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COUNTY CLERK'S
CONTRACT COVERSHEET
CONTRACT #: 065- 2010 -B
ORIGINATING DEPARTMENT: Health & Human Services
PROCUREMENT OFFICER: Mitzi Ledingham PHONE #: 9205766
PROJECT NAME: HCF Grant Programs CONTRACTOR: Youth Zone
DOLLAR AMOUNT: $45,000.00 LINE ITEM # 113.85.00000.84008
CONTRACT EXECUTION DATE: 1/1/201.2 CONTRACT END DATE: 12/31/2012
AUTOMATIC RENEWAL: ❑ YES ® NO TERM: partnership
❑ 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!
Contract # 065 -2010 -B
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CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number: 2 Ledger No. 113.85.00000.84008
OWNER: Pitkin County HHS
c/o Mitzi Ledingham
0405 Castle Creek Rd, Suite 7
Aspen, CO 81611
CONTRACTOR: YouthZone
803 School Street
Glenwood Springs, CO 81602
Attn: Debbie Wilde, Director
The 2010 -2012 YouthZone partnership grant agreement (the "Agreement ") dated _January 1st, 2010
between the Board of County Commissioners of Pitkin County (the "County ") and YouthZone (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: third year of three year partnership agreement
Original Contract Price $ 45.000
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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Contractor Date
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Authorized County • - : tive Date
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