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Home My WebLink Aboutbocc.con.228.2010FOR CONTRACTS SUBM TTED TO CLERKL�B RECORDER FOR SCANNING/ARCHIVING coNT�cT #: �� , a o ip ORIGINATINGDEPARTMEN NIVI$ION: p(('� ' CONTACT PERSON: �5j� �� ONE #: G�� -�/��J) ,� 6 y 3 • PROJECT NAME:1�� ❑ BOCC AGENDA ITEM �TAFF AUTHOR]ZED SIGNATURE (Requires [3pCC Signature) ❑ Over �50,000 (Rcyuires County Managcr's ,S'ignaturc�ed Procurement Code 7/2005) ✓ CHECK PROCUREMENT TYPE: ONone Q[nformal QFormal Sole Source QEmergency QState Bid � ❑Compliance with House Bills 06-1343 and 07-1073 — Immigration Form (Under $1Q000, Letters of Engagement, e DOI,LAR AMOUNT: ,�DUd (J v gln?GrT LINE ITF NIJMRTR: Il�. ��, 8�00 J ✓ CHECK CONTRACT TYPE: (for county employees) ental Agreement (Reyuires [3pC'C Action) � IJlioods, Equipment, Supplies ❑Grant Agreements (Requires [3pCC A��p� Other (e.g, revenue) OChange OrdedContract Amendment CONTRACTOR: COMPLE E LEGAL OF NAME OF BUSINESS Coutract Execution Date• y��/aU0 Contract End Date: ��/ 3j��U/�J(�f different from contractor) Automatic Renewal: �Yes �No Term of Co trach � orry,� �� STOP � All Contracts should be proofed for the following: � 9 `� [�o Pages Missing �(i `� [�f a Page is Lefr Intentionally Blank —Note on Page � `� [rPage numbered consecutively `� QA11 Signatures Affixed `� �All Dates Filled In `� [�All Other B(anks Filled In � (�All E�ibits Attached `� �i1B 06-1343 and 07-1073 (Immigration Legislation) Included in RFP and/or Contract `� QAII Legal Descriptions Attached (if applicable) `� ONotice of Award/Notice to Proceed Attached (if applicable) `� ❑Warranty(ifapplicable) � �Special Instructions for Finance Department: `� '�Sent to Clerk and Recorder for Scanning/Archivi g. � [ � Au thorizedStaffPerson'sName : �ss�/►� �� BY CHECKINC pgpVF, AND F NAME, THE AL�THORIZF,D STAFF PERSON IND(CA7'F.S'CHAT THF, ATTACHED DpC'UMF,NT HAS �[ PROOFF.D AND HF.Apy FOR SCph;v�K�;. NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE ARCHIVES RETAINAGE SCHEDULE. AMENDED 04/23/08 LETTER OF ENGAGEMENT September 1, 2009 Project Name TANF (Temoorarv Aid to Needv Familiesl: TANF Individual Theraov Provider Business Name Mickv Hohl Address P.O. Box 2701 City, State Zip Code Basalt. CO 81621 Re: Provision of Counseling utilizing TANF Funding Deaz Mia: The purpose of this ]etter 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 a notarized writing. Therapist will provide up to 12 sessions of therapy for approved individuals. Provider of service and/or qualified individuals can apply for funding through Pitkin County Youth and Family Services Manager. Services must be approved prior to provision of services. Qualified individuals must �t the following requirements: Applicant has income less than $75,000.00 Applicant is lawfully present. Applicant has children. Monthly invoices will be provided by provider of services to be paid through Pitkin County Hutnan Services. Monthly invoice will include # of sessions and rate of payment for each session (not to exceed $100.00/howly session). It is mutually agreed that the County does not have an exclusive right to your services and it is contemplated that you may provide similaz wark 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 ! � � � _ Rev 03/OS/08js available to you to discuss any details related to this engagement. This letter of engagement� will terminate on December 31 �� 2010 and will require a new document in succeeding years u to be e�f'ecfive. Contract will not exceed a total of $5000.00 in any given calendar year nless an updated agreement is generated. You acknowledge and agree that you shall not be entitled to workers' compensation beneSts in connection with this project and that you shall be responsible for the payment of all state and federal income taxes. Comoliance with House Bi1106-1343 and House Bi1107-1073 E1• In compliance with House Bill 06-1343 and House Bi1107-1073 amending Title 8 of the Colorado Revised Statutes by the addition of Article 17.5, Illegal Aliens-Public Contract for Services, enacted by the General Assembly of the State of Colorado, the Contractor shall not: Knowingly employ or contract with an illegal alien to perform work under this contract or; 2• Enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shal] not knowingly employ or contract with an illegal alien to perform work under this contract. B• In compliance with House Bi1106-1343 and House Bi1107-1073 enacted by the General Assembly of the State of Colorado: 1. The Contractor has confirmed or attempted to confirm the employment eligibility of all employees who are newly hired for employment in the United States through participation in the Basic Pilot Program [created in Public Law 208, 104th Congress, or its successor and expanded in Public Law 156, 108"' Congress, or its successor, that is administered by the United States Department of Homeland Security] and, if the Contractor is not accepted into the Basic Pilot Program prior to entering into this contract, the Contractor shall apply to participate in the Basic Pilot Program every three months unti] the Contractor is accepted or this contract has been completed, whichever is earlier. This provision shall not be required or effective if the Basic Pilot Program is discontinued. 