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Home My WebLink Aboutbocc.con.424.2016 )t I Pitkin County Cut VI ' 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?I pitkincounlv.com). Any contracts $50,000 and over will he routed for signatures to County Manager and Attorney's Office(if required) by Procurement& Contracts Manager. Contract Information Contract Number Click here to enter text. -1711.9-,ao/6 Pro ect Name _ Community Service Block Grant Contractor State of Colorado Dept. of Local Affairs Budget Line Item 001.72.94612.82000 expenditures Additional Budget Line Item(s) 001.72.94612.62374 revenue and special notes to Finance Contract Start Date 3/1/2015 Contract End Date 9/30/2018 Automatic Renewal Yes ❑ NoM 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 I Health and Human Services Project Manager Mitzi Ledingham Project Manager 970-920-5766 Phone Provide a brief description of the contract: Rental Assistance and Oral Health Assistance to low income families Contract Value Summary: Contract Amount $12,042.00 This Change order/Amendment amount(if applicable) $3457.00 New Contract Total $15499.00 Procurement Method: None M Informal❑ Formal ❑ Sole Source ❑ Emergency ❑ Contract Renewal ❑ Contract Type: Services/Maintenance M Construction ❑ Goods. Equipment, Supplies ❑ Change Order/Amendment M Other, please explain O Click here to enter text. NOTE: CLERICS OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST. CSPG25 - Pitkin County 2015-2018 RECEIVED OPTION LETTER, Number 1 JAN 0 5 2016 P(f KIN LOUNT1' HEALTH&HUMAN SERVICE: To GRANT AGREEMENT Between STATE OF COLORADO DEPARTMENT OF LOCAL AFFAIRS And PITKIN COUNTY Summary Form of Financial Assistance: ® Grant ❑ Loan This Option Letter Amount: $3,457.00 Revised Total Award Amount: $15 499.00 Agreement Identification: Contract Encumbrance#: L I5CSBG25 (BOLA's primary contract identification #) Contract Management System #: 85303 (State of Colorado's contract tracking#for this Original Grant's CMS#: 80243 option letter and for the original grant agreement) Project Information: Project/Award Number: CSBG25 Project Name: PITKIN COUNTY Performance Period: Start Date: 03/01/15 End Date: 09/30/18 Brief Description of Change(s) in Initial allocation of Year 2 funds to three- ear !rant a_reement. this Option Letter: Program & Funding Information: Program Name Community Services Block Grant Catalog of Federal Domestic Assistance(CFDA)Number(if federal funds): 93.569 Funding Account Codes: Page I oft—Option Letter CSBG25—Pitkin County 2015-2018 Date: 12/01/15 1)In accordance with Section 7(A) of the original grant agreement("Grant") between the State of Colorado, Department of Local Affairs, and PITKIN COUNTY, the State hereby exercises its option to approve the attached Budget Proposal for Program Year No. 2 from 1/1/2016 through 9/30/2017, which is attached hereto as Exhibit 1 and incorporated by reference herein (the"Budget Proposal-). 2)For use with Option 1(b): In accordance with Section 7(A) of the Grant, the Slate hereby exercises its option to® increase, ❑ decrease the Option Letter amount of S3 457.00 for Program Year No.2 from 1/1/2016 through 9/30/2017 and to encumber such funds. which shall be Grant Funds under the Grant. The table in Section 7(A) is hereby modified accordingly. 3)The aggregate maximum amount of Grant Funds in the Grant is hereby ®increased, ❑decreased to a new Grant Funds value of$15.499.00 as consideration for Work ordered under the Grant.The State's obligation is limited to the unpaid obligated Grant Funds amount that has not expired. 4)Effective Dale. The effective date of this Option Letter is upon approval of the State Controller or January 1,2016, whichever is later. STATE OF COLORADO .... John W.Hickenlooper,GOVERNOR PRE-APPROVED FORM CONTRACT REVIEWER DEPART LT OF LOCAL AFFAIRS By: P • By: v I/e 'leiecutive Director Rachel Harlow-Schalk, Financial Assistance Director Date ir Ar /2 -/S TTT""" Date: � ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER • CRS§24-30-202 requires the Slate Controller to approve all State grants. This Option Letter is not valid until signed and dated below by the State Controller or delegate. Grantee is not authorized to begin performance until such time. If Grantee begins performing prior thereto,the State of Colorado is not obligated to pay Grantee