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HomeMy WebLinkAboutbocc.con.272.192017-11-13 btf Contract Information Contract Number Project Name Sub-Recipient Budget Line Item 11437372.531000 - 10072 Procurement Method: Type: Contract Start Date Contract End Date Agree,e Type Retainage If this is a new contractor, please request they complete and submit to Finance a New Vendor Request Form. Contact Information: Department County Representative Karen Koenemann County Representative Phone (970) 429-6171 Provide a brief description of the contract: Contract Value Summary: $ 56,409.00 $ - $ - $ 56,409.00 272.19 Pitkin County Procurement Cover Sheet Please complete the Contract Cover Sheet when the contract/task order is complete and fully executed. Return all Contract Cover Sheets and Contracts/Change Orders/Amendments/Task Orders to Procurement No Immunizations and Treatment Services Community Health Services $ - Additional Budget Line Item(s) (Please fully allocate New Contract Total) $ - $ - $ - $ - None Services/Maintenance 7/1/2019 12/31/2019 New Contract NOTE: Clerks Office will keep original documents in compliance with Colorado State Archives retainage Public Health Immunization treatment and education services Original Contract Amount Previous Change Order/Amendment Amount This Change order/Amendment amount New Contract Total Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 1 PITKIN COUNTY SUB-RECIPIENT AGREEMENT FOR PROVISION OF SERVICES THIS AGREEMENT, made September 12, 2019 by and between the Board of County Commissioners of Pitkin County, Colorado, 530 E. Main St., Suite #302, Aspen, CO 81611, (hereinafter called the “County”) and Community Health Services, 0405 Castle Creek Road, Suite 201, Aspen, CO 81611 (hereinafter called the “Sub-Recipient”) to perform the following work: Immunizations and Treatment Services (“Project”). I. Term of Agreement: The term of this Agreement is from July 1, 2019 to December 31, 2019. At the expiration of the initial term, the Agreement may be extended for four (4) additional terms of one (1) year by the express written consent of both parties. II. Sub-Recipient’s Obligations. Sub-Recipient shall implement and operate the Immunization and Vaccines Program outlined by the Centers for Disease Control and Prevention (“CDC”), per the standards and requirements as stated by the State of Colorado (“State”) in task order Agreement 19 FAA 108899, attached and incorporated into this Agreement. The Sub-Recipient shall provide all services found in the attached documents and as summarized below: A. Immunization services within Pitkin County B. Maintain staff immunization expertise III. Compensation and Expenses, Invoicing, Payment and Offset. The County shall compensate Sub-Recipient for its services in accordance with the Project Budget and Schedule set out in Paragraph II. It is expressly understood and agreed that in no event will the total compensation and reimbursement to be paid hereunder exceed the sum of Fifty-Six Thousand Four-Hundred and Nine dollars and Zero cents ($56,409.00) for all services rendered. By Agreement or amendment, the County and Sub-Recipient may reallocate the budget among project tasks if the total budget amount remains unchanged. Sub-Recipient shall invoice Quarterly, with invoice(s) addressed to Pitkin County Public Health, and shall include, at minimum, the following: A. Actual hours spent on program objectives as set out in the attached documents, Scope(s) of Work, by Amendment, or mutually agreeable direction as provided and documented by Pitkin County Public Health B. Any and all detailed accounts of salary(ies) paid, including any fringe costs. Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 2 C. The actual/realized project costs; 1) In consideration of the above, the indirect rate for these services is hereby established as not to exceed Ten Percent (10%) Payment should be expected within thirty (30) days of invoice receipt. Any payment by the County may be offset by any amount the Sub-Recipient owes the County for any reason. IV. County’s Exclusive Ownership of Work Product. Drawings, specifications, guidelines and other documents prepared by Sub-Recipient in connection with this Agreement shall be the property of the County. However, Sub-Recipient shall have the right to utilize such documents in the course of its marketing, professional presentations, and for other business purposes. Sub-Recipient assigns to County the copyrights to all work prepared, developed, or created pursuant to this Agreement, including the right to: 1) reproduce the work; 2) prepare derivative works; 3) distribute copies to