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Home My WebLink Aboutbocc.con.157.2014 Rev. 08-30-11 jls 111101" COUNTY CLERK'S CONTRACT COVERSHEET CONTRACT #: 157-2014 ORIGINATING DEPARTMENT: HHS PROCUREMENT OFFICER: Mitzi Ledingham PHONE#: -9205766 PROJECT NAME: CONTRACTOR: Hilary Stunda DOLLAR AMOUNT: $1,340.00 LINE ITEM # 113.85.00000.81830 CONTRACT EXECUTION DATE: 5/6/2014 CONTRACT END DATE: 6/1/2014 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: Z 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/0: 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: ✓ Z 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 (if applicable, ✓ ® All Dates Filled In ✓❑ Warranty(if applicable) ✓ ❑ Special Instructions for Finance Department: ✓ ® 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! • 'l KID Coding: 113.85.00000.81830 COU Vri - - tr/'.'ND —. __ Contract: (5 J 7 < Zo I q PITKIN COUNTY STANDARD FORM OF AGREEMENT • AGREEMENT made as of 6th I day of May 201 4 , BETWEEN the Board of County COMMISSIONERS OF PITKIN COUNTY (the "BOCC") and Hilary Stunda (herein after called the "Contractor"to provide services for: Board of County Commissioners of Pitkin County Contract Amount: $ 1,340 C/O Mitzi Ledingham Address Deputy Director,HHS Project Healthy Community Fund Spotlight Report-updates 0405 Castle Creek Rd.Suite 103 Name: from 2013 year-end reports Phone Aspen,Colorado 81611 _-- _---------- -----_--- ---(970)920-5766 ---------------------------------------- -----_ Scope of services detail attach as exhibit below And the Professional(Contractor Info): Exhibits as appended and made a part of this Agreement: . , Project was to synthesize information from Name Ms.Hilary Stunda HCF grantee year end reports for 2013 into a Exhibit A "spotlight"document. Address P.O.Box 8803 Aspen,Colorado 81612 - 1 --- Phone (970)710-1474 Jun 7,2014 ' anew documentation in succeeding years to be and will require E-mail hstunda @gmail.com agreement ------- -.-.--....----- effective. The purpose of this agreement is to summarize the pertinent terms of Pitkin County's arrangement with you. The County's obligation under the Workers' Compensation Statute 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, 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 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 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. • y5 for the ,,at your own expense,occurrence form You shall obtain, and maintain continuously for the term of this arrangement, at your ow Commercial General Liability with limits of Each Occurrence, General Aggregate and $1,000,000 1 Products/Completed Operations Aggregate including an endorsement naming the County as an additional insured (for ongoing operations and completed operations) and/or other insurance to indemnify the County 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 sufficient amounts, durations, or types. Agreement for Sett ices Page l PUBLIC CONTRACTS FOR SERVICES. CRS§8-17.5-10I. [Not Applicable to agreements relating to the offer,issuance, or sale of securities, investment advisory services or fund management services, sponsored projects, intergovernmental agreements, or information technology services or products and services] Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract and will confirm the employment eligibility of all employees who are 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 pursuant to CRS §8-17.5-102 (5)(c), Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform 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, Institution 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 to 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 §24-76.5-101. Contractor, if a natural person eighteen (I8) 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 , sduced one form . identification required by CRS §24-76.5-103 prior to the effective date of this contract. Lisa--s ... J . • Name of' -pres ntative for Pit in County - • STATE 0 O LORADO ) . )ss. COUNTY OF PITKIN ) ■ t The forgoing instrument was acknowledged before me this t day of s 2015-by r. - �1 L Witnessed my hand and official seal. , //�/� _ g �� A�� /I /Y ' . • j �r,'ARKWOOD My commission expires: , ' 1u 'l '•T• PUBLIC• NotaryPublic STATE OF COLORADO AGREE NOTARY tD#19974015819 • h1y Commission Expires January 26,2017 `#- r Nam- .' •uthori e= ontractor Representative STATE OF COLORADO ) )ss. COUNTY OF PITKIN ) The forgoing instrument was acknowledged before me this V day of 1 .201(y `l �� _ l A �' II I Witnessed my hand and official seal. ARKWOOD � y My commission expires: � . )� �--1 I �t — �'�s 1 �� ) y,i,COLORADO Notary Public NOTARY.ID#19974015819 Agreement mrse,me: A1v Comntiss�on Expires January 26,2017 Page 3 .,..... Q