HomeMy WebLinkAboutC15-214 Colorado Department Public Health (16 FHLA 76436)DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 16 FHLA 76436
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 for the use
Department of Public Health and Environment and benefit of the Eagle County Public Health Agency
Prevention Services Division - Tobacco 551 Broadway
4300 Cherry Creek Drive South Eagle, Colorado 81631
A-5 CONTRACTOR DUNS: 084024447
Denver, Colorado 80246 CONTRACTOR ENTITY TYPE:
Political Subdivision Colorado
TASK ORDER MADE DATE: 4/13/2015
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 06/30/2018.
PROCUREMENT METHOD:
RFA
1278
BID/RFP/LIST PRICE AGREEMENT NUMBER:
Not Applicable
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE:
Natalya Verscheure, MA
Tobacco Program Manager
Prevention Services Division
4300 Cherry Creek Drive South
A-5
Denver, Colorado 80246
BILLING STATEMENTS RECEIVED:
Monthly
STATUTORY AUTHORITY: C.R.S. 25-3.5-804, et-seq., as
amended
CLASSIFICATION: Sub -Recipient
CONTRACT PRICE NOT TO EXCEED: $117,347.00
FEDERAL FUNDING DOLLARS: $0.00
STATE FUNDING DOLLARS: $117,347.00
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY16: $117,347.00
PRICE STRUCTURE: Cost Reimbursement
CONTRACTOR REPRESENTATIVE:
Jennifer Ludwig
Public Health Director
Box 660
Eagle, Colorado 81631
PROJECT DESCRIPTION:
This project serves to increase tobacco cessation, reduce initiation of tobacco use, decrease tobacco prevalence among youth, and decrease
exposure to secondhand smoke.
Contract_Template_Task _Order _012215.doc Pagel 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.
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.
In accordance with section 24-30-202(1), C.R.S., as amended, this Task Order Contract is not valid until it
has been approved by the State Controller, or an authorized delegee thereof The Contractor is not
authorized to, and shall not; commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date, then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date, then the Contractor shall only commence performance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract, unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its exhibits
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.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner, all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B" and "Exhibit U.
5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this
Task Order Contract's Statement of Work through a contract amendment. To be effective, the amendment
must be signed by the State and the Contractor, and be approved by the State Controller or an authorized
delegate thereof. This contract is subject to such modifications as 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, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning
the monitoring of vendor performance on state contracts and inclusion of contract performance information
in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies and Guidance.
Evaluation of Contractor's performance shall be part of the normal contract administration process and
Contractor's performance will be systematically recorded in the statewide Contract Management System.
Areas of review shall include, but shall not be limited to quality, cost and timeliness. Collection of
information relevant to the performance of Contractor's obligations under this Task Order Contract shall be
determined by the specific requirements of such obligations and shall include factors tailored to match the
requirements of the Statement of Project of this Task Order Contract. Such performance information shall
be entered into the statewide Contract Management System at intervals established in the Statement of
Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term. Contractor shall be notified following each performance and shall address or correct any identified
problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project, the Executive Director of the Colorado
Department of Personnel and Administration (Executive Director), upon request by the Colorado
Department of Public Health and Environment and showing of good cause, may debar Contractor and
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.
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.
1411WYM MTOK I;
Board of County Commissioners of Eagle County for the
use and benefit of the Eagle County Public Health Agency
Legal Name of Contracting Entity
Date
Print Title of Authorized Officer
STATE OF COLORADO:
JOHN W. HICKENLOOPER, GOVERNOR
By:
For Executive Director
Department of Public Health and Environment
By:
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.doe Page 5 of 6
This page left intentionally blank.
Contract_ Template_ Task_ Order_012215.doc Page 6 of 6
EXHIBIT A
ADDITIONAL PROVISIONS
To Contract Dated 04/13/2015 - CMS Contract Routing Number 16 FAAA 76436
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.
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 with the Excel workbook containing the Expenditure Details page to: Tobacco
Program at ccddphe steep pg(t4state.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 the appropriate federal agency.
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.
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
This award does not include funds for Research and Development.
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.
