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cpsTKIN Pitkin County
COUNT'i 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 176.2016A
Project Name Radon Testing&Analysis
Contractor HealthSafe Inspections,Inc.
Budget Line Item 110.18.92818.82726
Additional Budget Line Item(s) Click here to enter text.
and special notes to Finance
Contract Start Date 4/15/2016
Contract End Date 5/15/2016
Automatic Renewal Yes ❑ No®
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 Jodi Smith Project Manager 920-5396
Phone
Provide a brief description of the contract:
Radon gas post-test, analysis and report.
Contract Value Summary:
Contract Amount(Not to Exceed) $675.00
This Change order/Amendment amount(if applicable) $225.00
New Contract Total $900.00
Procurement Method:
None ® Informal❑ Formal 0 Sole Source 0 Emergency 0 Contract Renewal 0
Contract Type:
Services/Maintenance ® Construction 0 Goods,Equipment, Supplies 0
Change Order/Amendment 0 Other,please explain 0 Click here to enter text.
NOTE: CLERKS OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE.ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST.
Contract#176.2016 Rev. 8.31.11 jaa/js
Budget Line Item# 1 !b. 15?", 125a1$
cti Cr 14: N
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JUN i
CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number: 176.2016A
OWNER: Pitkin County Facilities
485 Rio Grande Place, Unit 101
Aspen, Colorado 81611
CONTRACTOR: Healthsafe Inspections, Inc.
1052 Vine Street,
Aspen, CO 81611
The Provision of the Radon Testing and Analysis contract (the "Agreement") dated 4/12/2016 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. Radon gas post-test, analysis and report following radon mitigation installation. See Exhibit A:
Estimate attached.
Reason for Change:
A follow up test is necessary after the installation of a radon mitigation system.
Original Contract Price(Not to Exceed) $ 675.00
Net Increase/Decrease in Contract Price (this change order) $ 225.00
*Total Adjusted Contract Price (including this change order) $ 900.00
In all other respects the Agreement is in full force and effect and remains unchanged by this
Amendment.
,i_p_An 0,,,,,/„.
ontractor Date
Print Name&Tide
i JO le' i / L_S/ e7"%. "-/(/
Jod. mith,Facilities Superintendent Date
HealthSafe Inspections Inc �X BIT A ESTIMATE
1052 Vine St
Aspen CO 81611
Account# 09180601
Date: 4/1212016
Customer Address: Service Address:
Pitkin County Pitkin County-Vectra Bank Offices
530 E Main St, Ste 202 534 E Hyman Ave
Aspen CO 81611 Aspen,CO 81611
Description Est. Hours/Qty. Rate Total
Radon Gas Test, Analysis & Report [Post-Test after 1 225.00 225.00
Radon Mitigation Installation]
I have enjoyed serving and helping you with your indoor environmental
concerns. Thank you.
SIGNATURE
Phone: Payments are due upon completion of work.Credit is
extended only to those customers with pre-approved accounts.
970-920-2100
ri Check
n Cash E C/C:Type # Exp—/—