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Home My WebLink Aboutbocc.con.amended.255.2015A .. ./• T K J N Pitkin County COul T'' 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 h eln@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 255-2015 CO A Project Name HC-Smuggler Mountain Cooperative Prescribed Burn Contractor USDA,Forest Service White River National Forest: Aspen-Sopris Ranger District Budget Line Item 118.57.02250.82841 Additional Budget Line Item(s) FS will bill Qtrly to OST: 12/31; 3/31;6/20;9/30 and special notes to Finance Contract Start Date 10/13/2015 Contract End Date 12/1/2018 Automatic Renewal Yes ❑ No►Z1 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 Open Space&Trails Project Manager Gary Tennenbaum Project Manager 920-5355 Phone Provide a brief description of the contract: Prescribed burn for wildlife and forest health as outlined in the Hunter-Smuggler Cooperative Plan. Contract Value Summary: Contract Amount 19,600 This Change order/Amendment amount(if applicable) 53,500 New Contract Total 73,100 Procurement Method: None ® Informal❑ Formal ❑ Sole Source ❑ Emergency ❑ Contract Renewal 0 Contract Type: Services/Maintenance 0 Construction 0 Goods,Equipment, Supplies 0 Change Order/Amendment ® Other,please explain ® USDA-FS Collection Agreement 15-00-11021501-048- modification 1 NOTE: CLERKS OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE ARCHIVES RETAINAGE SCHEDULE.ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST. SUSDA Forest Service OMB 0596-0217 FS-1500-19. PAGE OF PAGES MODIFICATION OF GRANT OR AGREEMENT 1 4 1.U.S.FOREST SERVICE GRANT/AGREEMENT NUMBER: 2.RECIPIENT/COOPERATOR GRANT or 3.MODIFICATION NUMBER: 15-CO-11021501-048 AGREEMENT NUMBER,IF ANY: 1 4.NAME/ADDRESS OF U.S.FOREST SERVICE UNIT ADMINISTERING 5.NAMEADDRESS OF U.S.FOREST SERVICE UNIT ADMINISTERING GRANT/AGREEMENT(unit name,street,city,state,and zip+4): PROJECT/ACTIVITY(unit name,street,city,state,and zip+4): White River National Forest Program Contact: White River National Forest Admin. Contact: Phil Nyland Clark M. Woolley POB 309,620 Main St. 900 Grand Avenue Carbondale,CO 81623 Glenwood Springs,CO 81601 Telephone: 970-963-2266 Phone: 970-945-3227 Email: pnyland@fs.fed.us E-Mail: cmwoolley(a,fs.fed.us 6.NAMF/ADDRESS OF RECIPIENT/COOPERATOR(street,city,state,and zip+ 7.RECIPIENT COOPERATOR'S HHS SUB ACCOUNT NUMBER(For HHS 4,county): payment use only): Pitkin County Program Contact: Gary Tennenbaum 530 E. Main St., Ste. 300 Aspen,CO 81611 Telephone: 970 920-5355 Email: Gary.Tennenbaum(a,co.pitkin.co.us 8.PURPOSE OF MODIFICATION CHECK ALL This modification is issued pursuant to the modification provision in the grant/agreement THAT APPLY: referenced in item no. 1,above. CHANGE IN PERFORMANCE PERIOD: CHANGE IN FUNDING: Pitkin County Open Space and Trails agrees to reimburse the U.S.Forest Service in the amount of$53,500.00 for prescribed burn activities under the scope of the agreement. ADMINISTRATIVE CHANGES: OTHER(Specify type of modification): Except as provided herein,all terms and conditions of the Grant/Agreement referenced in 1,above,remain unchanged and in full force and effect. 9. ADDITIONAL SPACE FOR DESCRIPTION OF MODIFICATION(add additional pages as needed): See attached financial plan for Modification Number 1. 10. ATTACHED DOCUMENTATION (Check all that apply): Li Revised Scope of Work Revised Financial Plan Other: Pitkin County Contract 255-2015 CO -A Page 1 of 4 — USDA Forest Service OMB 0596-0217 FS-1500-19 11. SIGNATURES AUTHORIZED REPRESENTATIVE:BY SIGNATURE BELOW,THE SIGNUNG PARTIES CERTIFY THAT THEY ARE nM OFFICIAL REPRESENTATIVES OF THEIR RESPECTIVE PARTIES AND AUTHORIZED TO ACT IN THEIR RESPECTIVE AREAS FOR MATTERS RELATED TO THE ABOVE-REFERENCED (IRAN(AGREEMENT. I Lk PITKIN COUNTY S•n, . 1 • 11.B.DATE I I9U.S.FOREST SERVICE SIGNATURE I I D.DATE / SIGNED � SIGNED (Signature,. Signatory Ofcial) " (." j of S' Ofci l) rl- ' i 11.E NAME(type or print)JON PEACOCK I1.F.NAME(type or print)).SCOTT G.FITZWILLIAMS 1 I.G.TTfLE(type or print):County Manager, 1 I.H. TTn.E(type or print):Forest Supervisor, Pitkin County White River National Forest 12.G&A REVIEW 12A The authority and format of this modification have been reviewed and approved for signature by: 12.B.DATE SIGNED CLARK M.WOOLL U.S.Forest Service Grants&Agreements Specialist Burden Statement According to the Paperwork Reduction Act of 1995,an agency may not conduct orsponsor,and a person Is not required to respond to a collection of information unless It displays a valid OMB control number. The valid OMB=tot cumber for this kdometion collection is 0598-0217. The time required to complete his information collection is estimated to average 30 rrwxAes per