Funds provided under this Task Order Contract may not be used to: supplant funding for any existing
programs/models; develop new cessation programs/models; develop curricula for youth or adults not
reviewed and approved by the State; pay for individual cessation aids or nicotine replacement therapy; fund
capital improvements; or fund costs of enforcement of state or local laws and ordinances.
9. 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.
10. 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.
11. 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).
12. 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.
13. 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 Exibit-A AdditionalProvisions 040715
Attachment A-1
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 routing number> is ❑ increased or ❑ decreased by $amount of change to a new total
funds available of $ <insert new cumulative total> for the following reason: Section
is hereby modified accordingly.
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
PROGRAM APPROVAL:
By:
By: Lisa 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.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
Contract_ GrantFundingChangeLetter_01-2015 Page 1 f 1
Attachment A-2
OPTION LETTER
Date: State Fiscal Year: Option Letter No. 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 REOUIRE 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_Option Letter_01-2015 Page 1 f 1
EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 16 FHLA 76436
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 and Environment
Term: July 1, 2015 through June 30, 2018
11. Project Description:
This project serves to increase tobacco cessation, reduce initiation of tobacco use, decrease tobacco
prevalence among youth, and decrease exposure to secondhand smoke.
III. Definitions:
1. 5As — Ask Advise Assess Assist Arrange
2. AAR — Ask Advise Refer
3. ECPHE — Eagle County Public Health and Environment
4. EHR — Electronic Health Record
5. Health Care Agency — health care agency, social services program, substance abuse practice, dental
office
6. SES — socioeconomic status
7. STEPP — State Tobacco Education and Prevention Partnership
8. TTA — Training and Technical Assistance
IV. Work Plan:
Goal #1: The cessation success gap affecting low SES youth and adult smokers will decrease by fifty (50)
percent and tobacco dependence will be treated as a chronic condition by health systems in Colorado.
Objective #1: No later than the expiration date of this contract, ECPHE shall integrate tobacco cessation into
routine health care practice.
The Contractor shall educate health care decision makers about the health and economic burden
Primary Activity
imposed by tobacco use and the evidence base for clinical cessation interventions, including the
#1
cost-effectiveness and return on investment of these interventions, and the importance of
treating tobacco use as a chronic condition.
1. The Contractor shall identify and recruit three (3) health care agencies.
2. The Contractor shall assess the knowledge in each health care agency using a standardized
survey tool.
3. The Contractor shall analyze results of standardized survey tool and identify educational
needs and training recommendations.
Sub -Activities #1
4. The Contractor shall disseminate training recommendation report to each health care agency.
5. The Contractor shall meet with each health care agency to review results of assessment and
training recommendations.
6. The Contractor shall provide recommended training to each health care agency to increase
staff knowledge.
7. The Contractor shall conduct follow up assessment with each health care agency using a
standardized survey tool.
Primary Activity
The Contractor shall provide technical assistance to each health care agency to integrate either
#2
the 5 A's or AAR Framework for Smoking Cessation and tobacco dependence treatment model
into electronic health records and regular clinical practice.
1. The Contractor shall identify and recruit six (6) health care agencies.
Sub -Activities #2
2. The Contractor shall administer the AAR survey tool to each health care agency to establish
baseline
3. The Contractor shall based on survey findings provide recommended strategies for
Page 1 of
Contract Statement of Work — Exhibit B
January 2015
EXHIBIT B
Page 2 of 6
Contract Statement of Work - Exhibit B
January 2015
integrating tobacco treatment into routine clinical practice in each health care agency using a
tailored consultation and technical assistance plan
4. The Contractor shall implement suggested changes by linking each health care agency to
cessation resources and implementing the consultation and technical assistance plan.
5. The Contractor shall reassess with each health care agency using standardized survey tool.
Primary Activity
The contractor shall complete and submit to CDPHE a project Evaluation Plan within 6 months
#3
of the start of the contract.
Primary Activity
The contractor shall develop and implement a media plan prior to placement of any media buys.
#4
Primary Activity
The contractor shall attend the Colorado Tobacco Conference and one other STEPP approved
#5
training each fiscal year.
