HomeMy WebLinkAboutbocc.con.amended.038.2016 A poky. Pitkin County
(Or '' Contract Cover Sheet
Please complete the Contract Cover Sheet when the contract is completed and signed by ContractorNendor and Pitkin
Count} Project Lead.
Return all Contract Cover Sheets and Contracts/Change Orders/Amendments to Procurement
(procurement helryapitkincounty.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 0382016 A
Project Name Healthy Community Grants
Contractor Valley Settlement
Budget Line Item 113.85 00000.84004 $ _
Additional Budget Line _ $
Item(s)
(Please fully allocate New $
Contract Total) $
Contract Start Date 1/1/2016
Contract End Date 12/31/2018
Automatic Renewal Yes U No
If Construction. Retainage Yes $ or 46 NoZ _
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 Mitzi Ledingham Project Manager (970)920-5766
Phone
Provide a brief description of the contract:
Valley Settlement name change
Contract Value Summary:
Original Contract Amount $25,000.00
Previous Change Order/Amendment Amount of applicable) S 0.00
This Change order/Amendment amount Of applicable) $0.00
New Contract Total $25,000.00
Procurement Method:
None IZ Informal❑ Formal U Sole Source ❑ Emergency U Contract Renewal ❑
Contract Type:
Services/Maintenance ® Construction U Goods, Equipment, Supplies U
Change Order/Amendment ❑ Other, please explain ❑ Click here to enter text
NOTE: CLERKS OFFICE W ILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RE LAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST.
Contract#038-20164 1'il Rev 8 31 11/aw/s
Budget Line Item# 113.85.00000.84004
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CONTRACT AMENDMENT
Amendment Number:
OWNER: Pitkin County
Aspen.Colorado 81611
AGENCY:
The "Agreement" dated January 1, 2016 between the Board of County Commissioners of Pitkin County
(the"County") and Manaus Fund/Valley Settlement(the "Agency"), is hereby amended as follows:
Description of Change:
The name of the Agency has been changed to Valley Settlement. They have a new Tax ID number given by
the IRS which is 81-2401368.
Original Contract Price $ 25,000
Net Increase/Decrease in Contract Price(this change order) $0
*Total Adjusted Contract Price(including this change order) $25,000
In all other respects the Agreement is in full force and effect and remains unchanged by this
Amendment.
ntractor Date
� aytr2 { I� ��R 7- I
County Authoriked Signer Date
41/4 sr /U/I
County Manager Date
*Increases over$25,000 and/or 10% (single increase or accumulative)of original contract must have
County Manager signature.