the public; 4) perform the works publicly; and 5) to display the work publicly. Sub-Recipient shall have right to use materials produced in the course of this Agreement for marketing purposes and professional presentations, articles, speeches and other business purposes. V. Pitkin County’s Obligations. Pitkin County shall administer this Agreement through a County Representative. Karen Koenemann, Public Health Director will manage the project as the County’s Representative. In the event that Karen Koenemann is not available, an authorized designee shall assume the County Representative’s duties. The services provided and products delivered by the Sub-Recipient under this Agreement will be subject to review by the County’s Representatives, or a designee, for compliance with Sub-Recipient’s obligations prior to final payment. VI. Termination Prior to Expiration of Agreement Term. The County has the right to terminate this Agreement, with or without cause, by giving written notice to the Sub- Recipient of such termination and specifying the effective date thereof. Such notice shall be given at least ten (10) days before the effective date of such termination. In such event all finished or unfinished documents, data, studies and reports prepared by the Sub-Recipient pursuant to this Agreement shall become the County’s property. Sub-Recipient shall be entitled to receive compensation in accordance with the Agreement for any satisfactory work completed pursuant to the terms of this Agreement prior to the date of termination. Notwithstanding the above, Sub-Recipient shall not be relieved of liability to the County for damages sustained by the County by virtue of any breach of the Agreement by the Sub-Recipient. VII. Independent Sub-Recipient Status. A. The parties to this Agreement intend that the relationship between them contemplated by the Agreement is that of independent Sub-Recipient. Sub- Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 3 Recipient, and any agent, employee, or servant of Sub-Recipient shall not be deemed to be an employee, agent, or servant of Pitkin County. B. Sub-Recipient is not required to offer his services exclusively to Pitkin County under this Agreement. Sub-Recipient may choose to work for other individuals or entities during the term of this Agreement, provided that the basic services and deliverable products required under this Agreement are submitted in the manner and on the schedule defined under this Agreement. C. Sub-Recipient warrants that all work produced will conform to all applicable industry standard of care, skill and diligence in the performance of Sub-Recipient’s obligations under this Agreement. D. Sub-Recipient shall not attempt to oversee or supervise the work or actions of any Pitkin County employee, servant or agent in the course of completing work under this Agreement. E. Sub-Recipient is not entitled to any Workers’ Compensation benefits through Pitkin County and is responsible for payment of any federal, state, FICA and other income taxes. VIII. Assignability. This Agreement is not assignable by either party. Any use of subcontractors by the Sub-Recipient for performance of this Agreement must be accepted in writing by the County. IX. Severability. In the event that any provision of this Agreement shall be held to be invalid or unenforceable, the remaining provisions of this Agreement shall remain valid and binding upon the parties hereto. X. Integration and Modification. A. This Agreement represents the entire and integrated Agreement between the County and the Sub-Recipient and supersedes all prior negotiations, representations, or Agreement, either written or oral. This Agreement may be amended only by written Agreement signed by both the County and the Sub- Recipient. B. The County may, from time to time, request changes in the scope of services of th e Sub-Recipient to be performed hereunder. Such changes, including the increase or decrease in the amount of the Sub-Recipient’s compensation, which are mutually agreed upon between the County and the Sub-Recipient, shall be in writing and upon execution shall become part of this Agreement. XI. Indemnity. A. The Sub-Recipient agrees to indemnify, hold harmless and, not excluding the County's right to participate, defend the County, its subsidiary, parent, associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, volunteers, and any jurisdiction or agency issuing permits for any work included in the project, hereinafter referred to as indemnitee, from all Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 4 suits and claims, including attorney's fees and cost of