure Health Links Advisors will receive training on Health Links, worksite wellness strategies, health equity, and other topics. 3. The Contractor shall provide trainings across the NWCCOG Economic Development Region to employers and other specified groups, to be identified, on specific topics for worksite wellness. Primary Activity #5 The Contractor shall ensure that Health Links Wellness Advisors will contact employers in five counties (across NWCCOG Economic Development Region) regarding worksite wellness programs and Health Links. 1. The Contractor shall contact, work with and provide technical assistance as needed to local stakeholder groups to promote and engage their audience in Health Links (e.g. local public health departments, Chambers of Commerce, High Country Human Resource Association, etc.). 2. The Contractor shall ensure that Health Links Advisors contact employers and business groups (e.g. chambers of commerce) to promote Health Links (e.g. chambers of commerce). 3. The Contractor shall ensure Health Links Advisors provide technical assistance to Sub -Activities #5 employers to improve existing wellness programs or develop to wellness programs and change organizational policies to support worksite wellness. 4. The Contractor shall develop a communications plan to educate employers about importance of worksite wellness and resources available to support them via Health Links. 5. The Contractor shall develop and -implement a public awareness campaign of worksite wellness program assistance tools (e.g. Health Links). 6. The Contractor shall ensure Health Links Advisors and other key staff participate in recognition events to increase awareness of worksite wellness programming in the region. Primary Activity #6 The Contractor shall complete a final detailed evaluation plan. 1. The Contractor shall comply with the requirements as specified in the Amendment 35 CCPD Strategy Requirements and Reporting Metrics document. This document is incorporated and made part of this contract by reference and is available on the Standards and following website https://www.colorado.gov/pacific/sitesldefault/files/DC A35 - Requirements CCPD Strategy -Specifications -and -Metrics pdf 2. The Contractor shall comply with the requirements as specified in the CCPD Final Evaluation Plan Guidance document. This document is incorporated and made part of this contract by reference and is available on the following website https:!/w-ww.colorado.gov/pacificlsites/default/files/'DC A35 -CCPD Evaluation Plan.pdf Page 2 of 4 Contact Statement of Work—Exhibit B January 2015 EXHIBIT B 3. The content of electronic documents located on CDPHE and non-CDPHE websites and information contained on CDPHE and non-CDPHE websites may be updated periodically during the contract term. The contractor shall monitor documents and website content for updates and comply with all updates. 4. The Contractor shall submit information required by the evaluation contractor (to be determined), including quarterly and final reports. This includes project monitoring as well as evaluation activities. 5. The Contractor shall send 1-2 representatives to attend a kick-off event in the Denver Metro Area in Fall 2015 (date(s) TBD). Increase the number of workplaces in Eagle, Grand, Jackson, Pitkin, and Summit Counties Expected Results of offering comprehensive worksite wellness programs that include healthy eating, physical Activity(s) activity and other healthy lifestyle behaviors, in order to reach at -risk populations to reduce chronic disease risk factors. 1. Number of participating employers due to the regional implementation of Health Measurement of Expected Links. Results 2. Baseline number of employers with worksite wellness programs as identified by the assessment. 3. Number of organizations receiving Healthy Business Certification. 4. Results of communication plan and public awareness camnaiens. Completion Date The Contractor shall submit the following to the CDPHE Program Contracts coordinator via email: Deliverables Page 3 of Contract Statement of Work—Exhibit B January 2015 1. The Contractor shall provide a CDPHE Progress Report. No later than 15 days following Q1, Q2, Q3, Q4 2. The Contractor shall provide a copy of the final evaluation No later than Q2 plan. 3. The Contractor shall provide an organizational summary of the No later than Q2 NWCCOG RHWSP. 4. The Contractor shall provide a report of the RHWSP goals, No later than Q2 objectives, member roster and meeting schedule. 5. The Contractor shall report on the results of the RHWSP No later than Q3 effectiveness survey. 6. The Contractor shall provide a summary document of meta- No later than Q4 analysis of the existing data relevant to worksite wellness in the NWCCOG Economic Development Region. 7. The Contractor shall provide a copy of the assessment tool No later than Q2 developed to gather information on worksite wellness across the region. 