Primary Activity
The contractor shall develop an individualized training and technical assistance plan in
#6
collaboration with the Technical Assistance provider.
1. The contractor shall ensure that all work, including the work performed by subcontractors
follows the RFA requirements for each strategy included in the Scope of Work.
2. 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.
3. Evaluation plan will include the participation of the contractor in evaluation -related TTA as
recommended by CDPHE program staff.
4. Then contractor shall coordinate with the external evaluation contractor by providing access
to program information and data as needed by CDPHE's evaluation contractor, attending
bi- monthly meetings (or as needed) with CDPHE's evaluation contractor to provide
program updates and to review evaluation progress, successes and barriers, and comply
with data reporting requirements established by CDPHE's evaluation contractor.
Standards and
5. The Contractor shall develop the media plan with guidance from the CDPHE Tobacco
Requirements
Communication Specialist. The media plan shall be approved by CDPHE before placement
of media buys.
6. The Contractor shall use existing, customizable materials available at
www.cohealthresources.com for media materials. Should these existing materials not meet
grantee needs, a proposal for the development of additional resources must be submitted by
the grantee, for approval from the CDPHE Tobacco Program Generalist and CDPHE
Tobacco Communications Specialist.
7. The Contractor shall participate in at least one (1) consultation meeting with the School of
Public Health Technical Assistance provider to develop an individualized training and
technical assistance plan, for each strategy in the work plan.
8. The Contractor shall use all standardized survey tools available from CDPHE to conduct the
knowledge assessment, AAR, and Workflow Assessment to be provided by CDPHE.
9. The Contractor shall ensure that all work follows best practices using the following as
required resources: Centers for Disease Control and Prevention's Best Practices for
Comprehensive Tobacco Control Programs -2014, United States Public Health Service
Clinical Practice Guideline: Treating Tobacco Use and Dependence - 2008 Update, Patient
Protection and Affordable Care Act, and The Health Information Technology for
Page 2 of 6
Contract Statement of Work - Exhibit B
January 2015
EXHIBIT B
Page 3 of 6
Contract Statement of Work - Exhibit B
January 2015
Economic and Clinical Health Act.
10. The Contractor shall prioritize their work to promote health systems change with health
care systems, social service settings and other applicable interagency programs serving
low -SES and other priority populations.
11. The contractor shall comply with the requirements in the A35 Tobacco Goals Required and
Optional Strategies for Community and Cessation Initiatives. This document is
incorporated and made part of this contract by reference and is available on the following
website: https://www.colorado.go,,,/pacific/sites/default/files/PW A35 Tobacco-2016-
2018-strategies.pdf:
12. The contractor shall ensure that all work follows best practices using the following as
required resources: CDC's Best Practices for Comprehensive Tobacco Control Programs -
2014, US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and
Dependence - 2008 Update. All work must align with the Patient Protection and Affordable
Care Act (ACA), and The Health Information Technology for Economic and Clinical
Health Act (HITECH). These documents are incorporated and made part of this contract by
reference and are available on the following websites:
http://www.cdc.gov/tobacco/stateandeol-nmunity/best 12ractices/pdfs/2014/comprehensive.pdf
http://www.ahrq. gov/professionals/clinicians-providers/guidelines-
recommendations/tobacco/clinicians/update/treating tobacco use08.pdf
Expected Results
All heath care agencies have integrated tobacco cessation into routine clinical practice.
of Activity(s)
1. Increase the number of referrals and enrollment conversion rate to the Colorado
QuitLine from each health care agency
Measurement of
2. Demonstrated increase in knowledge of the burden of tobacco and importance of
Expected Results
treating tobacco as a chronic condition
3. Demonstrate the progress of sub -activities and primary activities.
4. AAR Framework for Smoking Cessation implementation into EHR and clinical
practice is completed, strengthened or expanded for each health care agency
Completion Date
Deliverables
The Contractor shall submit progress reports to the STEPP Tobacco
No later than
Program Generalist via email prior to the report deadline. Progress report
November 15,
must include key elements of project work (i.e. number and demographics
January 15,
of persons reached/served, work completed, accomplishments, barriers
April 15 and
and resolution) into the A35 Reach and Implementation Reporting Tool,.
