HomeMy WebLinkAboutbocc.con.amended.055.2010ACLERK'S CHECK LI5T
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR
SCANNING/ARCHIVING
CONTRACT #: oss-aoio-
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Originating Department/Division: Health & Human Services
Contact Person: Mitzi Ledingham Phone #: 920-5766
Project Name: Healthy Community Fund Grant Programs
❑ BOCC AGENDA ITEM �STAFF AUTHORIZED SIGNATURE
(BOCC signature required) (per Revised Pzocurement Code 7/2005)
Check procurement type:
�None �Informal QFormal QSole Source QEmergency �State Bid ❑
Check Contract Tvue:
Dollar Amount: $20,000
se
�, Equipment, Supplies
(e.g. revenue)
Budget Line Item/Ledger Number 113.85.00000.84007
❑Employment (for county employees)
❑Intergovernmental Agreement (Requires BOCC Action)
�Non-Profit
�Quasi-Public
❑Grant Agreements (Requires BOCC Action)
QChange Order/Contract Amendment
ContractorBusiness Complete Legal Name: Family Visitor Programs, �� 1
acting as fiscal agent for Aspen to Parachute Dental Health Coalition P����
Contract Execution 1/3/2011 Contract End Date: 12/31/11 ' a��'
Automatic Renewal
Term of Contract: annual, automatic 12
month extension
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
"U
� �
Other Blanks Filled In
Exhibits Attached
Legal Descriptions Attached �itapPropdare�
ice of Awazd/Proceed Attached (itaPpropnace)
�cial Instructions for Finance Department: see grant payment worksheet
i to Clerk and Recorder for Scanning/Archiving
horized Staff Person's Name: Mitzi Ledingham
LJWarranty, if applicable
BY CHECHING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF
PERSON INDICATES THAT DOCUMENT AAS BEEN PROOFED AND READY
FOR SCANNING.
Contract # 055-2010 -A
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6
Change Order Number: l
OWNER: Pitkin County HHS
c/o Mitzi Ledingham
0405 Castle Creek Rd. suite 7
Aspen, CO 81611
CONTRACTOR: Family Visitor Programs
Aspen to Pazachute Dental Health Coalition
P.O. Box 1845
Glenwood Springs, CO 81602
Rev l2/10/09js
The 2010 Family Visitor Programs Aspen to Pazachute Dental Health Coalition grant agreement (the
"AgreemenY') dated Januarv 1 st, 2010 between the Board of County Commissioners of Pitkin County
(the "County") and Aspen to Pazachute Denta] Health Coalition c/o the Family Visitor Programs (the
"Contractor"), is hereby amended as follows:
Descrintion of Chan�e: continuation of contract terms for 2011 with funding level of $20,000
Reason for Chan¢e; additional 12 month extension of 2010 Agreement
Original Contract Price
Net Increase/Decrease in Contract Price (this change order)
Total Adjusted Contract Price (including this change order)
$ so.000
$ -$t0.0��
$ zo,000
In all other respects the Agreement is in full force and effect and remains unchanged by this
Amendment.
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Date
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CHANGE ORDER/CONTRACT AMENDMENT