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Home My WebLink Aboutbocc.con.122.2015Rev. 08-30-11 Jls COUNTY CLERK'S CONTRACT COVERSHEET CONTRACT #: 4 9 � 1-9015 ORIGINATING DEPARTMENT: rj 4XLa PROCUREMENT OFFICER: V)) in vthPHONE #: M`76) L12, 1--lot-i3 PROJECT NAME: CAA pD . CONTRACTOR: 'A F5 — g G.rn - Do t3015 Cotlu bmil,-e mcrt. 9"Je k- DOLLARAMOUNT: ,t"4;¢0 LINEITEM# 1, a•�t3: naeai�.,8aoo0 ` CONTRACT EXECUTION DATE: /3bja(,S CONTRACT END DATE: *�Vpb/s AUTOMATIC RENEWAL: '—y YES X NO TERM: _z -- a M61%f->75 ❑ 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 LK 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/0: 10% or 525K whichrur is the lesser must have County Manages 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 fifapplicable) ✓ ® All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (rfapplicab, ✓ ® All Dates Filled In ✓❑ Warranty (if applicable) ✓ ❑ Special Instructions for Finance Department: ✓ ® Authorized Procurement Officer's Name: j ]`•ygj::./ jj��i�' 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! PITIGN COUNTY STANDARD FORM OF AG M M M AGREF31EN r made as of 24._ . 'day of rebruary 201 !.'._i , BETWEEN the Board of Comity i C011Ih1ISSIOIVERS OF PITKl1 COUNTY (the "BOCC") and (herein after called the "Con r"tn provide semees for: Board of Conary Commissioners ofPhkin Conary Gist Main Sweet ren, CO And the Professional (ConnectorInfa): haeme Cu*nHardln.Crystal Springs SZAudons Adm P.O. Box 13% jl( rbondale,00816B Phone (970) 963-S5351&70) 953-2951 E-mailhardin@soprisnet j Ceatrzat Amounts J �O oRaborativeManagement PMJeM Grant j iVame: appended and made apart ofthis Agreement: cesA ren onFslv"Se gand grantnaldng supportforstate Fnd= ed prplectfor Pitidn County Old Welfare i+is a, emeat ail temyayaie onDec 31, 2011!, and *ill require a.new doannanation in saoceecrmgye=tDteecfxdve. It is mutually agreed that the County does nat have an exclusive right to your services and it is contemplated 03e you may provide similar work to other busInesses, governments and non-rrv&t organizations. You admowledge that the work performed for Pitkin Comity will be that of an independent contractor aid that no employee-arnployer releonft is created You have full control over how Ste services are peaformed and it is expected that work will be conducted in accordance with "industry standards by applying professional udgare rt The County wiz provide if necessary, documents aid information to complete the mark described in the scope of wont The Com*} representative sigain this letter is available to you to discuss arty details related to this agreemerL You acknowledge and agree ihstyou sball be entitled to workere compensation benefits in connection with this project and that you shall be rwpu� for the payment of all state and federal income taxes. 1 t . 1. [I . ...- �!L .1 . ! •` - ,. Col. - - �!�'�� .a, w. . �• .n.1 —tor a .., I• a1, +1 .uml• rw .a.ol nu.I n, •,n :l,. a .11! I. ! in e!. _ v -u _ -1-•-. s . n • .aur .1.1 •.u�I r. 1! �I `- II I • • 1. .1 - It !'! Y.�{I 11 . .R:.. - Y . A�tJ}�IY.R to fTKIN courcTif PUBLIC CONTRACT'S FOR SERVICES_ CRS §8-17.5.101. [NviA tomtp r¢I4armmeee rp yle,gb> aeg Or We Of secmEtia, iiirzawa d a&szsory saykes or fiord Mmuganent service, Vemored pnvica, uetagovanareatal We==Z Or wf0?MZfi iia techw&V savwes or praduras and smwal Contractor certifies, warrant, and am= egal it does cot knowi fly employ o_- contract with an file -gal alien who -mfl perform work under this contract and will confam the employment eligibility of all employees who are newly hired £or employrierrr in #re United States to perform wodt