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HomeMy WebLinkAboutbocc.con.amended.206.2013 CPitkin County COO"' Y 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 helonpitkineounty eon). 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 206.2013 C Pro'ect Name Pitkin County Ilealth Officer Contractor Ur. Kimberly Slevin Bud et Line Item 001.72.00000.82008 Additional Budget Line Item(s) and s cial notes to Finance Click here to enter test Contract Start Date 7/24/2013 Contract End Date 12/31/2017 Automatic Renewal _ Yes® NoC If Construction: Retainage If thi _ There to enter [ext. s is a new contractor, please request they complete and submit to Finance a W-9 Eorm. Contact Information: De artment Human Services Project Manager Sundeen Project Manager 5209 I Phone IJ Provide a brief description of the contract: Contractor shall advice the Public Health Director of the Local Public Health Agency and local Board of Heahh on medical issues and medical decisions affecting public health. Contractor shall at all times be licensed to practice medicine in the state of Colorado. Contract Value Summary: yr 1=8,700 yr 2=12,000 yr 3=12,000 yr 4=12,000 $ 12,000.00 $ 56,700.00 Procurement Method: None ❑ Informal© Formal ❑ Sole Source ❑ Emergency ❑ Contract Renewal ❑ Contract Type: Services/Maintenance ® Construction ❑ Goods, Equipment, Supplies ❑ Change Order/Amendment ❑ Other, please explain ❑ Click here to enteitest, ronhaIX pi halo con G2013 Budget Line It'004,720000082008 1 1� 'rI ®UNi ?" Jagyarytl�Z2017 ;11 DI 4'tn° }7�.5. 102iti' Wa 'Js . enuc iF2 Asper QQR{iG,1I ' � ' `j " RD LOC AL MEDICAL opPICER ReI �aleer nCAL MEDICAL OFFICER ul ,y 'r t4 P llontC Ip pas eleptedfio renew the'Agreement, Local Medical Officer with Dr. ICimbern y�d 1 ,eVm MD Iy1Pk which is set tojexpire:on 12/31/16. Per the terms of the coq�ract itatatcs that $i t,the expiration of thelmitial term, the contract may be extended apnpallyl q_r carrms by the express written consent of both parties," If the renewal of this Contract is agreeable to Dr. Kimberly S. Levin MD, MPH, please sign Ads le(t6 in the space. pro.+ded below and return it, along with a current copy of your eerlric to of insurance, Harping Pitkin County has additionally insured on the CerhGcayytyySi p required Pi?klib�,p t fiereby authoJlize,'d the renewal pf 236.2013 with _ - Di 'Klmbe, MPH, for a penoo of l -yeah from contract expiration date; neje e�;puaijin to isttocember 31, 2017. o All rates wilCremain the same for die year 20I 7 Apy changes lin rates thereafter will be by as addendum. 13q I {III 1}ate:' AUTHORIZED SI ER , f I,11'�'I�- J! III t ii t�k�UI , ��Iynl;'Ij r.:I. i I