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Home My WebLink Aboutbocc.con.261.2013 Rev. 08-30-1/jls COUNTY CLERK'S CONTRACT COVERSHEET CONTRACT #: 261-2013 ORIGINATING DEPARTMENT: Fleet management PROCUREMENT OFFICER: James Gilliam PHONE #: -9205765 PROJECT NAME: Tires CONTRACTOR: Two Valley Tire DOLLAR AMOiJNT: $15,112.00 LINE ITEM# 505.52 00000 83753 CONTRACT EXECUTION DATE: 1 1/4/2013 CONTRACT END DATE: 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: I�� `� ❑ Services/Maintenance ❑ Employment ' ❑ License/Use ❑ Intergovernmental Agreement(Resolution Required) ❑ Lease ❑ Non-Profit ❑ Construction ❑ Quasi-Public(e.g.-AVH) � Goods, Equipment, Supplies ❑ Grant Agreements (No[ify Finance & Resolution Required) ❑ Other(e.g. revenue) ❑ Change Order/Contract Amendment (C/O: 10%or$25K whichover is the lesser must have County Manager signamre) All Contracts should be prooPed 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 ('fapplicable) ✓ � All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (ijapplicahle) ✓ � All Dates Filled In ✓� Warranty(if applicable) ✓ � Special Instructions for Finance Department: Paid with p-card ✓ � Authorized Procurement Oflicer's Name: james Gilliam BY CHECKING ABOVE AND ENTF,121NG NAME,THE AUTHORIZF,D STAFF PERSON INDICATES THAT THE ATTACHED DOCUMENT HAS BEEN PROOFED AND RI;ADY FOR SCANNINC. NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE ARCHNES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST! .s...N4 ....♦!.... _ . . .. . . . -n.+.a k.....,'�,�y' . . .�,.. I r^ . .. . � ' � � �.: .i. . . : . . . � a� �-aa �3 � i INVOICE , N� 5Ei14 .��.,_ . - DATE OF ORDER �I � 4 - 13 . CONTACTPERSON �'� �` PHONE � 970.904.0090 • fax 970.524.4959 Po# P.O. Box 4 • Eagle, CO 81631 twovalleytire@yahoo.com i . ... Name �rr'�c2►..� �euNT Physical Address Billing Address :.QTY _ ' � � � �„,' � , ,.� :�;;�' �'DESCRIPTION ,�'°,, ' '; .' ' �." UN T�°.,.��:AMOUNT,� ,;rl !�4 �rz�s=�-7oar7 oG65ro�� w9� — lo ZoS.00 l3/Zo . (o� �olo. �rasTE 1—EE �• 5d �,'7��0 00 `3 2�� oerd 2 T �x 235.SO / 84 —° � g of�. �Acrc-' &r- /Sa �� °� . Z4 ��. �o- � 0- �3 �.� w4�s' ' 8 'I�L lo- 2�- /3 ...., C,� 2 srm�oc I�EL. IO -�"�3 13L W4L5 Df L. . 1�- 4- 13 � Z� �4(os _. , . :. 'L .'�y � � r PLEASE PAY FROM THIS INVOICE - � �' "Section 25-17-202, Colorado Revised Statutes, requires retailers to collect a $1.50 waste tire recyc�ling development fee on the sale of each new motor vehicle tire." ;, . UNIT# g �� 7� MILEAGE - �� / 7S TAX �x�� . LICENSE# �NnP 4 � ,G �v� VJHEEL POSITION / TOTAL—► IS IIZ 00 , � �Iluz�l2j,au SIGNATU E Q hereby acknowledge the satisfactory completion of the above described work.)