8. The Contractor shall provide documentation of Health Links No later than Q2 Advisors background and description. 9. The Contractor shall provide a list of Health Links training No later than Q2 topics and materials. 10. The Contractor shall provide a list of stakeholder groups No later than Q4 contacted during outreach activities with event details and list of attendees reached. 11. The Contractor shall provide Health Links quarterly employer No later than Q2, reporting identifying the employers certified. Q3, Q4 12. The Contractor shall provide a copy of the communication No later than Q 1 plan used to educate employers regarding worksite wellness. 13. The Contractor shall provide copies of advertisements for No later than Q2, public awareness camnaien. M nA EXHIBIT B I 14. The Contractor shall provide reporting on recognition events No later than Q1, held to increase awareness of worksite wellness in the reeion. 02.0304 V. Monitoring: CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout the contract period by the CCPD Program Contracts Coordinator. Methods used will include a review of documentation determined by CDPHE to be reflective of performance to include fiscal and programmatic documentation as applicable. 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 in writing within 10 calendar days of discovery of a compliance issue. Within 30 calendar 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 in writing and agreed to by both parties. If extenuating circumstances arise that requires an extension to the time line, the Contractor must email a request to the contract 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 provisions of this contract. Page 4 of 4 Contract Statement of Work—Exhibit B January 2015 COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing # 16 FHLA 76514 Contractor Name Eagle County Public Health Agency Budget Period July 1, 2015 -June 30, 2016 Project Name Work Well Collaborative Exhibit C Budget Program Contact Name, Katie Haas, Healthy Communities Title, Phone and Email Coordinator, 970-328-8855, katie.haas@eaglecounty.us Fiscal Contact Name, Title, Wendi Gill, Fiscal Specialist, 970 -328 - Phone and Email 8804, wendi.gill@eaglecounty.us Expenditure Categories Personal Services Salaried Employees Budget Item Percent of Total Amount Position Title/Employee Supports SOW Gross or Time on Requested from Name Description of Work (Yes/No) Annual Salary Fringe Project CDPHE The Healthy Communities Manager will provide oversight of staff, programming and ensure fiscal responsibility of budgeting and coordinating subcontractors. (Fringe detail -FICA: $4,668.16, Medicare: $1091.75 County Retirement: $4,517.57 Workser Comp: 189.35 County Wellness $450.00 Healthy Communities County Health Insurance: $18,085, Vision: $419.64, Manager Other e.g. Life Insurance: $195.52) Yes $75,292.88 $29,617.07 10% $10,491.00 The Healthy Communities Coordinator will be housed in the Eagle County Public Health and Environment office and will 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 N WCCOG, Health Links, and other community partners to assure program implementation. The Coordinator will also work CDPHE's Evaluator to provide data and evaluation support as needed (Fringe detail - FICA: $3338.45, Medicare $780.77, Retirement $2153.84, Vision $419.64, Health Insurance Healthy Communities $18085.08, County Wellness $450, Wrokers Comp Coordinator $135.74, other e.g. Life insurance $195.52) Yes 1 $53,846.00 1 $25,559.041 50% $39,702.52 Personal Services Hourly Employees Total Amount Requested from Budget Item Total # of CDPHE Position Title/Employee Supports SOW Hours on Name Description of Work (Yes/No) Hourl Wa a Hourl Frin a Project $0.00 Page 1 of 4 V. 1 Jan 2013 PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing # 16 FHLA 76514 Contractor Name Eagle County Public Health Agency Budget Period July 1, 2015 -June 30, 2016 Project Name Work Well Collaborative Exhibit C Budget Program Contact Name, Katie Haas, Healthy Communities Title, Phone and Email Coordinator, 970-328-8855, (inelud[n frin a benefits) katie.haas@eaglecounty.us Fiscal Contact Name, Title, Wendi Gill, Fiscal Specialist, 970 -328 - Phone and Email 8804, wendi.gill@eaglecounty.us Page 2 of 4 V. 1 Jan 2013 $0.00 Tota[ Personal Services (inelud[n frin a benefits) $So 193.52 Supplies & Operating Expenses Total Amount Budget Item Requested from Item Supports SOW CDPHE Description of Item (Yes/No) RateQuantity PARTNER TOOL or similar tool to measure collaboration/effectiveness of Coalition Evaluation regional worksite wellness coalition. ($50 for use of tool by public entity; Software $110 per hour for TA - estimated to utilize at least 3 hours of TA) Yes $380.00 1 $380.00 Laptop to enable working remotely across NWCCOG Economic Development Region; standing desks to exemplify good worksite wellness practices among grant representatives; flip charts for meeting facilitation etc. Standing desk - $200 