HomeMy WebLinkAboutbocc.con.129.2010CLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR SCANNING/ARCHIVING
CONTRACT #: X0'1 y, ,'1~/G
ORIGINATING DEPARTMENT/DIVISION: Library
CONTACT PERSON: Susan Keenan PHONE #: 970-429-1925
PROJECT NAME: Children's summer programs
^ BOCC AGENDA ITEM ®STAFF AUTHORIZED SIGNATURE
(Requires BO(:'C` Signature) (per Revised Procurement Code 7/2005)
^ Over 550,000 (Requires C"ounty 1llanager'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,
~~DOhLAR AMU[.~NT: $250.00 Bt1DGET LINE ITEl~1/1_;EDGER NLrMBEl2: 16662-00000-82008
/ CHECK CONTRACT TYPE:
®S ervice s/Maintenanc e
^License/LJse
^Lease
^Construction
^Goods, Equipment, Supplies
^Other (e.g. revenue)
^Employment (for county employees)
^Intergovernmental Agreement (,Requires BOC"C Action)
^Non-Profit
^Quasi-Public
^Grant Agreements (Requires BOCC Action)
^Change Order/Contract Amendment
CONTRACTOR: Cody Landstrom COMPLETE LEGAL OF NAME OF BUSINESS (if different from contractor)
Contract Execution Date:04/13/10
Automatic Renewal: ^Yes ®No
Contract End Date: 06/28/10
Term of Contract: n/a
ST~ 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:
/ ®Sent to Clerk and Recorder for Scanning/Archiving
/ ®Authorized Staff Person's Name: Susan Keenan
1;Y CI~lEC1tINC; :ABOVE, AND ENTFR[NG NAME, THE ALITHOR.IT..ED STAFF PERSON INDIt:'ATF,S "i'HAT
'I'HF. A"TTAC`HF.,D DOCUNIEN'I' IIAS BEEN PI200FED AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE.
LETTER OF ENGAGEMENT
April 13, 2010
Cody Landstrom
1216 Clearview Court
Fort Collins, CO 80521
Re: Summer Children's Program
Dear Cody:
The purpose of this letter is to summarize the pertinent terms of Pitkin County's
arrangement with you to provide the specified services enumerated in the following
paragraph. The County's obligation under the Workers' Compensation Statute requires
Pitkin County and you to formalize the terms of this engagement in writing.
You will perform your magic show for children ages 5 -10 on Monday, June
28 at 2:00 p.m. at the Pitkin County Library. You will arrive at least 30
minutes in advance. The program will last approximately one hour. The fee
will be $250.00 and will be paid at the time of the performance. All other
expenses shall be yours.
It is mutually agreed that the County does not have an exclusive right to your services
and it is contemplated that you may provide similar work to other businesses,
governments and non - profit organizations. You acknowledge that the work performed
for Pitkin County will be that of an independent contractor and that no employee -
employer relationship is created. You have full control over how the services are
performed and it is expected that work will be conducted in accordance with industry
standards by applying professional judgment. The County will provide, if necessary,
documents and information to complete the work described in the preceding paragraph.
The County representative signing this letter is available to you to discuss any details
related to this engagement. You acknowledge and agree that you shall not be entitled
to workers' compensation benefits in connection with this project and that you shall
be responsible for the payment of all state and federal income taxes.
If you are in agreement with the terms of this letter, please sign below and return a copy
to us for our files. We appreciate the opportunity of working with you.
Sincerely,
sz 44e,c- )
usan Keenan
Children's Services Librarian
AG D:
y��/0
Cody Land om Date
Social Security Number
1
Pitkin County Risk Management Department
Workers'. Compensation Waiver
for Individuals
I.
C~(ti I~
as sole proprietor or
partner of
,(business name),
represent that I have no person or persons in my employ, but that I shall obtain and
maintain workers' compensation protection pursuant to those insurance
requirements as set forth in the Workers' Compensation Act of Colorado (Articles
40 to 54 of Title 8 of the Colorado Revised Statutes) for any and all persons as I
may employ in performing any work in the future.
7~ ~ ~
Date signed