2. The Contractor shall be prohibited from using Basic Pi]ot Program procedures to undertake pre-employment screening of job applicants while this contract is being performed. 3. If the Contractor obtains actual knowledge that a subcontractor performing work under this contract knowingly employs or contracts with an illegal alien, the Contractor shall be required to: a• Notify the subcontractor and the County within three days that the Contractor has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and b• Terminate the subcontract with the subcontractor if within 5/osjs three days of receiving the notice required pursuant to subparagraph (a) of this paragraph (3) the subcontractor does not stop employing or conh�acting with the illegal aliens; except that the Contractor shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. 4• The Contractor shall comply with any reasonable request by the Deparhnent of Labor and Employment made in the course of an investigation that the Department of Labor and Employment is undertaking pursuant to the authority established in Subsection (5) of C.R.S. § 8-17.5-102. In all other respects the Agreement is in full force and effect and remains unchanged bY this Amendment. If you are in agreement with the terms of this ]etter, please sign below in the presence of a notary and return a copy to us for our files. We appreciate the opportunity of working with you. � n •ely, Tit of Co epresehtative STATE OF COLORADO COUNTY OF PTTKIN ) ) ss. ) The forgoing instrument was acknowledged before me this Name of County Representative. Witnessed my hand and official seal. My commission expires: Notary Public AGREED: ��,�� z�� Other Party's Na�e to Agreement ,. STATE OF COLORADO ) COITNTY OF PITKIN ) ss. ) day of Month. Year, by The forgoing instrument was acknowled ed before me this � a o f �� '+�ev o3/o5/OSjs g � y Rqet3th, �, b rn �� a s ame , y Witnessed my hand and official seal. My commission expires: ��/�'3/aDl3 Notary public / / L� CHRIS ROWgERRY �Y Canm�s,a, E,� t�t3 0 Under lOK HB# Comoliance with House Bi1106-1343 and House Bi1107-1073 A• In compliance with House Bill 06-1343 and House Bill 07-1073 amending TiUe 8 of the Colorado Revised Statutes by the addition of Article 17.5, Dlegal Aliens-Public Contract for Services, enacted by the General Assembly of the State of Colorado, the Contractor sha11 not: Knowingly employ or contract with an illegai alien to perform work under this contract or; z. Enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this conhact. B. In compliance with House Bill 06-1343 and House Bill 07-1073 enacted by the General Assembly of the State of Colorado: I. The Contractor has confirmed or attempted to confirm the employment eligibility of all employees who are newly hired for employment in the United States through participation in the Basic Pilot Program [created in Public Law 208, 104th Congress, or its successor and expanded in Pubiic Law 156, 108�' Congress, or its successor, that is admi�istered by the United States Department of Homeland Security] and, if the Contractor is not accepted into the Basic Pilot Program prior to entering into this contract, the•Contractor shall apply to participate in the Basic Pilot Program every three months until the Contractor is accepted or this contract has been completed, whichever is eazlier. This provision shall not be required or effective if the Basic Pilot Program is discontinued. 2. The Contractor shall be prohibited from using Basic Pilot Program procedures to undertake pre- employment screening ofjob applicants while this contract is being performed. 3. If the Contractor obtains actua] knowledge that a subcontractor performing work under this contract knowingly employs or contracts with an illegal alien, the Contractor shall be required to: a. Notify the subcontractor and the CounTy within three days that the Contractar has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and b. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subpazagraph (a) of this paragraph (3) the subcontractor does not stop employing or contracting with the illegal aliens; except that the Contractor shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. 4• The Contractor shall comply with any reasonable request by the Department of Labor and Employment made in the course of an investigation that the Department of Labor and Employment is undeRaking pursuant to the authority established in Subsection (5) of C.R.S. § 8-17.5-102. Signed and dated this �_ day of �� {�+- (,� � Zp v�t CONTRACTOR: � � /� r ,/ i ln'i�/l ;�. . Title: � � �'( Company Name : i�� , � / � PITKIN COUNTY: - - By:�� i 1 �� Authorized Signer Department: l / r ' � n / Cr'C._. ✓ . �if � (olease orintl 5 Re� 0I2�/ORn � .. _syr�.� Pitkin County Risk Management Department Workers' Compensation Waiver for Individuals I, 16�1 i c��/ � ih� �u'� �d ��' � d, / , as sole proprietor or I ✓ partner of �'licG !' l� G, ( L �°� (business name), represent that I have � 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. I shall also require any subcontractor as I may contract with or obtain for any work to maintain workers' compensation protection for its employees. � �i /o`� Date signed , �:Z�lf"� � Sign�ture of Contractor ,/ �