July 15 of each
Grantees will be provided metrics, measures and a reporting tool through
fiscal year.
CDPHE's evaluation contractor. These data will be aggregated as part of
the macro -evaluation of the grantsprogram.)
Goal #2: Exposure to secondhand smoke, with an emphasis on low SES populations, decreases by fifty
percent (50%).
Objective #1: No later than expiration date of the contract, ECPHE shall engage in a tobacco policy change process
that reduces prevalence and initiation of tobacco and exposure to secondhand smoke
Primary Activity
The Contractor shall complete a community assessment and identify opportunities for a tobacco
#1
policy chane process.
1. The Contractor shall develop an assessment plan.
Sub -Activities #1
2. The Contractor shall assess the tobacco problem and second hand smoke exposure (inclusive
of marijuana) in workplaces and multi -unit housing facilities in Eagle, Garfield and Pitkin
counties.
Page 3 of 6
Contract Statement of Work - Exhibit B
January 2015
EXHIBIT B
Page 4 of 6
Contract Statement of Work — Exhibit B
January 2015
3. The Contractor shall research, review and analyze existing tobacco policies to identify
strengths and areas for improvement in Eagle, Garfield, and Pitkin counties.
4. The Contractor shall create decision maker profiles.
5. The Contractor shall meet with key decision -makers to discuss the local burden of tobacco,
proven tobacco and environmental policy change strategies and best practices, and the policy
change process.
Primary Activity
The Contractor shall implement a tobacco education and policy promotion campaign.
#2
1. The Contractor shall conduct a stakeholder analysis.
2. The Contractor shall conduct research to gauge support for, determine barriers to, and inform
the development of key talking points and future messaging for the implementation of the
proposed tobacco policy change.
3. The Contractor shall collaborate with Technical Assistance partners to ensure clarity, impact,
Sub -Activities #2
and focus of the proposed policy.
4. The Contractor shall create a tobacco education and policy change campaign.
5. The Contractor shall create burden report presentation for decision-makers/stakeholders.
6. The Contractor shall present burden report to community groups and leaders impacted by
tobacco policy change.
7. The Contractor shall attend community events to provide education about the community's
tobacco burden and gather support/supporters for proposed tobacco policy change.
Primary Activity
The Contractor shall convene a taskforce to advocate for environmental tobacco policy
#3
changes.
1. The Contractor shall conduct meetings with key decision makers and taskforce members to
assess support for tobacco policy'change.
2. The Contractor shall adopt or modify model tobacco policy language.
3. The Contractor shall identify, schedule, and confirm dates of presentations to council/board.
Sub -Activities #3
4. The Contractor shall develop a plan to monitor and assist with implementation.
5. The Contractor shall educate and inform key decision makers and taskforce leadership
regarding the policy issue, enforcement and implementation.
6. The Contractor shall organize and facilitate a community event to increase awareness and
gain support of the tobacco policy change campaign.
7. The Contractor shall present policy proposal to formal decision-making authority.
Primary Activity
The Contractor shall support the implementation and enforcement of the tobacco policy change
#4
campaign.
1. The Contractor shall promote and support implementation and compliance of the policy.
2. The Contractor shall execute the implementation plan.
Sub -Activities #4
3. The Contractor shall execute an evaluation of the compliance and enforcement of the
selected policy.
4. The Contractor shall present results of compliance and enforcement evaluation to taskforce
members, key stakeholders, decision -makers and the public and determine if adjustments need
to be made.
Primary Activity
The contractor shall complete and submit to CDPHE a project Evaluation Plan within 6 months
#5
of the start of the contract.
1. 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
Standards and
during the contract term. The Contractor shall monitor documents and website content for
Requirements
updates and comply with all updates.