x 2 = $400; Tall chair to go wtih Office Equipment and standing desk $175 x 2 = $350; New Laptop - $1,000; Flip charts, Supplies markers, etc. = $250) 1 Yes $2,000.00 1 $2,000.00 Registration fees for Health Links Advisors, ECPHE and N WCCOG key staff to participate in recognition and promotion events for Health Links Registration for Employer and worksite wellness (e.g. Vail Valley Partnership Success Awards, Recognition Events Healthy Mountain Business Symposium) Yes $100.00 10 $1,000.00 Supplies to support meetings and local events to engage employers in Health Links with key partners across the region (Approximately 6 events anticipated per year; esimtaed costs include: $200 for food, $100 for Meeting and event su liesosters, $300 for booths ace) Yes $600.00 6 $3,600.00 Tota[ Supplies ti $6,980.00 Travel Total Amount Budget Item Requested from Item Description of Item Supports SOW (Yes/No) Rate Quantity CDPHE Trips required for meetings and coordination among community Mileage- in state partners, reimbursed at $0.56 per mile. Yes $0.56 1,7281 $967.68 Lodging Lodgingfor required CCPD meetingfor two staff members Yes $125.00 2 $250.00 Page 2 of 4 V. 1 Jan 2013 PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing # 16 FHLA 76514 Contractor Name Eagle County Public Health Agency Budget Period July 1, 2015 -June 30, 2016 Project Name Work Well Collaborative Exhibit C Budget Program Contact Name, Katie Haas, Healthy Communities Title, Phone and Email Coordinator, 970-328-8855, katie.haas@eaglecounty.us Fiscal Contact Name, Title, Wendi Gill, Fiscal Specialist, 970 -328 - Phone and Email 8804, wendi.gill@eaglecounty.us Page 3 of 4 V. 1 Jan 2013 ECPHE staff will attend one mandatory meeting in Denver. Meal estimate is based on current government per diem rate for Denver: $49.50. One day per diem per staff member for the meeting (2 x $49.50 = $99). In addition, at least one meeting/training per County in 5 County region is anticipated, requiring travel by ECPHE Staff (Healthy Communities Coordinator), so lunch based on per diem rate for of $11 is Meals being included $11 x 5 = $55 Yes $154.001 1 $154.00 Total Travel $1,371.68 Contractual Total Amount Budget Item Requested from Supports SOW CDPHE Subcontractor Name Description of Item (Yes/No) Rate Quantit $23,000 - public awareness campaign about worksite wellness and Health Links (50 newspaper ads x $300 = $15,000, 4 radio campaigns x $1,250 each = $5,000); $4,000 - print materials for public awareness of Northwest Colorado Health Links and RHWSP; $1,000 - food and general supplies to support Council of Governments RHWSP meetings; $6,000 -fee for regional coordination of marketing (NWCCOG) and outreach, conducting RHWSP meetings, etc.) Yes $34,000.00 1 $34,000.00 $72,000-4 Health Links Advisors (1 for each county (Pitkin, Eagle, Summit and 1 shared between Grand and Jackson) - $1,500 per month x 12,x 4 = $72,000; $20,000 - two training events per county (Grand and Health Links Jackson shared; $2,500 per training event x 8) Yes $92,000.00 1 $92,000.00 Outreach to employers of vulnerable populations and unique employers of the region to better understand their specific needs for implementation of worksite wellness programs. An evaluator will need to be selected via a County bidding process; based on experience, it is estimated that an evaluator will charge approximately $85 per hour. Evaluator - TBD This project is estimated to take about 125 hours (125 x $80 = $10,000). Yes $80.00 125 $10,000.00 Facilitator for four health equity trainings for Health Links Advisors and stakeholder groups. A trainer will need to be selected via the County bidding process; based on preliminary quotes requested, it is estimated that a trainer will charge approximately $2500 per half day training (includes preparation for training, per diem and travel expenses). 4 Trainer - TBD trainings x $2,500 each = $10,000. Yes $2,500.00 4 $10,000.00 m ,,} t -r; r t �. �. rr t t ot�l Con ractua '- ` - �, s w _ _� t z .S.-'��:�'�s 0"x00 k.: a�� .•5146,00. SUB -TOTAL BEFORE INDIRECT $204 545.20 Page 3 of 4 V. 1 Jan 2013 Exhibit C Budget Page 4 of 4 V. 1 Jan 2013 PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM Contract Routing # 16 FHLA 76514 Contractor Name Eagle County Public Health Agency Program Contact Name, Katie Haas, Healthy Communities Title, Phone and Email coordinator, 970-328-8855, katie. haas @eaglecounty. us Budget Period July 1, 2015 - June 30, 2016 Fiscal Contact Name, Title, Wendi Gill, Fiscal Specialist, 970 -328 - Phone and Email 8804, wendi.gill@eaglecounty.us Project Name Work Well Collaborative Indirect unt Item Description of Item rom Negotiated Indirect cost rate (Federal, State, or CDPHE) Ause Indirect rate (other): Indirect (modified or Eagle County does not currently have a negotiated Federal or CDPHE indirect rate agreement. Eagle base) Coadditional the 10% DeMinimis rate for MTDC. 54 52T^�5d_R���. Page 4 of 4 V. 1 Jan 2013