HomeMy WebLinkAboutbocc.con.138.2010CLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR SCANNING/ARCHIVING
CONTRACT #: ~ 3 $~ o~~ ~~
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 Bt)CC Signature) (per Revised Procurement Code 7/2005)
^ Over 550,000 (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,
` ~ DOLLAR AMO[.~N'T: $558.00 13[~DGET LINE ITE14I/LEDGER Nl:'M13ER; "
16662-00000-82008
/ CHECK CONTRACT TYPE:
®Services/Maintenance
^License/LTse
^Lease
^Construction
^Goods, Equipment, Supplies
^Other (e.g. revenue)
^Employment (for county employees)
^Intergovernmental Agreement {Requires BC)C`(: Action)
^Non-Profit
^Quasi-Public
^Grant Agreements {Requires BOCC Action)
^Change Order/Contract Amendment
CONTRACTOR: Susan Marie Frontczak COMPLETE LEGAL OF NAME OF BUSINESS (if different from
contractor)
Contract Execution Date:04/14/10 Contract End Date: 06/21/10
Automatic Renewal: ^Yes ®No Term of Contract: n/a
SST All Contracts should be proofed for the following: ~ ~Q~
/ ®No Pages Missing ~ ~~b
/ ^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
BY CHECKING ABOVE ANI) ENTERING NAtiIE, TH.E ALTII:ORIZED STAFF 1'E:RSON INDICATES TII:~T
T'1-1:E ATTACHED 170CU:bIE~1T HAS BEEPV PROOFED ANL) :READY FOI2 SCA\?tiI~G.
LETTER OF ENGAGEMENT
April 14, 2010
Susan Marie Frontczak
3664 Chase Court
Boulder, CO 80305 -5531
Re: Summer Children's Program
Dear Susan Marie:
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 "A Trip at Sea" storytelling event for children ages 5 -10 on
Monday, June 21 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.
Your fee will be $350. The cost of mileage will be $208.00 (416 miles round
trip @.50 /mi.). A check will be given to you at the time of the event in the
amount of $558.00. 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,
AO
Susan Keenan
Children's Services Librarian
AG' ED:
i
� dAr Zs / -i 1 J t h c 2_016
Susan Marie Frontczak 1 Date
Social Security Numbe
Pitkin County Risk Management Department
Workers' Compensation Waiver
for Individuals
I, Susan Marie Frontczak , as sole proprietor or
partner of Storysmith® (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.
1 June 2010
Date signed
i~
Signature of Performer
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