HomeMy WebLinkAboutbocc.con.amended.045.2009ACLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR SCANNING/ARCHIVING
CONTRACT #: 45-2009-A
ORIGINATING DEPARTMENT/DIVISION: Health and Human Services
CONTACT PERSON: Mitzi Ledingham PHONE #: 970-920-5766
PROJECT NAME: Healthy Community Fund Grant Programs
^ 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 OState Bid ^
^Compliance with House Bills 06-1343 and 07-1073 - Immigration Form (Under $10,000, Letters of Engagement, etc
~DOLLAR AMOUNT: $20,000 BUDGET LINE ITEM/LEDGER NUMBER:
/ CAECK CONTRACT TYPE:
^ Services/Maintenance
^License/LJse
^Lease
^Construction
^Goods, Equipment, Supplies
^Other (e.g. revenue)
^Employment (for county employees)
^Intergovernmental Agreement (Requires BOCC Action)
~Non-Profit
^Quasi-Public
^Grant Agreements (Requires BOCC Action)
^Change Order/Contract Amendment
CONTRACTOR: COMPLETE LEGAL OF NAME OF BUSINESS (if different from contractor) Mountain
Family Health Centers
Contract Execution Date:l2/31/08 Contract End Date: 12/31/2011
Automatic Renewal: ^Yes ONo Term of Contract: contract amendment; 2"d year of 3 year parinership
a,'.
~du~" 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)
/^Notice of Award/Notice to Proceed Attached (if applicable)
/ ^Warranty (if applicable)
/~Special Instructions for Finance Department: see grant payment worksheet
/~Sent to C1erk and Recorder for Scanning/Archiving
/~Authorized Staff Person's Name: Mitzi Ledingham
BY CI~ECKING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF PERSON INDICATES THAT
THE ATTACHED DOCUMENT HAS BEEN PROOFED AND READY FOR SCANNING.
Feb.18~ 2010 1~43PM COLUMBINE HEALTH 910 945 2893 No•9155 P. 2
Kev 1~;10/09,js
C..ontract #t 045-2009-A
~.~.:. <. ._
Cliange O.rderNumbcr: l
OWNF..R: 1'itkin Gounry HHS
c/o Mitzi Lcdin~laam
0405 Castle C,reck Rd. suite 7
Aspcn, CU S l C 1~
CONT.RACTOR: Mr. David Aci:unson
Ex~cutivc llirect~r
Mauntain Family Heal~~ Centers
19U5131ake Avenue, Suite 1 U1
Glenwood Springs, GO R] GO1
The 20Q.4-2Q11 Mountain Family Hcalth Centers partncrship ~;raa~t agreenicnt (the "Agr.eement") dated
January ls~ 200.9 _ betwccn the Baard of County Commi~sioners of ~'itkin Cc~unty (thc "C:ounty") and
Mc~untain Famity Health Centers (thc "C:ontrac~c~r"), is hcreby Funended as follows:
Dcscription of Ch~nge: continuaiion c~('contract terms for 2Q10 as written at same funding lcvel
Rcason for Chan e• sccond year of three ycar partnersl~i~ agrecmcnt.
Uri~lnal Gontract Pricc $ 20,000
Net lncrea.~e/i~eerease in Contract Priee (this change orcier) $ same le~el ~hrou~h Uee 2010
Total Adjusted Contrac:t Pric~ (includ'u~~ tiiis changc order) ~:~ame lcve! tluou~h Dec 20l 0
Tn ~.11 other respects the Agrccment is in full force and el'1'ect and remains unchanged by this
naenl.
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Contracto.r llate
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Authorized Caun~y cpresentat~ve llate
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CHANG~ ORDER/C:ONTRACT AMENllM~NT