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Pitkin County
COUNT/1 Contract Cover Sheet
Please complete the Contract Cover Sheet when the contract is completed and signed by Contractor and Pitkin County
Project Manager.
Return all Contract Cover Sheets and Contracts/Change Orders/Amendments to Procurement
(procurement help@pitkincounty.com).Any contracts$50,000 and over will be routed for signatures to County Manager
and Attorney's Office(if required)by Procurement&Contracts Manager.
Contract Information
Contract Number 269.2015A
Project Name . Asbestos Inspections
Contractor HealthSafe Inspections,Inc.
Budget Line Item- 110.18.92818.72724
Additional Budget Line Item(s)- Click here to enter text.
and special notes to Finance
Contract Start Date ' 11/10/2015
ContractEnd•Date _ 12/15/2015
Automatic Renewal.. Yes ❑ No El
If Construction:'Retainage Click here to enter text.
If this is a new contractor,please request they complete and submit to Finance a W-9 Form.
Contact Information:
Department Facilities
Project Manager' '.. Smith Project Manager 5396
Phone
Provide a brief description of the contract:
Amendment A adding samples
Contract Value Summary:
Contract Amount .,. $1,347.00
This Change order/Amendment amount(if applicable) - $400.00
New Contract:Total $1,747.00
Procurement Method:
None El Informal Formal 0 Sole Source 0 Emergency 0 Contract Renewal 0
Contract Type:
Services/Maintenance N Construction 0 Goods,Equipment, Supplies 0
Change Order/Amendment 0 Other,please explain 0 Click here to enter text.
NOTE: CLERKS OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE.ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST.
Contract if 269.2015 Rev.8.31.11 jaajs
Budget Line Item# 110.18.92818.82724
•
4
CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number:269.2015A
OWNER: Pitkin County
485 Rio Grande Place,Unit 101 •
Aspen,Colorado 81611
CONTRACTOR: Healthsafe Inspections,Inc
The Provision of Services for Asbestos Inspections (the "Agreement") dated 11/12/15 between the
Board of County Commissioners of Pitkin County (the"County") and HealthSafe Inspections, Inc. (the
"Contractor"), is hereby amended as follows:
•
Description of Change:
a. An additional 14 asbestos samples are needed at Vectra Bank Offices.
b. An additional 6 asbestos samples are needed at the Ute City Offices.
Reason for Chance
At both sites there are more dissimilar materials that initially thought thus requiring more samples.
Original Contract Price $ 1,347.00
Net Increase/Decrease in Contract Price(this change order) $400.00
*"Total Adjusted Contract Price(including this change order) $ 1.747.00
In all other respects the Agreement is in full force and effect and remains unchanged by. this
Amendment:
P7
Co ctor Date
IZ f /5
Procurem t Officer Date
*Increases over$25,000 and/or 10% (single increase or accumulative)of original contract must have
County Manager signature.