corder #tis contract flnongh partrcipa*ion in the E Verify Pt = or tlr Dep P ogram a abiished pursuant to CRS §S -17.5-,W (5)(c), Couaactor shall not knowingly employ or with an illegal alien to perform work traderibis Shaer or enterano a owdract with a subcontractor that fails to certify to Cofactor that the subarncactvr shall not knowingly employ or contract with an illegal alien to perform morin under tbis contract Contractor (a) shall not use E -Verify Program or Depattmart program Pyr= to tmdertake Pm emPlscreening ofjob applicants while I& contwt is being pmfb med, (b) shall notify the subcontractor and the cont -a effirg State agency within three days r. Coatacwr has actual lmcwledge tbat a subcontractor is employing or courting with an ill,—d alien fe work under this contract; (c) shall terminate the subcordract if a sahcontractor does not slop employing ac contracting avlth the illegal alien within three days of receiving the nodce, and (d) sbali comply with reasonable requests made in the course of an investigadom, rmdertakea pursuam to CRS §g -IIS -102(5), by the Colorado Department of Labor and Employment If Contractor particzpatrs in the Department program, Contra. -ter shall deliver to the asnttaci>ug Srate agency, Iasft;ritnoa of liigbtr Education or political subdivision a wriitcu, notaized siiirma�, affiming that Contractor has examined the legal work scams of such employee, and shad armply with all of the other requirements of fie Department prw,a,raru. li Cmmarior fails to oomply wiih any reguiemcat of #ds provision or CRS §&173-101 et seq., the contractnrg Stare agency . mstivaion of higher education or political subdivision may terminate this contract fest breach and, if so terminated, Contractor shall be liable for damages. PUBLIC CONTRACTS VaM NATURAL PERSOM CRS §24276-5-101. Contractor, if a nanaal person eiglrteen (1s) years of age or older, hereby swem and ;'firms under panalty of pmjmy that he or she (a) is a cifi= or otherwise idly present in the I.faited States puawmt to federal law, (b) sbaR camply wkb the provisions of CRS §24765-I01 et seq., and (c) has/�P/�-'dduu`ced one of idenffi re=ed by CRS §7A-763-103 prior to the elihcdvo date of this fact Name ofRepresedtative Pigrin Coanty STATE OF COLORADO } ,"� )u COUNTY OFA f*d' n Tic forgoinginstmmeatwas acknowledged before me#tis7`[day off ch = b9 Witnessed my band and official seal //J� , ///� - ywmmissicnacpires: 91f%/b' `/ —, A9/�/jar Notary Pnbimc f/ mmurio-mumu) Name of Authorized ConuacwrReprweataaive meaty Pubac State of cow"D STATE OF COLORADO } _ WW ffi 2034403790 Cmmatksiat 28 2013 COUNTY OF PrnnM j The forging insn'maent was ackre ledged bef= me thi ]dal of iywf442.06by 4i tmrssed my hand and official seal - My commitsiaa empires: Aix cs.-s��a tion: Scope of Work Attachment A Carolyn Hardin, MPH Principal Consultant Crystal Springs Solutions Review of Collaborative Management Project and information related to the application of funds for FY15. (Website and reading material) Review MOU's provided by other CMP sites. Participate in CMP state meeting and local CMP/1OG with neighboring Counties (Garfield and Eagle). Work with AFS Manager to outline next steps to procure funds from State Collaborative Management Program by April 15, 2015. identify stakeholders to participate in the development and approval of a Memorandum of Understanding for interagency leadership and oversight of existing CMP Programs/services. Develop a draft MOU per state requirements. Finalize MOU for submission by May 10, 2015. Estimate time: no more than 80 hours @ 75.00/hour—Project Due Date: May 10, 2015 15