HomeMy WebLinkAboutbocc.con.130.2010CLERK'S CHECK LIST
CONTRACT #: /,.~~~ aQ ~L
ORIGINATING DEPARTMENT/DIVISION: Library
CONTACT PERSON: Susan Keenan
PROJECT NAME: Children's summer programs PHONE #: 970-429-1925
^ BOCC AGENDA ITEM ®STAFF AUTHORIZED SIGNATURE
(.Requires BO('C Signature) (per Revised Procurement Code 7/2005)
^ Over $50,000 (Requires C"ount~~ 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,
(. IVT: $500.00 BI'DGET LIi~E ITEMLI:,EDGEIt NL)MBER: 16662-00000-82008
CHECK CONTRACT TYPE:
®S er<'ices/Maintenance
^License/Use
^Lease
^Construction
^Goods, Equipment, Supplies
^Other (e.g, revenue)
^Employment (for county employees)
^Intergovernmental Agreement (:Requires BOCCE Action)
^Non-Profit
^Quasi-Public
^Grant Agreements (Requires 13CX: C; Action}
^Change Order/Contract Amendment
CONTRACTOR: Mary Sue Rogers COMPLETE LEGAL OF NAME OF BUSINESS (if different from contractor)
Mary Sue and Cari
Contract Execution Date:04/14/10 Contract End Date: 06/14/10
Automatic Renewal: ^yes ®No 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
Y t I-1 [~'C[t[NG AT30~E AND 1~,TFR[Nt; NA~IF T1-1F Al
TNF. A`ITACHED DOLL".M19ENT IIAS BF>±N 1 ROOFF .iTHORI/.,EI) STAFF PERSON INDIt'ATES'I'1-IAT
_=D A'~D 12EAD~' FOR SC"ANNI1~'G.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS 1N COMPLIANCE WITH COLORADO ST
ARCHIVES RETAINAGE SCHEDULE. ATE
LETTER OF ENGAGEMENT
April 14, 2010
Mary Sue Rogers
P.O. Box 3761
Boulder, CO 80307
Re: Summer Children's Program
Dear Mary Sue and Cari:
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 the "Make a Splash with Mary Sue and Cari" event for r obi
children ages 5 -10 on Monday, June 14 at 2:00 p.m. at the Pitkin County✓ f fan
Library. You will arrive at least 30 minutes in advance. The program will last efr O
approximately one hour. Your fee will be $500 including mileage. It will be J
paid to you at the time of the performance. The one night hotel stay will be
paid for by the Pitkin County Library. All other expenses shall be yours.
It is mutually agreed that the County does not have an exclusive right to your services
and it is contemplated that you may provide similar work to other businesses,
governments and non -profit organizations. You acknowledge that the work performed
for Pitkin County will be that of an independent contractor and that no employee -
employer relationship is created. You have full control over how the services are
performed and it is expected that work will be conducted in accordance with industry
standards by applying professional judgment. The County will provide, if necessary,
documents and information to complete the work described in the preceding paragraph.
The County representative signing this letter is available to you to discuss any details
related to this engagement. You acknowledge and agree that you shall not be entitled
to workers' compensation benefits in connection with this project and that you shall
be responsible for the payment of all state and federal income taxes.
If you are in agreement with the terms of this letter, please sign below and retum a copy
to us for our files. We appreciate the opportunity of working with you.
Since l 8(0 /Oo k'J�4 i1Jl G�l�f
lf.f�lw -'1 i2e101. part if Tai 3uknin '
Susan Keenan j + V
Children's Services Librarian
AGREED:
2R /eR$%r Date tik/oio
Social Security Number
~ ~
_ ~ ,
~e
~ropnetor or
(business name),
Cpresent inat i nave 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.
t~ll~
Date signed
Signat re o erformer
a
Pitkin County Risk Management Department
Workers' Compensation Waiver
for Individuals