litigation, actions, loss, damage, expense, cost or claims of any character or any nature arising out of the work done in fulfillment of the terms of this Agreement or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the Sub-Recipient to conform to any statutes, ordinances, regulation, law or court decree. It is agreed that the Sub-Recipient will be responsible for primary loss investigation, defense and judgment costs where this Agreement of indemnity applies. In consideration of the award of this Agreement, the Sub-Recipient agrees to waive all rights of subrogation against the County its subsidiary, parent, associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers for losses arising from the work performed by the Sub-Recipient for the County. B. The Sub-Recipient further shall investigate, process, respond to, adjust, provide defense for and defend, pay or settle all claims, demands, or lawsuits related hereto at its sole expense and shall bear all other costs and expenses related thereto, even if the claim, demand or lawsuit is groundless, false or fraudulent. XII. Insurance. Sub-Recipient and subcontractors shall procure and maintain until all of their obligations have been discharged, including any warranty periods under this Agreement are satisfied, insurance against claims for injury to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Sub-Recipient, its agents, representatives, employees or subcontractors. The insurance requirements herein are minimum requirements for this Agreement and in no way limit the indemnity covenants contained in this Agreement. The policies shall include, or be endorsed to include, the following provision: On insurance policies where the County is named as an additional insured, the County shall be an additional insured to the full limits of liability purchased by the Sub-Recipient even if those limits of liability are in excess of those required by this Agreement. The County in no way warrants that the minimum limits contained herein are sufficient to protect the Sub-Recipient from liabilities that might arise out of the performance of the work under this Agreement by the Sub-Recipient, its agents, representatives, employees, or subcontractors. The Sub-Recipient shall assess its own risks and if it deems appropriate and/or prudent, maintain higher limits and/or broader coverages. The Sub-Recipient is not relieved of any liability or other obligations assumed or pursuant to the Agreement by reason of its failure to obtain or maintain insurance in sufficient amounts, duration, or types. Commercial General Liability Completed Operations coverage must be kept in effect for up to three (3) years after completion of the project. Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 5 A. Coverage and Limits of Insurance. Sub-Recipient shall provide coverage with limits of liability requirements provided that the coverage is written on a “following form” basis. 1) Statutory Workers’ Compensation: Colorado statutory minimums a. Policy shall contain a waiver of subrogation against the County. b. This requirement shall not apply when a contractor or subcontractor is exempt under Colorado Workers’ Compensation Act AND when such contractor or subcontractor executes the appropriate sole proprietor waiver form. Minimum Limits: Coverage A (Workers’ Compensation) Statutory Coverage B (Employers Liability) $ 500,000 $ 500,000 $ 500,000 2) Commercial General Liability – ISO 1CG 0001 form or equivalent. (With County named as an additional insured) Minimum Limits: General Aggregate $ 2,000,000 Products/Completed Operations Aggregate $ 2,000,000 Each Occurrence Limit $ 1,000,000 Personal/Advertising Injury $ 1,000,000 Fire Damage (Any One Fire) $ 50,000 Medical Payments (Any One Person) $ 5,000 Coverage to include:  Premises and Operations  Explosions, Collapse and Underground Hazards  Personal / Advertising Injury  Products / Completed Operations  Liability assumed under an Insured Agreement (including defense costs assumed under Agreement)  Independent contractors  Designated Construction Project(s) General Aggregate Limit, ISO CG 2503 (1997 Edition or equivalent)  Additional Insured—Owners, Lessees or contractors Endorsement, ISO Form 2010 (2004 Edition or equivalent)  Additional Insured—Owners, Lessees or contractors Endorsement, ISO CG 2037 (2004 Edition or equivalent) Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 6  The policy shall be endorsed to include the following additional insured language on the Additional Insured Endorsements specified above: “County, its subsidiary, parent, associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers named as an additional insured with respect to liability and defense of suits arising out of the activities performed by, or on behalf of the Sub-Recipient, including completed operations”. 