for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Rohert Jaros,CPA anet iks;CPA, Contro cr Delegate Date: /'.A01 Page 2 of 2—Option Letter Applicant Pitkin County Health and Human Semtex Name: Budget Information for 2016(Program Year 2): Budget Detail Explanation A.Direct Rename'Raley) Under Item,list the position for which salary is requested If there are multiple positions of the same type/title being funded through CSBG,record the number of positions under Item as well. Be sure to show under Computation,the annual salary for persons already funded and the percentage of devoted to the program. Remember,only time spent on the CSBG program is allowable. Examples are pro ided in the instructions packet. Item '. Canpotelon Federal FwWs:.. Pe �vl(S.I/)Total x/A mm &Direct Fringe Benefits Only include range benefits for individuals paid.These should not be included in the salary calculations covered under category 4.under Item,un the position nnelsl for which fringe benefits are requested.If the position(s)is(are)not filled.record'To Hire_' If there are multiple positions of the same type/title being funded through[SRC, record the number of positions under Item as well. Item +' CanwtaWn Federal Funds Fringe Molests Tial x/A C.Direct operating Casts and Training Under Item.indicate the type of travel and training requested.Include the number of individuals if knorm. Show under computation how amount determined. sora : Computation Federal Funds 'Travel Total I N/A D.Viral Operettg Costs-Supplies Under Item,indicate the type supplies to be purchased,as is reasonable to predict Include the quantity or number of items. Show under computation how determined. Item Computation Federal Funds Supplies Total -. N/A E.Direct Operating Costs.SxNces Under Item,indicate the services(such as Emergency Services,Employment Services,Nutrition Services,etc.I to be provided.Show under computation the detail of services provided(rent/mortgage assistance,bus passes,food boxes etc) ...Item Computation Federal Funds`. Services otal N/A F.opect Operating Costs-Other Under Item,indicate any other direct expenses that do not it in the above categnnes.Include the quantity or number of items. Show under computation how determined. Nen Cmnputrtbn Federal Funds Other Total N/A G. Total Direct[(larges(Sections A-F) Federal Funds Total Direct charges I Add Sections mF to total direct costs. NIA H.Sub-Grantee Budget Under em,indicate the name of the sub granteeShow under description of services the federal object ve(3(addressed and primary use(s)of funds.Please Include any supporting documentations such as board minutes showing sub grams approved,and/or ContractancAs/MOU5 with sub grantees Item DeolpNm of Services Federal Funds Catholic<anter G eligible clients receive dental screening and treatment services;recondary use is up to two months of $13,330 emergency rant assistance for indMdualsand fa mniea in rase management I.sub-Grantee Total $ 13,83000 2.Sub-Grantee Total allowable for Indirect Expenses(limited to first$25,000 of each sub-award). a Total dollar amount of sub awards less than 5 $15000 each • 1100%of sub.awards that are less than 525.000 may be included in natnllinuuns for 'obvert rare_) S b.Number of sub. awards more than 515,000 from$b x525,000 5 limit For sub awards that exceed$25,M0.only the first 5$5,000 per award may he included in mkumnans for indirectrote. Enter the rota/from 2c for the sub grantee total allowable for Indirect expenses In the box to the right. You will and this amount to the total (Area charges to calculate indirect in the next section. Figure: J.Indirect CostRats' Federal Funds I. Federal negotiated indirect cost rate of %I Please attach supporting documentation.)if using this option,enter%In green cell here'. 2 De minimus rate of l0%.Enter t is green cell here 3 x_Not using an Indirect rate(may include administrative costs in direct expenses) Total Direct Charges NIA (Section 5)'. - Allowable 5ub.Grantee 5 Total(Section HII: Total Costs eligible for $ indirectate - S (Multiply indirect rate by Total costs eligible and enter amount In the box to the right $ M. Total Program Budget Federal Funds. Subtotal Direct Charges(Section G) N/A Subtotal Subgrantee Awards‘Section HI) 5 13,030.00 Subtotal Indirect Cost Rate(If applicablel $ TOTAL Grant Award(Must match projected allocation.) 5 13,830.00