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COUNTY CLERK'S
CONTRACT COVERSHEET
CONTRACT #: 012 - 2011 -A
ORIGINATING DEPARTMENT: Health & Human Services
PROCUREMENT OFFICER: Mitzi Ledingham PHONE #: 9205766
PROJECT NAME: HCF Grant Programs CONTRACTOR: Access Roaring Fork
DOLLAR AMOUNT: $3,000.00 LINE ITEM # 113.85.00541.82173
CONTRACT EXECUTION DATE: 1/1/2012 CONTRACT END DATE: 12/31/2012
AUTOMATIC RENEWAL: ❑ YES ® NO TERM: biennial
❑ BOCC AGENDA ITEM (Grants, IGA) ® STAFF AUTHORIZED SIGNATURE
(Requires BOCC Signature) (Per Revised Procurement Code 7/2005)
❑ OVER $50,000 (Requires Section Leader & County Manager's Signature)
✓ CHECK PROCUREMENT TYPE:
® None ❑ Informal ❑ Formal ❑ Sole Source ❑ Emergency ❑ Outside Agency /State Bid
❑ Compliance with C.R.S. 8 -17 -5 -101, 102 as amended (Immigration Form) ❑ Exempt
❑ Contract Renewal
✓ CHECK CONTRACT TYPE:
❑ Services/Maintenance ❑ Employment
❑ License/Use ❑ Intergovernmental Agreement (Resolution Required)
❑ Lease ® Non - Profit
❑ Construction ❑ Quasi - Public (e.g. -AVH)
❑ Goods, Equipment, Supplies ❑ Grant Agreements (Notify Finance & Resolution Required)
❑ Other (e.g. revenue) ❑ Change Order /Contract Amendment
(C /O: 10% or $25K whichever is the lesser must have County Manager signature)
All Contracts should be proofed and all exhibits and notices must be attached for the following:
✓ ® No Pages Missing ✓® All Other Blanks Filled In
✓ ❑ If Page Left Intentionally Blank —Note on Page -✓❑ All Exhibits Attached
✓ ® Page numbered consecutively ✓❑ All Legal Descriptions attached (if applicable)
✓ ® All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (if applicable)
. ✓ ® All Dates Filled In ✓❑ Warranty (if applicable)
✓ ® Special Instructions for Finance Department: see contract payment worksheet
✓ ® Authorized Procurement Officer's Name: Mitzi Ledingham
BY CHECKING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF PERSON INDICATES THAT
THE ATTACHED DOCUMENT HAS BEEN PROOFED AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST!
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Contract # 012 - 2011 -A
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CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number: 1 Ledger No. 113.85.00541.82173
OWNER: Pitkin County HHS
c/o Mitzi Ledingham
0405 Castle Creek Rd. suite 7
Aspen, CO 81611
CONTRACTOR: Access Roaring Fork
Deb 6 a't'h Stew4C-atirrmn, Executive Director
PO Box 411116 8 19
Ca bondale- fit, CO Natalie 216.13
The 2011 Access Roaring Fork biennial grant agreement (the "Agreement ") dated _January 1st, 2011
between the Board of County Commissioners of Pitkin County (the "County ") and Access Roaring Fork
(the "Contractor "), is hereby amended as follows:
Description of Change: continuation of contract terms for 2012 as written at same funding level
Reason for Change; second year of two -year biennial agreement
Original Contract Price $ 3.000
Net Increase/Decrease in Contract Price (this change order) $ same level through Dec 2012
Total Adjusted Contract Price (including this change order) $ same level through Dec 2012
In all other respects the Agreement is in full force and effect and remains unchanged by this
Amendment.
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Co ractor VIP Date
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Authorized County ' epresentative Date
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