2. Evaluation plan will include the participation of the contractor in evaluation -related TTA as
recommended by CDPHE program staff and coordinate with the external evaluation contractor
by providing access to program information and data as needed by CDPHE's evaluation
Page 4 of 6
Contract Statement of Work — Exhibit B
January 2015
EXHIBIT B
Page 5 of 6
Contract Statement of Work — Exhibit B
January 2015
contractor, attending bi- monthly meetings (or as needed) with CDPHE's evaluation contractor
to provide program updates and to review evaluation progress, successes and barriers, and
comply with data reporting requirements established by CDPHE's evaluation contractor.
3. The Contractor shall use the following sources and approaches to assess the tobacco
problem:
A. The Attitudes and Behaviors Survey (TABS) 2012
B. Healthy Kids Colorado Survey
C. FDA Store Audits
D. Focus Groups studies
E. Observational studies
F. Key Informant interviews
4. The Contractor shall participate in at least one (1) consultation meeting with the School of
Public Health Technical Assistance provider to develop an individualized training and technical
assistance plan for each strategy in the work plan.
5. The Contractor shall maintain a taskforce that is made up of: strategic community leaders,
those impacted by proposed environmental tobacco change, youth leaders, and power brokers
from community.
6. The Contractor shall ensure that the environmental tobacco change campaign will include
community members, decision -maker and a media outreach and education component to
support the proposed environmental tobacco change.
7. The Contractor shall ensure that promotion of implementation and enforcement at a
minimum will include: letters of thanks to decision makers and advertisements for the passage
of the policy and implementation plans to the community.
9. Throughout the contract period, the Contractor shall immediately inform STEPP of any
tobacco control municipal ordinance issues arising in the contractor's service area not already
covered under all other deliverables in this scope of work, and shall collaborate with STEPP in
determining a local strategy approach.
Expected Results
A strengthen, expanded or newly develop local policy leading to the reduction in prevalence
of Activity(s)
and incident of secondhand smoke exposure among Low SES populations
Measurement of
1. Fidelity to the policy implementation process outlined in the work plan.
Expected Results
Completion
Date
01
Deliverables
The Contractor shall submit progress reports to the STEPP Tobacco
No later than
Program Generalist via email prior to the report deadline. Progress
November 15,
report must include key elements of project work (i.e. number and
January 15,
demographics of persons reached/served, work completed,
April 15 and
accomplishments, barriers and resolution) into the A35 Reach and
July 15 of
Implementation Reporting Tool,. Grantees will be provided metrics,
each fiscal
measures and a reporting tool through CDPHE's evaluation contractor.
year.
These data will be aggregated as part of the macro -evaluation of the
rants program.)
Page 5 of 6
Contract Statement of Work — Exhibit B
January 2015
EXHIBIT B
V. Monitoring:
The contractor shall submit progress reports no later than fifteen (15) days after each calendar quarter and
fifteen (15) days after end of the life of the contract to the Tobacco Program via email at:
cdphe stepp pRLwstate.co.us
Methods used will include a review of documentation determined by CDPHE to be reflective of
performance to include: key elements of project work (i.e., number and demographics of persons
reached/served, work completed, accomplishments, barriers and resolution) into the A35 Reach and
Implementation Reporting Tool, quarterly progress reports, invoices and other fiscal and programmatic
documentation as applicable. Grantees will be provided metrics, measures and reporting tool through
CDPHE's evaluation contractor. These data will be aggregated as part of the macro -evaluation of the
Tobacco grants program.
A Final Contractor Performance Evaluation will be conducted at the end of the life of the contract and
results communicated to the contractor. Failure to submit progress reports in accordance with the above
time frames may result in a delay or denial of the reimbursement request for those periods.
VI. Resolution of Non -Compliance:
The Contractor will be notified in writing within (30) calendar days of discovery of a compliance issue.