3) Auto Liability: Bodily injury and property damage for an y owned, hired and non-owned vehicles used in the performance of this Agreement. Minimum Limits: Statutory Coverage Bodily/Property Damage (Each Accident) $ 1,000,000 4) Special Coverages (check as appropriate and insert amount): a. ☐ Performance Bond $ b. ☐ Professional Errors and Omissions c. ☐ Aircraft Liability d. ☐ Owner’s Protective e. ☐ Builder’s Risk f. ☐ Boiler and Machinery g. ☐ Loss of Use Insurance h. ☐ Pollution Liability i. ☐ Crime, including Employee Dishonesty Coverage, or Fidelity Bond B. Proof of Insurance: 1) Each insurance policy required by the insurance provisions of this Agreement shall provide the required coverage and shall not be suspended, voided or canceled except after thirty (30) days prior written notice has been given to the County, except when cancellation is for non -payment of premium, then ten (10) days prior notice may be given. Such notice shall be emailed directly to Procurement@pitkincounty.com. If the insurance carrier will not provide the required notice, the Consultant/Sub-Recipient and or its insurance broker shall notify the County of any cancellation, or reduction in coverage or limits of any insurance within seven (7) days of receipt of insurers’ notification to that effect. Simultaneously with the Certificates of Insurance, the Sub-Recipient shall file with the Project Lead a certified statement as to claims pending against the required coverages, reserves established on account of such claims, defense costs expended and amounts remaining on policy limits. 2) In addition, these Certificates of Insurance shall contain the following clauses: a. The Sub-Recipient’s insurance shall be primary and non-contributory with any insurance or self-insurance purchased by the County. Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 7 b. The insurance companies issuing the policy or policies hereunder shall have no recourse against the County of Pitkin for payment of any premiums or for assessments under any form of policy. c. Any and all deductibles or self-insured retentions in the above- described insurance policies shall be assumed by and be for the amount of, and at the sole expense of the Sub-Recipient. d. Location of operations shall be: “all operations and locations at which work for the referenced Project is being done.” 3) Certificates of Insurance for all renewal policies shall be delivered to the County’s Representative at least fifteen (15) days prior to a policy’s expiration date except for any policy expiring on the expiration date of this Agreement or thereafter. 4) The County reserves the right to request and receive a copy of any policy and any policy endorsement at any time during the term of this Agreement. XIII. Exemptions and Preferences. All purchases of construction or building or any other materials for this Agreement shall not include Federal Excise Taxes or Colorado State or local sales or use taxes. Pitkin County is exempt from such taxes under registration numbers 98-02624 and 84-78000-5k. XIV. Records. The Sub-Recipient shall maintain comprehensive, complete and accurate books, records, and documents concerning its performance relating to this Agreement for a period of three (3) years after final payment under the Agreement and the County shall have the right within the three (3) year period to inspect and audit these books, records and documents, upon demand, in a reasonable manner and at reasonable times, for the purpose of determining, by accepted accounting and auditing standards, compliance with all provisions of the Agreement and applicable law. XV. Agreement Made in Colorado. The parties agree that this Agreement was made in accordance with the laws of the State of Colorado and shall be so construed. Venue is agreed to be exclusively in the courts of Pitkin County, Colorado. XVI. Attorney’s Fees. In the event that legal action is necessary to enforce any of the provisions of this Agreement, the substantially prevailing party shall be entitled to its costs and reasonable attorney’s fees. XVII. Governmental Immunity. Sub-Recipient agrees and understands that Pitkin County is relying on and does not waive, by any provision of this Agreement, the monetary limitations or terms (presently $150,000 per person and $600,000 per occurrence) or any other rights, immunities, and protections provided by the Colorado Governmental Immunity Act, 24-10-101, et seq., C.R.S., as from time to time