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Home My WebLink Aboutbocc.con.181.2013 Rev. 08-30-11 jls COUNTY CLERK'S CONTRACT COVERSHEET CONTRACT #: � �J -dUl3 ORIGINATING DEPAI2TMENT: ��„""�" y- �� Y'/WZ'(/_� �1 PROCUREMENT OFFICER: PHONE #: �/ 7 a� �f �L a/ —� y 3 p,�-�-�-�c�,�a ,./ PROJECT NAME: �}�u�� CONTRACTOR: ��r l� � � ��'`"�� DOLLAR AMOUNT:��d7LINE ITEM# �j ai � y 3� b�0�• S 3 bGYJ CONTRACT EXECUTION DATE: L0�7��-0J3CONTRACT END DATE: �Z� 3J`�U�3 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& Counry 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 ❑Con[ract Renewal ✓ CHECK CONTRACT TYPE: � �� /�Services/Maintenance ❑ Employment ❑ License/Use ❑ [ntergovernmental 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/0: !0%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 oo Page ✓0 All Exhibits Attached ✓ ❑ Page numbered consecutively ✓0 All Legal Descriptions attached (ifapplicab(e) ✓ ❑ All Originai Signatures Affixed ✓0 Notice of Award/Notice to Proceed Attached ('rjapplicab/e) ✓ ❑ All Dates Filled In ✓� Warranty(if applicable) ✓ � Special Instructions for Finance Departmenh ✓ ❑ Authorized Procurement Ofticer's Name: l3Y CHFCKING ABOVE AND �Y'fFR1NG�VAME, THE AUTHORI'LED STAFF PERSON INDICATES THAT ' THE ATTACHF,D DOCUMENT HAS l3EEN YROOF ED ANB READY FOR SC.4tiN{NG. NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE ARCHNES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST! �f T'K I N Coding: 112.43.00000.8300� COU N T� aU��n7 Contract: � � b j PITHIN COUNTY STANDARD FORM OF AGREEMENT AGREEMENT made as of sth day of lune 2013, BETWEEN the Board of County COMMISSIONERS OF PITKIN COUNTY (the "BOCC") and 7erri Allender,M.A. (herein after called the "Contractor"to provide services for: Board of County Commissioners of Pitkin County ConVact Amount: $ 2,500 C/O Kim Dubois Address Adult and Family SErvices Manager Project ParenUChild,Emotional Availability Assessment 0405 Castle Creek Road,Suite 8 Name: Child We�fare,Dependency and Neglect Case Phone Aspen,CO 81611 (970)429-2043 . Scope of services detail attech as e�chibit below And the Professional(Contractor InFo): Exhibits as appended and made a part of this Agreement: va uate aren i e ations ip Name Terri Allender,M.A. ssessment and Recommendations for Address Licensed Professional Counselor Exhibit ngoing Family Services Plan P.O.Box 8325,Avon,CO 81620 Phone 970-390-5708 terrikallender@gmail.com / This agreement will terminate on •��3 and will require E-mail a new documentation in succeeding years[o be effec[ive. The purpose of this agreement is to summarize the pertinent terms of Pitkin County's arrangement wi[h you. The Counry's obligation under the Workers' Compensation Siatute requires Pitkin County and you to formalize the terms of this engagement in a notarized writing. 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, governmenu and non-profit organizations. You acknowledge that the work performed for Pitkin County witl 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 scope of work. The County representative signing this letter is available to you to discuss any details related to this agreement. You acknowledge and agree that you shall not be entitied 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. You shall obtain, and maintain continuously for the term of this arrangement at our own expense, occurrence form Commercial General Liability with limiu of 5i,000,000 Each Occurrence, $1,000,000 General Aggregate and 51,000,000 Products/Completed Operations Aggregate including an endorsement naming the Counry as an additional insured (for ongoing operations and completed operations) and/or other insurance to indemnify the Counry for the activities and services of this of this arrangement. You are not relieved of any liability or other obligations assumed pursuant to this arrangement by reason of your failure to obtain or maintain insurance or by reason of your failure to procure or maintain insurance in su�cient amounts, durations,or types. Ag�eanmt fw Servim P4ge 1 �rTxi�v COUNT� C�/>,C� PUBLIC CONTRACTS FOR SERVICES.CRS§8-17.5-101. [NolApp/icab[e!o agreements reloting Jolhe ojjer, issuance, or sale oj securrties, rnvestment advisory services or jund management services, sponsored projecls, intergovernmenta/ agreements, or injormation technology services or products and services] Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegai alien who will perform work under this contract and will confirm the employment eligibility of all employees who aze newly hired for employment in the United States to perform work under this contract, through participation in the E-Verify Program or the Department program established puTSUant to CRS §S-U.5-102 (5)(c),Contractor shali not Imowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract with a subconhactor that fails to certify to Contractor that the subcontractor shall not knowingty employ or contract with an illegal alien to perfortn work under this contract. Contractor(a)shall not use E-Verify Program or Department program procedures to undertake pre-employment screening of job applicants while this contract is being performed,(b)shall notify the subcontractor and the contracting State agency within three days if Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien for work under this contract, (c)shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three days of receiving the notice, and (d) shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to CRS §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Contractor participates in the Department program, Contractor shall deliver to the contracting State agency, [nstitution of Higher Education or political subdivision a written,notarized affirmation,affirming that Contractor has examined the legal work status of such employee, and shall comply with all of the other requirements of the Department program. If Contractor fails ro comply with any requirement of this provision or CRS §8-17.5-101 et seq., the contracting State agency, institution of higher education or political subdivision may terminate this contract for breach and, if so terminated,Contractor shall be liable for damages. PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §2476.5101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b)shall comply with the provisions of CRS §24-76.5-101 et seq., and(c) has produced one form of identification required by CRS §24-76.5-103 prior to the effective date of this contract. ��h.RCP�,�iA.E �'JIA.B�I� r�V`�—� �. \�G�Z�� ep ese tative for Pitkin Coanty STATE OF COLORADO ) )ss. COUNTY OF PITKIN ) The Forgoing instrumen[was acknowledged before me[his�ay of��2013,by ��.1 Wi[nessed my hand and official seal. O�\yCOL .• !� i ��' ��Q-�•U'$� � My commission expires: /'��—/� �� G � �p 6 otary Public ?' a' � AGREED: �'•. �:��V � ..STA'�O ame of Authorized Contractor Representa[ive STATE OF COLORADO j ) ({c�l ,SS. COUNTY OF-PI�ifiN tu�i��`� ) The forgoing instrument was acknowledged before me this�o�day o��^� 2013,by �✓i !'��(�✓1 G E✓ Witnessed my hand and official seal. .••+�+« My commission expires: y�i o a��S _ _- _=K�REN.MARTINEZ � 9�ARY PUBLIC Notary Pu lic STATE OF COLORADO Ageemenf for Servica Page 2 My Commission F�cpires 04/1012015 mm Terri K. Allender, M.A., L.P.C. P.O. Box 8325 Avon, CO 81620 970-390-5708 lune 7, 2013 terrikallender@gmail.com Kim Du Bois Pitkin County Health and Human Services 0405 Castle Creek Rd. Suite#8 Aspen, CO 81611 Hi Kim, I thought it would also be appropriate for me to send you an addendum to the contrect with the hourly rates I agreed on with Sarah Fedishen.They are: Video Recording: $75.00 per hour Video Review and Report writing $100.00 per hour Travel: .52 per mile (Federal rate) Testimony and/or court Preparation $110.00 per hour I am looking forward to working with you! /� � ��G.c�-�^�`�-� .�� Terri