HomeMy WebLinkAboutbocc.con.261.2008A CLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR SCANNING/ARCHIVING
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ORIGINATING DEPARTMENT IVISION: ~ G2~6°A4't' ~ r
CONTACT PERSON: / PHONE 4~Q _ ,SS B~ ~'6~K
PROJECT NAME: ij /
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? BOCC AGENDA ITEM ?STAFF AUTHORIZED SIGNATURE
(Requires BOCC Signature) (per Revised Procurement Code 7/2005)
? Over $50,000 (Requires County Manager's Signature)
? CHECK PROCUREMENT TYPE:
?None ?Informal ?Formal ?Sole Source ?Emergency ?State Bid ?
?Compliance with House Bills 06-1343 and 07-1073 -Immigration Form (Under $10,000, Letters of Engagement, e
DOLLAR AMOUNT: 92o,dn BUDGET LINE ITEM/LF,DGER NUMBF,R:
? CHECK CONTRACT TYPE:
?Services/Maintenance ?Employment (for county employees)
?License/CTse ?Intergovemmental Agreement (Requires BOCC Action)
?Lease ?Non-Profit
?Construction ?Quasi-Public
?Goods, Equipment, Supplies~C.rant Agreements (Requires BOCC Action)
?Other (e.g. revenue) Change Order/Contract Amendment
CONTRACTOR: COMPLETE LEGAL OF NAME OF BUSINESS (if different from contractor)
Contract Execution Date: '~s"0~ Contract End Date:
Automatic Renewal: ?Yes ?No Term of Contract:
S~~ All Contracts should be proofed for the following:
? ?No Pages Missing
? ?If a Page is Left Intentionally Blank -Note on Page
? ?Page numbered consecutively
? ?All Signatures Affixed
? ?All Dates Filled In
? ?All Other Blanks Filled In
? ?All Exhibits Attached
? ?HB 06-1343 and 07-1073 (Immigration Legislation) Included in RFP and/or Contract
? ?All Legal Descriptions Attached (if applicable) P~5 v
? ?Notice of Award/Notice to Proceed Attached (if applicable)
? ?Warranty (if applicable)
? ?Special Instructions for Finance Department:
? ?Sentto Clerk and Recorder for Scanning/Archiving
? ?Authorized Staff Person's Name:
BY CHECKING ABOVF, AND ENTERING NAME, THE AUTHORIZED STAFF PERSON INDICATES THAT
THF. ATTACHED DOCUMENT HAS BF.F.N PROOFED AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE.
AMENDED 04/23/08
Rev 03/31/08 js
Project Purchase Name Contract # v?~o% oZ0798'~
CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number: 01-274-2008
OWNER: Pitkin County
76 Service Center Road
Aspen CO 81611
CONTRACTOR: American Asphalt
PO Box 3467
Glenwood Springs CO 81601
970-404-0173
The Asphalt Services "Agreement") dated September 29, 2008, between Pitkin County (the "County")
_ and Amcric~n Asphalt (the "Contractor"), is hereby amended as follows:
Description of Change: Contractor's obligations
West Sopris Creek Road " 2 "Patch
East Sopris Creek Road " 2"Patch
Reason for Chance
Original Contract Price $ 97.625.00
Net Increase/Decrease in Contract Price (this change order) $ 17.920.00
Total Adjusted Contract Price (including this change order) $ 115.545 .00
This change order extends the time to complete work by 14 calendar days
In all other respects the Agreement is in full force and effect and remains unchanged by this
Amendment.
In all other respects the Agreement is in full force and effect and remains unchanged by this
Ame ent.
~nUa ~ Date
/b-~j-p~
r, eputy Director of Public Works Date
APPROVED AS TO FORM, this day of 2008
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