amended, or otherwise available to Pitkin County or any of its officers, agents or employees. Further, nothing Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 8 in this Agreement shall be construed or interpreted to require or provide for indemnification of the Sub-Recipient by the County for any injury to any person or any property damage whatsoever which is caused by the negligence or other misconduct of the County or its agent or employees. XVIII. Current Year Obligations. The parties acknowledge and agree that any payments provided for hereunder or requirements for future appropriations shall constitute only currently budgeted expenditures of Pitkin County. Pitkin County’s obligations under this Agreement are subject to Pitkin County’s annual right to budget and appropriate the sums necessary to provide the services set forth herein. No provisions of the Agreement shall constitute a mandatory charge or requirement in any ensuing fiscal year beyond the then current fiscal year of Pitkin County. No provision of the Agreement shall be construed or interpreted as creating a multiple-fiscal year direct or indirect debt or other financial obligation of Pitkin County within the meaning of any constitutional or statutory debt limitation. This Agreement shall not directly or indirectly obligate Pitkin County to make any payments beyond those appropriated for Pitkin County’s then current fiscal year. No provisions of this Agreement shall be construed to pledge or create a lien on any class or source of Pitkin County’s moneys, nor shall any provision of this Agreement restrict the future issuance of Pitkin County’s bonds or any obligations payable from any class or source of Pitkin County’s money. XIX. Notice. Any notice required or permitted under this Agreement shall be in writing and shall be provided by electronic delivery to the e-mail addresses set forth below and by one of the following methods 1) hand-delivery or 2) registered or certified mail, postage pre-paid to the mailing addresses set forth below. Each party by notice sent under this paragraph may change the address to which future notices should be sent. Electronic delivery of notices shall be considered delivered upon receipt of confirmation of delivery on the part of the sender. Nothing contained herein shall be construed to preclude personal service of any notice in the manner prescribed for personal service of a summons or other legal process. To Pitkin County: Karen Koenemann 0405 Caslte Creek Rd., Suite 202 Aspen, CO 81611 Email: Karen.Koenemann@PitkinCounty.com with copies to: Pitkin County Attorney’s Office 530 E. Main St., Suite #301 Aspen, Colorado 81611 Email: Attorney@pitkincounty.com To Sub-Recipient: Community Health Services 0405 Castle Creek Road, Suite 201 Aspen, CO 81611 Phone: (970) 920-5010 Email: Liz.Stark@PitkinCounty.com Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 9 XX. Public Agreements for Services and Public Agreements with Natural Persons. In conformance with the provisions of C.R.S. §§ 8-17.5-101, et seq., as amended and C.R.S. §§ 24-76.5-101, et seq., as amended: A. PUBLIC AGREEMENTS FOR SERVICES. §§8-17.5-101, et seq. C.R.S. [Not applicable to agreements relating to the offer, issuance, or sale of securities, investment advisory services or fund management services, sponsored projects, intergovernmental agreements, or information technology services or products and services] Sub-Recipient certifies, warrants, and agrees that it does not knowingly employ or Agreement with an illegal alien who will perform work under this Agreement and will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E-Verify Program established under Pub. L. 104-208 or the State verification program established pursuant to §8-17.5-102(5)(c), C.R.S., Sub- Recipient shall not knowingly employ or Agreement with an illegal alien to perform work under this Agreement or enter into a Agreement with a Subcontractor that fails to certify to Sub-Recipient that the Subcontractor shall not knowingly employ or Agreement with an illegal alien to perform work under this Agreement. Sub-Recipient (i) shall not use E-Verify Program or State program procedures to undertake pre- employment screening of job applicants while this Agreement is being performed, (ii) shall notify the Subcontractor and the Contracting State agency within 3 days if Sub- Recipient has actual knowledge that a Subcontractor is employing or contracting with an illegal alien for work under this Agreement, (iii) shall terminate the Subcontractor if a Subcontractor does not stop employing or contracting with the illegal alien within 3 days of receiving the notice, and (iv) shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to §8-17.5-102(5), C.R.S., by the Colorado Department of Labor and Employment. If Sub-Recipient participates in the State program, Sub-Recipient shall deliver to the contracting State agency, Institution of Higher Education or political subdivision, a written, notarized affirmation, affirming that Sub-Recipient has examined the legal work status of such employee, and shall comply with all of the other requirements of the State program. If Sub-Recipient fails to comply with any requirement of this provision or §§8-17.5-101 et seq., C.R.S., the contracting State agency, institution of higher education or political subdivision may terminate this Agreement for breach and, if so terminated, Sub-Recipient shall be liable for damages. B. PUBLIC AGREEMENTS WITH NATURAL PERSONS. §§24-76.5-101, et seq., C.R.S. Sub-Recipient, if a natural person 18 years of age or older, hereby swears and affirms under penalty of perjury that he or she (i) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (ii) shall comply with the provisions of §§24- Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 10 76.5-101 et seq., C.R.S., and (iii) has produced one form of identification required by §24-76.5-103, C.R.S. prior to the Effective Date of this Agreement. Agreement # 272.19 Revision: 2018-06-13 btf Budget Line Item # 11437372 531000 - 10072 11 IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first set out herein above. COMMUNITY HEALTH SERVICES ________________________________________________ !#VENDOR SIGNATURE#! Date PITKIN COUNTY, COLORADO _________________________________________________ !#DEPARTMENT REPRESENTATIVE#! Date Assistant County Manager Phylis Mattice Oct-03-2019 Executive Director Oct-03-2019 Liz Stark Immunization Scope of Work July - December 2019 Duties and Responsibilities:​ Community Health Services (CHS) shall provide the following services to Pitkin County Public Health: 1.CHS shall perform all activities in the time period required in the attached Statement of Work from the Colorado Department of Public Health and Environment (CDPHE). 2.CHS shall report on indicators defined in the table below for the contract period. Accountability:​ A designated representative from CHS will participate in quarterly meetings, or more frequently as reasonably needed or requested, with Pitkin County Public Health’s Health Promotion Program Administrator, or designee. The meetings will be a forum to provide updates and to discuss accomplishments, challenges and barriers. CHS will report on certain metrics, as indicated in this table: Indicator Frequency Cross-cutting County of residence for clients seen at CHS across programs (consider finer detail, ie town) Where are patients coming from and how is that distributed? Bi-annual Immunizations Age of patients receiving vaccines What percent of patients are children vs adults and is this changing over time? Bi-annual % who qualify for each vaccination program or none What percent of patients qualify for each of the vaccination programs- (VFC and 317 vs private pay) and is this changing over time? Bi-annual For later: decrease in vaccine preventable illnesses, vaccination rates among children Work with Carlyn to see if it is possible to get accurate values for these going forward -- Compensation: ​CHS will send a quarterly invoice to Pitkin County Public Health together with hours spent on the program and actual costs. The indirect rate for this contract is 10%. The Page 1 of 2 total compensation under this Agreement shall not exceed​ $56,409.00​, for the term ending December 31, 2019. Invoices are to be emailed to Pitkin County Public Health no later than the 15th of October 2019 and January 2020. Page 2 of 2 Certificate Of Completion Envelope Id: 4803D776718D47ADA74CD6B69CDF61E0 Status: Completed Subject: Community Health Services | Pitkin County Agreement 272.19 for Review and Signature Source Envelope: Document Pages: 21 Signatures: 2 Envelope Originator: Certificate Pages: 5 Initials: 0 Pitkin County Procurement AutoNav: Enabled EnvelopeId Stamping: Disabled Time Zone: (UTC-07:00) Mountain Time (US & Canada) 530 East Main Street Suite 203 Aspen, CO 81611 Procurement@PitkinCounty.com IP Address: 65.38.144.66 Record Tracking Status: Original 10/2/2019 4:45:47 PM Holder: Pitkin County Procurement Procurement@PitkinCounty.com Location: DocuSign Signer Events Signature Timestamp Phylis Mattice phylis.mattice@pitkincounty.com Assistant County Manager Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 65.38.144.66 Sent: 10/3/2019 8:41:56 AM Viewed: 10/3/2019 8:42:30 AM Signed: 10/3/2019 