Within (45) 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 Tobacco Program Generalist 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 6 of 6
Contract Statement of Work— Exhibit B
January 2015
A&V:COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 16 FHLA 76436
Contractor Name
Eagle County Government
Budget Period
7/1/15-6/30/16
Project Name
West Mountain Tobacco Program
Exhibit C Budget
Program Contact Name, Title,
Mandy Ivanov, Project
Phone and Email
Coordinator, 970-328-8808,
Fiscal Contact Name, Title,
Wendi Gill, Fiscal Lead Specialist,
Phone and Email
970-328-88004,
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
Ms. Koenemann provides oversight of staff,
programming, and ensures fiscal responsibility of the
Project Director, Karen
budget including subcontracts. Fringe detail -FICA:
Koenemann
$4,342.48 Medicare: $1,015.58 County Retirement:
Yes
$70,040.00
$ 23,873.00
5%
$4,695.65
4,202.40 Workser Comp: 210.12 County Wellness
$450.00 County Insurance: $13,652
Ms. Ivanov will collaborate with health care and dental
health providers evaluating current protocols and
practices related to patient tobacco use information and
referral systems. Train health care and dental health
providers in evidence -based models of 5As and AAR, and
support implementation of the 5As and AAR model and
Colorado Quitline referral into healthcare systems. She
will collaborate with Eagle County Housing Authority to
Project Coordinator, Mandy
strengthen multi -unit housing tobacco policies, and work
Ivanov
with County Human Resource and Health and Human
Yes
$51,000.00
$ 21,216.50
100%
$72,216.50
Services to strengthen existing tobacco policies and
promote tobacco cessation and education through
worksite wellness initiatives. She will assess current
policies in three county region. Ms. Ivanov will also
design and implement media plans to support cessation
and policy work. Fringe Detail - FICA: $3,162.00
Medicare: $739.50 County Retirement: 3,060.00 Workers
Comp: 153.00 County Wellness: $450.00 County
Insurance: $13,652
Page 1 of 4
V. 1 Jan 2013
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 16 FHLA 76436
Contractor Name
Eagle County Government
Budget Period
7/1/15-6/30/16
Project Name
West Mountain Tobacco Program
Exhibit C Budget
Program Contact Name, Title,
Mandy Ivanov, Project
Phone and Email
Coordinator, 970-328-8808,
Fiscal Contact Name, Title,
Wendi Gill, Fiscal Lead Specialist,
Phone and Email
970-328-88004,
Page 2 of 4
V. 1 Jan 2013
Ms. Carey is a public health nurse who will provide
techincal assistance to Eagle County Public Health
programs to ensure that all staff are following consistent
intake procedures and referals. Work with health care
Theresa Carey
providers to ensure they have the resources and
Yes
$56,135.00
$ 26,738.37
5%
$4,143.67
knowledge to implement their models. Fringe Detail -
FICA: $3,480.37 Medicare: $813.96 County Retirement:
$3,368.10 Workers Comp: $419.95 County Wellness:
$450.00 County insurance: $18,206.00
Personal Services
Hourly Employees
Budget Item
Total # of
Total Amount
Position Title/Employee
Supports SOW
Hours on
Requested from
Name
Description of Work
(Yes/No)
Hourly Wage
Hourly Fringe
Project
CDPHE
$0.00
Total Personal Services
(inducling fringe benefits)
$81,056
Supplies & Operating Expenses
Budget Item
Total Amount
Supports SOW
Requested from
Item
Description of Item
(Yes/No)
Rate
Quantity
CDPHE
Refreshments for Lake Creek resident groups ($5 person x 20 participants x 6
Food/Refreshments
meetings) = $600; Light lunch for TA and AAR/SAs trainings at healthcare
Yes
$ 880.00
1
$880.00
providers (4 trainings x $10/person x 7 participants) = $280
Advertising for Colorado Quitline (4 campaigns -Great American SmokeOut, New
Years, Kick Butts Day, World No Tobacco Day. Newspapers (3 papers x 4 ads x
Media/Marketing
$225/ad= $2700), bus shelter ads (3 placements x 4 cycles x $160/cycle =
Yes
$ 12,520.00
1
$12,520.00
$1920); exterior bus ads (2 placement x $2600 = $5200)and radio stations
($15.00/spot x 180 times=$2700).
