PURCHASE OF SERVICE AGREEMENT

NORTH DAKOTA DEPARTMENT OF HEALTH AND HUMAN SERVICES

SFN 53772 (09-2022)

Contract Number CFDA Name CFDA Number

PF21.124 RW: HIV Care Formula Grants RW: 93.917 for $68,896
VH: Health Department Based HIV Prevention Activities
VH: 93.940 for $50,000
STD: Sexually Transmitted Diseases (STD) Prevention and
Control Grants STD: 93.977 for $31,104
FAIN Number Contract Type (Check One) Start Date End Date
RW: X07HA00043 Acquisition Research 1/1/2023 12/31/2023
VH: NU62OS924540
STD: NH25PS005181
Federal Award Date Federal Awarding Agency
RW: 03/03/2022 Health Resources Services Administration (HRSA) & Centers for Disease Control & Prevention
VH: Unknown
STD: Unknown
This contract is not effective and expenditures related to this contract
should not be incurred until all parties have signed this document.
Title of Project/Program North Dakota Department of Health and Human Services
Importance of Sexual Health and HIV and STD Testing Media (NDDHHS) Project Code
Campaign RW: 2201 HLH5433-09:$68,896
VH: 2201 HLH5373-07: $50,000
STD: 2201 HLH6873-01:$31,104
Contractor Name : Commando, LLC Project Director: Lindsey VanderBusch, MPH, Director
Sexually Transmitted and Bloodborne Diseases Unit
Address:12004 N Formosa Ave, Unit A Address: 600 E Boulevard Ave, Dept 325
City/State/ZIP Code: West Hollywood, CA 90046 City/State/ZIP Code: Bismarck, ND 58505-0250
Contact Name: Lucas Anemone Contact Name: Lindsey VanderBusch
Telephone Number: 949-241-6946 Telephone Number: 701-328-4555
Email Address: luke@runwithcommando.com Email Address: lvanderbusch@nd.gov
NDDHHS Cost Share Contractor Cost Share Total Costs
Amount Awarded $150,000 $0 $150,000
Previous Funds Awarded $0 $0 $0
Total Funds Awarded $150,000 $0 $150,000
Scope of Service
Contractor will provide services as outlined in the RFP 301-221-21.02.
Reporting Requirements
Contractor must provide monthly invoices and activity reports to be submitted via email to Lindsey VanderBusch at
lvanderbusch@nd.gov.
Expenditure report for the period ending June 30, 2023 must be received by July 14, 2023.
Final invoice and post analysis report for the period ending December 31, 2023 must be received by February 15, 2023.
Reimbursement will be processed upon Department approval of invoices and activity reports.
Special Conditions
Financial obligation of the Department is contingent upon funds being made available by the U.S. Department of Health and Human
Services. This notification serves as official documentation and should be filed with the Notice of Grant Award for documentation.
Non-allowable expenses can be found in 2 CFR Part 200, 45 CFR Part 75, HHS Grants Policy Statement.
This contract does not include any options for extension or renewal.
This Purchase of Service Agreement is subject to the terms and conditions incorporated either directly or by reference in the
following: (1) Requirements Addendum for Purchase of Service Agreements issued by the NDDHHS as signed by Contractor for the
period of July 1, 2021 to June 30, 2023 [Finance Use Only: Requirements Received] and
(2) applicable State and Federal regulations.
Evidence of NDDHHS Acceptance
Date Signature Date Signature
12/14/2022
Typed Name/Title of Authorized Representative Typed Name/Title of Authorized Representative
Lindsey VanderBusch, MPH, Unit Director
Sexually Transmitted and Blood Borne Diseases
Date Signature Date
12/16/2022 Christopher Jones
Signature

Christopher Jones (Dec 16, 2022 16:46 CST)

Typed Name/Title of Authorized Representative Typed Name/Title of Authorized Representative

Christopher D. Jones, Executive Director

If attachments are referenced, they must be returned with the signed award.
If you did not receive attachments as indicated, contact the Program Director identified above.
Notice of Grant Award NDDoH Page 2 of 2
Chris Jones PF21.124 Commando
Final Audit Report 2022-12-16

Created: 2022-12-16

By: Sally Meier (slmeier@nd.gov)

Status: Signed

Transaction ID: CBJCHBCAABAAD6SYEawSQLheXw1kB8MHNZQg1ARqxIi5

"Chris Jones PF21.124 Commando" History

Document created by Sally Meier (slmeier@nd.gov)
2022-12-16 - 10:43:08 PM GMT

Document emailed to cdjones@nd.gov for signature

2022-12-16 - 10:43:37 PM GMT

Email viewed by cdjones@nd.gov

2022-12-16 - 10:45:52 PM GMT

Signer cdjones@nd.gov entered name at signing as Christopher Jones

2022-12-16 - 10:46:21 PM GMT

Document e-signed by Christopher Jones (cdjones@nd.gov)

Signature Date: 2022-12-16 - 10:46:23 PM GMT - Time Source: server

Agreement completed.
2022-12-16 - 10:46:23 PM GMT