response,Including the time for renewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing tie collection of information. The U.S.Department of Agriculture(USDA)prohmits discrimination in all its programs and activities on the basis of race,cab(,national origin,age,disability,and where applicable,sex,marital status,familial status,parental status,religion,sexual orientation,genetic information,political beliefs,reprisal,or because ail or part of an individual's Income is derived from any public assistance. (Not al prohb(ted bases apply to all programs) Persons with disabilities who require alternative means for communication of program Intommalon(Braille,large print,audiotape,etc.)should contact USDA's TARGET Center at 202-720-2600(voice and TDD). To file a complaint of discrimination,write USDA,Director,Office of Civil Rights,1400 Independence Avenue,SW,Washington,DC 202509410 or call toil free (866)632-9992(voice). TDD users can contact USDA through loux!relay or the Federal relay at(800)877-8339(TD))or(868)377-0642(relay voice). USDA is an equal opportunity provider and employer. • Pitkin County Contract 255-2015 CO -A Page 2 of 4 U S Forest Service OMB 0596-0217 FS-1500-18 Forest Service Agreement#1 15-CO-11021501-048 I Cooperator Agreement# Collection Agreement Financial Plan Cooperator and FS Contributions ‘7,77t7.2N7FS and relad data I Cooperator FS Non-Cash ; Contribution Contributson Line Item Cost Subtotals ‘:tibtotal Subtotal 1,totals. PERSONNEL Resource Specialists(List all personnel): #of S/Day Days Sopris Militia $389266 $3,892.66 Central Zone Fire Personnel $1679680 $16,796 80 Unaweep Fire Personnel $348000 $3,480.00 Rifle Helitack Personnel $3,464.80 $3,464.80 East Zone Fire Personnel $5,079.23 $5,079 23 Grand Junction Dispatch Personnel $1,213.44 ' $1,213.44 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Subtotal,Personnel: 0.00 $33,926.93 $0.00 $33,926.93 TRAVEL Explanation of trips: Vehicle From Where/To Where/For Whom Mileage PerDiem #of Cost or and Trips Airfare Lodging Cost Central Zone Per Diem $1,140.00 $1,140.00 East Zone Per diem $1,934.86 $1,934.86 PIO Barth Per Diem $131.31 $131.31 Subtotal,Travel: $0.00 0 $0.00 $3,206.17 $0.00 $3,206.17 EQUIPMENT Unit Name and Type of Equipment: Cost Quantity Central Zone Fire Engines and Transport $2,945.77 $2,945.77 Unaweep Fire Transport $575.35 $575.35 Rifle Helitack HI and H2 Transport $524.40 $524.40 East Zone Engines and Transport $602.70 $0.00 $602.70 Subtotal,Equipment: $0.00 0 $4,648.22 $0.00 $4,648.22 SUPPLIES Unit Name and Type of Supplies: Cost Quantity Plastic Spheres $1/9 10 $1,800.00 $1,800.00 $0.00 $0.00 $0 00 Subtotal,Supplies: $179.00 10 $1,800.00 $0.00 $1,800.00 Pitkin County Contract 255-2015 CO -A Page 3 of 4 U.S.Forest Service OMB 0596-0217 FS-1500-18 CONTRACTUAL Describe Contracts that will most likely result from this project: Mountain Blade Runners(Helicopter) $9918.68 $9,918 68 $000 $0.00 Subtotal,Contractual: 59,918.68 $0.00 $9,918.68 OTHER Describe Other Costs of the Project: $000 $0.00 $0.00 Subtotal,Other: $0.00 $0.00 $0.00 TOTAL DIRECT CHARGES $53,500.00 $0.00 553.500.00 Insert OVERHEAD ASSESSMENT Rate (if applicable,see FSH 1909.13) Here: 0.0% 50.00 Total Party Costs $53,500.00 50.00 S53,500.00 C ' ELEMENTS SUBJECT TO NATIONAL PASS-Th 3OU3 .TE Cooperator Contribution TOTAL CHARGES $0.00 Insert OVERHEAD ASSESSMENT Rate (if applicable,see FSH 1909.13) Here: $0.00 Total Pass-Through Costs $0.00 TOTAL PROJECT COSTS $53,500.00 Burden Statement According to the Paperwork Reduction Act of 1995,an agency may not conduct or sponsor,and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0217. The time required to complete this information collection is estimated to average 45 minutes per response,including the time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. The U.S.Department of Agriculture(USDA)prohibits discrimination in all its programs and activities on the basis of race,color,national origin,age,disability,and where applicable,sex,marital status,familial status,parental status,religion,sexual orientation,genetic information,political beliefs,reprisal,or because all or part of an individual's income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information(Braille,large print,audiotape,etc)should contact USDA's TARGET Center at 202-720-2600(voice and TDD). To fele a complaint of discrimination,write USDA,Director,Office of Civil Rights,1400 independence Avenue,SW,Washington,DC 20250-9410 or call toll free(866) 632-9992(voice). TDD users can contact USDA through local relay or the Federal relay at(800)877-8339(TDD)or(856)377-8642(relay voice). USDA is an equal opportunity provider and employer. Pitkin County Contract 255-2015 CO -A Page 4 of 4