Educational materials for Multi -unit housing - County Facilities -approved
Printing/Copying
Signage for each building ($30 x 34 buildings = $1020); paper for community
Yes
$ 1,220.00
1
$1,220.00
assessments and trainings ($200)
Page 2 of 4
V. 1 Jan 2013
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 16 FHLA 76436
Contractor Name
Eagle County Government
Budget Period
7/1/15-6/30/16
Project Name
West Mountain Tobacco Program
Exhibit C Budget
Program Contact Name, Title,
Mandy Ivanov, Project
Phone and Email
Coordinator, 970-328-8808,
Fiscal Contact Name, Title,
Wendi Gill, Fiscal Lead Specialist,
Phone and Email
970-328-88004,
Office Supplies
Standing desk ($544); general office supplies (pens, notebooks, folders, printer
Yes
$ 724.00
1
$724.00
cartridges; estimated at $15/mo x 12mo. _ $180)
Promotional Materials
Quitline Promotional materials not available through cohealthresources.org
Yes
$ 0.62
300
$186.00
(stress balls 300 x .62 = $186)
Incentives for Lake Creek Village residents to complete assessments (850
residents x $5 City Market gift card). Gift cards will be stored in a locked file
cabinet. Gift cards will be marked with a number and a spreadsheet will be
Incentives
maintained for tracking each card number. Upon completing an assessment,
Yes
$ 5.00
850
$4,250.00
the resident will receive a gift card, print their name and sign the spreadsheet
for the corresponding number on the card.
$0.00
Total Supplies
$19,780.00
Travel
Budget Item
Total Amount
Supports SOW
Requested from
Item
Description of Item
(Yes/No)
Rate
Quantity
COPHE
Coordinator will attend two mandatory trainings in Denver. Round trip is
Mileage
approximately 300 miles x 2 trips = 600 miles. Reimbursement at $.575/mile.
Yes
$ 0.575
5400
$3,105.00
Coordinator will be driving 400 miles p pport activities with
per month to support
Health Care Providers, housing authority and county public health agencies.
Coordinator will attend two mandatory trainings in Denver. Meal estimate is
Meals
based on current government per diem rate for Denver: Travel day per diem
reimbursement at $49.50 (2 days) and full day reimbursement at $66.00 (2
Yes
$ 231.00
2
$462.00
days). $231/trip x 2= $462
Overnight stay for Coordinator to attend two mandatory meetings in Denver.
Lodging
Estimate is based on current government per diem rate for Denver. $163/night
Yes
$ 163.00
6
$978.00
x 3 nights x 2 trainings
Page 3 of 4
V. 1 Jan 2013
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 16 FHLA 76436
Contractor Name
Eagle County Government
Budget Period
7/1/15-6/30/16
Project Name
West Mountain Tobacco Program
Exhibit C Budget
Program Contact Name, Title,
Mandy Ivanov, Project
Phone and Email
Coordinator, 970-328-8808,
Fiscal Contact Name, Title,
Wendi Gill, Fiscal Lead Specialist,
Phone and Email
970-328-88004,
Parking
Parking downtown Denver for two mandatory meetings - $10/day x 6 days.
Yes
$ 10.00
6
$60.00
Total Travel
$4,605.00
Contractual
Budget Item
Total Amount
Supports SOW
Requested from
Subcontractor Name
Description of Item
(Yes/No)
Rate
Quanti
CDPHE
Aspen to Parachute Dental Alliance will reach out to dental offices and
provide technical assistance to support tobacco cessation and Quitline
Aspen to Parachute Dental
Resources and referral. (110 hrs x $32.00 =$3520 staff hours; Travel -
Health Alliance
500 miles x.575/mile = $288 Total = $3808)
Yes
$ 3,800.00
1
$3,800.00
Total COIi#raCtllBl
$3,800.00'
SUB -TOTAL BEFORE INDIRECT
$109,240.82
Indirect
Total Amount
Requested from
Item
Description of Item
CDPHE
Negotiated Indirect cost
rate (Federal, State, or
CDPHE)
Indirect rate (other):
Eagle County does not currently have a negotiated Federal or CDPHE indirect rate agreement. Eagle County is electing to use 10%
Indirect (modified or
of personnel costs for this budget instead of the 10% DeMinimis rate for MTDC. Approved by Patti Theriot, CDPHE Internal
additional base)
Auditor.
$8,106.00
Page 4 of 4
V. 1 Jan 2013
