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Home My WebLink Aboutbocc.con.298.2016 7/2015 kjm p‘ orKIN Pitkin County CouNT' 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 298.2016 Project Name Amendment to Child Care Fiscal Agreement Contractor Blue Lake Preschool—License 1677287 Budget Line Item Click here to enter text. Additional Budget Line Item(s) Click here to enter text. and special notes to Finance Contract Start Date 9/12/2016 Contract End Date Click here to enter a date. 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 Health and Human Services Project Manager Ledingham Project Manager 5766 Phone Provide a brief description of the contract: 2016-2017 CCAP Fiscal Agreement Contract Value Summary: Contract Amount $ This Change order/Amendment amount(if applicable) $ New Contract Total $ Procurement Method: None ® Informal❑ Formal ❑ Sole Source 0 Emergency 0 Contract Renewal 0 Contract Type: Services/Maintenance ►1 Construction ❑ Goods,Equipment, Supplies ❑ 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. Amendment to Child Care Services Fiscal Agreement This Amendment between Pitkin County * Blue Lake Preschool Herein referred to as"Department"and " (herein referred to as 0189 JW Dr., STE C "Provider")who will provide child care at the following address: Carbondale, CO 81623 is made to amend the Fiscal Agreement entered into by these parties effective the 10th day of December, 2015 and incorporated herein by reference. This amendment is in effect as of the 12th day of September, 2016 and remains in effect until the termination of the above-referenced Fiscal Agreement. In addition to all provision of the Agreement, Provider agrees to: Comply with the provisions of the Illegal Aliens-Public Contracts for Services Act found at C.R.S. Section 8-17.5-101 et. seq. By execution of the Agreement and this Amendment, Provider certifies that it does not knowingly employ or contract with an illegal alien who will perform work under the Agreement and that Provider will participate in either the E-Verify Program or Department Program in order to confirm the eligibility of all employees who are newly hired for employment to perform work under the Agreement. The rates to be paid to the provider are amended to be as follows' Per the provisions of House Bill 14-1317, State and County reimbursement rates must include a system of tiered reimbursement for child care providers based on Colorado Shines Quality Rating. See County Rate Reimbursement Chart/Page two Rate Information: By signing the amendment, the provider acknowledges that rates will be amended based on the provider's Colorado Shines Quality Level to pay either the county rate limit or the provider's private pay, whichever is less. The County reimbursement Chart is attached which will be compared to the Provider's Private Pay rate sheet on file with current fiscal agreement. (Provider will supply the most current rate sheet with this amendment if previous submission is not the most current.) Provider type: Day Care Home —School-Age Center/Day Camp Out-of-Home Exempt Relative X Child Care Center In-home Non-Relative Out-of-Home Exempt Non-relative Preschool —In-home Relative _Other Exempt License/Certificate No.: 1677287 Date License Expires' 1.t^': . (J Provider Social Security or Tax I.D. No.: . N (tqlGo ILD CARE PROVIDER DEPARTMENT OF SOCIAUHUMANSERVICES ±) • Vt5-)t, ider Signature ate Aut d Repr s ntative Signa ure Dale Nrt� 4514,10E N. Mailing Address, Department Address P16 (/ 81(023 cr(03 . 50 I.L ?'f(oil co-0,320gg City,Zip Phone City, ZiP Phone lE gI O N L5 Fiscal Agreement Amendment AUG 0 9 201654 :810-80 394-25-18-5707 (05/2016) By ___---1 Full Tlqne Cner Rates Tier 0-6 months 6-12 months 12-18 months 18-24 months 24-30 months 30-36 months 36 months-Syrs School Age 1 -- $65.00- 65.00 65.00 65.00 65.00 65.00 65.00 65.00 2 $65.00 65.00 65.00 _ 65.00 65.00 65.00 65.00 65.00 3 ~• $76.00 76.00 76.00 76.00 76.00 76.00 76.00 76.00 4 $78.00 78.00 78.00 - _78.00�_ 78.00 78.00 - 78.00 - 78.00 .5 $78.00 78.00 78.00 78.00 78.00 78.00 78.00 78.00 P.artTlme Center Rates Tier 0 6 months 6-12 months 12-18 months 18-24 months 24-30 months 30-36 months 36 months Syrs School Age 1 $35.75 35.75 35.75 35.75 35.75 35.75 35.75 35.75 2 $35.75 35.75 35.75 35.75 35.75 - 35.75 __ 35.75 35.75 3 $41.80 41.80 41.80 41.80 41.80 41.80 41.80 41.80 4 $42.90 - 42.90 - 42.90 42.90 42.90 42.90 - 42.90 42.90 5 $42.90 42.90 42.90_ 42.90 42.90 42.90 42.90 42.90 Full Time Home Rates _ Tier 0-6 months 6-12 months 12-18 months 18-24 months 24-30 months 30-36 months 36 months Syrs' School Age 1 $70.00 70.00 70.00_ 70.00 70.00 70,00 70.00 70.00 2 $70.00 70.00_ _70.00 70.00_ _70.00 70.00 70.00 70.00 3 $71.00 71.00 _ 71.00 71.00 _ 71.00 _- 71.00 71.00 71.00 4 _ _ $72.00 72.00 72.00 72.00 72.00 72.00 72.00 72.00 5 $72.00 72.00 72.00 __`72.00-__ 72.00 i 72.00 72.00 _ 72.00 Part Time Home Rates ter 0-6 months 6-12 months 12-18 months 18-24 months 24-30 months 30-36 months 36 months-5yrs School Age 1. $38.50 38.50 38.50 38.50 _ 38.50 38.50 38.50 38.50 -- - -- - - - 3385 2 _ $38.50__ 38.50 38.50 38.50 38.50 38.50 38.50 38.50 $39.05 39.05 T__ 39.05 39.05 39.05 39.05 39.05 39.05 4 -$39.60 -_ 39.60 __ 39.60 39.60 39.60 39.60 39.60 39.60 5 $39.60 39.60 39.60 39.60 39.60 39.60 39.6039.60 C.ILD CARE PROVIDER DEPARTMENT OF SOCIAUHUMAN SERVICES j ' (2 / • r e- i^^J 045/4. f'er Signature Date Autho 6 Ntur Represb tative Sign eftw Date 4A ► - IA' TO f30( Litho Mailing Address Department Address JO i tt 81,23 1 `�13t n c61(o? l 9g0.328100�(Q0UQ��( City,Zip Phone City,zvr Phone Fiscal Agreement Amendment 54508810-80 394-25-18-5707 (05/2016)