8:42:41 AM Electronic Record and Signature Disclosure: Accepted: 10/3/2019 8:42:30 AM ID: 3b4881b5-aa1f-4bd1-8856-e570ac0a151e Company Name: Pitkin County, Colorado Liz Stark liz.stark@pitkincounty.com Executive Director Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 65.38.144.66 Sent: 10/3/2019 8:42:50 AM Viewed: 10/3/2019 1:13:57 PM Signed: 10/3/2019 1:14:58 PM Electronic Record and Signature Disclosure: Accepted: 10/3/2019 1:13:57 PM ID: 137c4cc9-4ea3-4281-a89a-0d77b7841563 Company Name: Pitkin County, Colorado In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Carbon Copy Events Status Timestamp Karen Koenemann Karen.Koenemann@PitkinCounty.com Public Health Director Pitkin County Security Level: Email, Account Authentication (None) Sent: 10/3/2019 8:42:03 AM Electronic Record and Signature Disclosure: Accepted: 6/13/2019 7:18:15 PM ID: 61e0809f-fa5f-4eb4-b315-7caa500096bc Company Name: Pitkin County, Colorado Pitkin County Procurement procurement@pitkincounty.com Procurement Pitkin County Security Level: Email, Account Authentication (None) Sent: 10/3/2019 1:15:01 PM Resent: 10/3/2019 1:15:11 PM Viewed: 10/9/2019 2:52:30 PM Electronic Record and Signature Disclosure: Accepted: 6/21/2019 11:35:47 AM ID: f4b0c7d5-e378-4bad-8806-08d16f6ff44c Company Name: Pitkin County, Colorado Accounts Payable AP@pitkincounty.com Accounts Payable Pitkin County Security Level: Email, Account Authentication (None) Sent: 10/3/2019 1:15:03 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Suzuho Shimasaki suzuho.shimasaki@pitkincounty.com Security Level: Email, Account Authentication (None) Sent: 10/3/2019 1:15:06 PM Viewed: 10/3/2019 3:41:13 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 10/3/2019 1:15:06 PM Certified Delivered Security Checked 10/3/2019 1:15:06 PM Signing Complete Security Checked 10/3/2019 1:15:06 PM Completed Security Checked 10/3/2019 1:15:06 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, Pitkin County (we, us or Pitkin County) may be required by law to provide to you certain written notices or disclosures. 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After such time, if you wish for us to send you paper or electronic copies of any such documents from our office to you, you may be charged a per-page fee. You may request delivery of such paper or electronic copies from us by following the procedure described below. Withdrawing your consent If you are an authorized DocuSign Account holder, you can decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. Described below is the process for informing us of your decision to receive future notices and disclosure in paper format and also how to withdraw your consent to receive notices and disclosures electronically. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. To indicate to us that you are changing your mind, you must withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of your DocuSign account. This will indicate to us that you have withdrawn your consent to receive required notices and disclosures electronically from us and you will no longer be able to use your DocuSign user account to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through your DocuSign user account all required notices, disclosures, authorizations, acknowledgments, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact Pitkin County: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: susan.sullivan@pitkincounty.com To advise Pitkin County of your new e-mail address To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to us at susan.sullivan@pitkincounty.com and in the body of such request you must state: your previous e-mail address, your new e-mail address . In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected in your DocuSign account by following the process for changing e-mail in DocuSign. To request paper or electronic copies from Pitkin County To request delivery from us of paper or electronic copies of the notices and disclosures previously provided by us to you electronically, you should request those documents from Pitkin County under the Colorado Open Records Act by contacting the Pitkin County custodian who sent you the document for signature. . To withdraw your consent with Pitkin County To inform us that you no longer want to receive future notices and disclosures in electronic format you may: i. decline to sign a document from within your DocuSign account, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may; ii. send us an e-mail to susan.sullivan@pitkincounty.com and in the body of such request you must state your e-mail, full name, Postal Address, telephone number, and account number.