HomeMy WebLinkAboutbocc.con.203.2017 A th r"I N. Pitkin County
Uill `i' Contract Cover Sheet
Please complete the Contract Cover Sheet when the contract is completed and signed by Contractor,Vendor and Pitkin
County Representative.
Reium all Contract Cover Sheets and Contracts/Change Orders/Amendments to Procurement
( rogurement help(ipitkmeounty.eoni).Any contracts$50.000 and over will be routed for signatures to Coun4v Manager
and Attorney's Office(if required)by Procurement
Contract Information
Contract Number 20331117 A
Project Name Training:Grief,Loss, trauma, Workforce Well Being Critical
_ __ I Intersections
Contractor f ANC hamih Services
Budget Line Item 112.49.0000(1.810(12 $ 1
Additional Budget Line $
Item(s) -- $ - -- -_,j
(Please fully allocate New — —— - -- $ —
Contract Total) — _ I $
F Contract Start Date 3/1!1019
Contract End Date 10/31/2017
Automatic Renewal Yes 'F$ No'.
I if Construction: Retainage Yes$ or Gib NoM
If this is a new contractor.please request they complete and submit to Finance a New Vendor Request Form
Contact Information:
Department _ I Adult and Family Services _
Project Manager Kim DuBois ` Project Manager t(3370,429-2043
l _ __ _ I l Phone I
Provide a brief description of the contract:
l Additional Funds for Contract Coverage _ _ _ _ _I
Contract Value Summary:
Original Contract Amount $40,250.00
Previous Change Order/Amendment Amount(ifapptitablcl _ S 0.00
This Change order/Amendment amount 1iapplicable) S 2,995.20 j
New Contract Total Y _ S 43,244 20 1
Procurement Method:
None [ l Informal❑ Formal M. Sole Source Z Emergency
Contract Type:
Services/Maintenance M Construction E Goods, Equipment, Supplies CJ
Change Order!Amendment U Contract Renewal U Other, please explain C C'ick here to enter;est
NOTE: CLERKS OFFICE WILL KELP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO S I ATE
ARCHIVES RETAINAGE SCHEDULE:. Al,L ATTACHMENTS MUST BE WITH THIS CHECKLIST.
Contact a xxx.2017 Rn'. 8.31.11 jaa/js
Budget Line Item p xxx.xx.00000.xxxxx
fri b it IN
MA
CHANGE ORDER/CONTRACT AMENDMENT
Change Order Number: 203.2017 A
OWNER: Pitkin County
123 Emma Rd., Suite#106
Basalt,Colorado 81621
CONTRACTOR: ANU Family Services
The Provision of Services (the "Agreement") dated lune 26, 2017 between the Board of County
Commissioners of Pitkin County (the "County") and ANU Family Services(the "Contractor"), is hereby
amended as follows:
Description of Change. Additional funds for Contract Coverage
Reason for Change: Additional funds required
Original Contract Amount S 40,250.00
Previous Change Order/Amendment Amount or,ppbub)e) S 0.00
This Change Order/Amendment Amount of,po.4hic) S 2,995.20
New Contract Total S 43,245.20
In 1 other respects the Agreement is in full force and effect and remains unchanged by this Amendment.
Family S Date+ f
�vt)f' i 1/7/17
County Representative Date
*Increases over 525,000 and/or 10% (single increase or accumulative) of original contract must have
County Manager signature.
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