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COUNTY CLERK'S
CONTRACT COVERSHEET
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CONTRACT #: 04-2-2011-A
ORIGINATING DEPARTMENT: Health & Human Services
PROCUREMENT OFFICER: Mitzi Ledingham PHONE #: 9205766
PROJECT NAME: HCF Grant Programs CONTRACTOR: KDNK: Carbondale
Community Access Radio
DOLLAR AMOUNT: $6,000.00 LINE ITEM # 113.85.00541.82187
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:
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❑ 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 (f applicable)
✓ ® All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (f 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!
013
Contract # 41 2011 -A
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CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number: 1 Ledger No.: 113.85.00541.82187
OWNER: Pitkin County HHS
c/o Mitzi Ledingham
0405 Castle Creek Rd. suite 7
Aspen, CO 81611
CONTRACTOR: KDNK: Carbondale Community Access Radio
PO Box 1388
Carbondale, CO 81623
The 2011 -2012 KDNK Carbondale Community Access Radio biennial grant agreement (the
"Agreement ") dated January 1st, 2011 between the Board of County Commissioners of Pitkin County
(the "County") and KDNK Carbondale Community Access Radio (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 $ 6,000
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.
January 4, 2012
Contractor Date
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Authorized County Representative Date
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