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Home My WebLink Aboutbocc.con.109.2012COUNTY CLERK'S CONTRACT COVERSHEET CONTRACT #: ORIGINATING DEPARTMENT: Library PROCUREMENT OFFICER: Genevieve Smith / o g, �o �Z. PHONE #: 4291948 Rev. 08-30-11 jls PROJECT NAME: ACT Cram Session CONTRACTOR: Kalfas Educational Services c/o Philip Kalfas DOLLAR AMOUNT: 600.00 LINE ITEM # 166-62-00000-82000 CONTRACT EXECUTION DATE: 4/11/2012 CONTRACT END DATE: 4/12/2012 AUTOMATIC RENEWAL: ❑ YES � NO TERM: ❑ 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 ❑ License/Use ❑ Lease ❑ Construction ❑ Goods, Equipment, Supplies ❑ Other (e.g. revenue) �/ , / , ❑ Employment ❑ Intergovernmental Agreement (Resolution Required) ❑ Non-Profit ❑ Quasi-Public (e.g.-AVH) ❑ Grant Agreements (Notify Finance & Resolution Required) ❑ Change Order/Contract Amendment (GO: 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 (ifapplicable) �� 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: None ✓� Authorized Procurement Officer's Name: Genevieve Smith �� t.II�:C�i�:i:'t�(; .��()"4� E r�hD E11TE12t:'VC. :�AlY1E, THE ALTH()(2iZE1) �TAFF PE12;.S(3� I:�I�I(:�.�4."i l�� "I'�i�'I' �t'�#I� �`�"T<�C;HEI) Dt3C;i.?t19F�T HAS 1BEEl\ Plt()(.)FEII A"��D RFADY F()R �C;A:�I��:�C.. NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS 1N COMPLIANCE WITH COLORADO STATE ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST! Contract # Ledger # Rev. 12/27/10 jls LETTER OF ENGAGEMENT March 21, 2012 Philip Ka1fas 42 Mining Stock Pkwy # 101 Aspen, CO 81511 Re: ACT Prep Study Hall Dear Mr. Kalfas: The purpose of this letter 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 �Vorkers' Compensation Statute requires Pitkin County and you to formalize the terms of this engagement in a notarized writing. As a professional ACT test prep tutor, you will work with high school students in a program entitled "ACT Prep Course" prior to the scheduled ACT test on April 14�', 2012. The program be held on Wednesday, April 11�' from 6-8 pm and Thursday, April 12'� from 4-6 pm. Please arrive at least 30 minutes in advance. Yow fee will be $600. It will be paid to you at the time of the program. It is mutually agreed that the County does not have an exclusive right to your services and it is contemplated that you may provide similar work 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 pazagraph. The County representative signing this letter is available to you to discuss any details related to this engagement. This letter of engagement will terminate on December 31St and will require a new document in succeeding yeazs to be effective. You acknowledge and agree that you shall not be entitled to workers' compensation benefits in connection with this project and that you shall be responsible for the payment of all state and federal income taxes. Contract # Rev. 12/27/10 jls Ledger # Ille�al Aliens — Public Contracts for Services In conformance with the provisions of C.R.S. § 8-17.5-101 and 102, as amended; 1. Contractor shall not knowingly employ or contract with an illegal alien to perform work under the public contract for services. 2. Contractor shall not 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 the public contract for services. 3. Contractor has confirmed the employment eligibility of all employees who are newly hired for employment to perforrn work under the public contract for services through participation in either the E-Verify Program or the Department Program. 4. Contractor shall use either the E-Verify Proga.m or the Department Program procedures to underta.ke pre-employment screening of job applicants while the public contract for services is being performed. 5. Should Contractor obtain actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien, 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; (b) Terminate the subcontract with the subcontractor if within three days of receiving the required notice the subcontractor does not stop employing or contracting with the illegal alien; except that the contractor shall not terminate the contract with the subcontractor if the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien; 6. Contractor shall comply with any reasonable request by the department made in the course of an investigation that the departrnent is undertaking pursuant to C.R. S. 8-17.5-102(5). If you are in agreement with the terms of this letter, 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. 2 Contract # Ledger # �� Sincerely, Genevieve S th, oung A u t Services Librarian STATE OF COLORADO ) ) ss. COUNTY OF PITKIN ) Rev. 12/27/10 jls Ap,�� I, 2ot 2 The forgoing instrument was acknowledged before me this _ day of , by Genevieve Smith � �►�►tE OR� Witnessed my hand and official sea.l. •�•�;:•NaT •� . �r , i -P-a-... My commission expires: -/ .- � � N� ;. �fC ��'•••....�Ol� ry il� °Fca �. ��ie�• � �� .-'� — � STATE OF COLORADO COUNTY OF PITKIN ) ) ss. ) The forgoing instrument was acknowledged before me this � day of March, 2012 by Philip Kalfas Witnessed my hand and official seal. My commission expires: �� l(� a�`i � Notary Public - .�:;��n:..r.��, � , �R'=� ,s.;_ .�° r „� ,�:\ia. °:�+4.! ��'�'i �:��('� '••.;�'',� ��. r= ,� . , . .��nT,v,qy'. --�+� _•-- : � �::.�-''!1A.11� "�` . - <• �°;;:: �s:�., �,��. , ;, �;, � �•eae,a •� �� :,� �� , . ,.. 3 � . ... �r ... �,�� :� �e �, �� m. _,.,,, �.�,,. ,._ � �, Workers' Compensation Waiver Sole Prourietorships or Partnerships � � c �s" I,�1-t� t � i��15 , as sole proprietor or partner of �fl� trc,��l. � business name), represent that I have no 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 v�ork-to �n,aintain workers' compensation protection for its employees. �' � * L� - � � Contractor � atu e Date � ��-� � � ,-+� � , K,��S Print Name Corporations I, , in my capacity as (title) of (corporation name) represent that (corporation name) has no person or persons in its employ and that each stockholder of (corporation name) owns at least 10% of 's (corporation name) stock, but that (corporation name) 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 it may employ in performing any work in the future. (corporation name) shall also require any subcontractor it may contract with or obtain for any work to maintain workers' compensation protection for its employees. Contractor Signature Date Print Name ��