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HomeMy WebLinkAboutbocc.con.amended.271.19 D 41) iTKIN Pitkin County Procurement Cover Sheet COUNT Q/D.CV 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 Contract Information Contract Number 271.19 D Project Name Tuberculosis Prevention, Control, Education, and Treatment Services Contractor Community Health Services Budget Line Item 11437372.531000.10075 $ $Additional Budget Line $ _ Item(s) $ _ (Please fully allocate New Contract Total) Procurement Method: None Type: Services/Maintenance Contract Start Date 7/1/2019 Contract End Date 12/31/2022 Contract Type Change Order/Contract Amendment Retainage No If this is a new contractor, please enter the New Vendor information into Munis for workflow approval. Contact Information: Department Public Health County Representative Jordana Sabella County Representative (970) 920-5062 Phone Provide a brief description of the Contract or Change Order: Extension of Contract term to 12/31/2022 and allocation of not to exceed budget in the amount of$12,000.00 for the extension term beginning 1/1/22 and expiring 12/31/22. Contract Value Summary: Original Contract Amount $ 13,745.00 Previous Change Order/Amendment Amount $ 40,000.00 This Change order/Amendment amount $ 12,000.00 Contract Total $ 65,745.00 Contract#:271.19 Rev. 2018.06.13 btf Budget Line Item#: 11437372.531000.10075 if KIN COUNT • CHANGE ORDER/CONTRACT AMENDMENT Change Order Number: 271.19 D OWNER: CONTRACTOR: Pitkin County, Colorado Community Health Services 530 E. Main St., Suite#302 0405 Castle Creek Road, Suite 201 Aspen, CO 81611 Aspen, CO 81611 The Provision of Tuberculosis Prevention, Control, Education, and Treatment Services (the "Contract") dated October 1, 2019 between the Board of County Commissioners of Pitkin County, Colorado (the "County") and Community Health Services (the "Contractor"), is hereby amended as follows: Description of Change: 1. Per the terms of the Contract, at the expiration of the initial term, the Contract may be extended for four(4) additional years by the express written consent of both parties. Expiration of the current term is set as December 31, 2021. If agreeable to both parties, the Contract term is hereby extended for a period of one (1) year and the new expiration date shall be December 31, 2022. 2. Incorporation of the updated Tuberculosis Scope of Work("Attachment A") for the 2022 extended term. 3. Allocation of not to exceed budget in the amount of$12,000.00 for the 2022 extended term, per the terms of Attachment A. Reason for Change: Continued need for services following expiration of 2021 term and incorporation of 2022 term Scope of Work and costs. Original Contract Amount $ 13,745.00 Previous Change Order/Amendment Amount $ 40,000.00 This Change Order/Amendment Amount $ 12,000.00 New Contract Total $ 65,745.00 *Increases over$25,000 and/or 10%(single increase or accumulative)of original contract must have County Manager signature. 1 Contract#:271.19 Rev. 2018.06.13 btf Budget Line Item#: 11437372.531000.10075 In all other respects, the Contract is in full force and effect and remains unchanged by this Amendment. COMMUNITY HEALTH SERVICES (,boAJn, k o1. Jan-27-2022 Logan Hood Date Executive Di rector PITKIN COUNTY,COLORADO RECOMMENDED FOR APPROVAL: jOrdtatA . AWL& Jan-27-2022 7ordana Sabel la Date Interim Public Health Director *Increases over$25,000 and/or 10% (single increase or accumulative)of original contract must have County Manager signature. 2 Tuberculosis Scope of Work 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 2021 Statements of Work (SOW)from the Colorado Department of Public Health and Environment (CDPHE). Since Pitkin County does not have a current TB contract with CDPHE the 2021 Tuberculosis Contract is provided as an outline. If there are any discrepancies in the 2021 SOW, please notify Pitkin County Public Health for resolution a. Attachment A: Tuberculosis SOW 2. CHS shall work collaboratively with Pitkin County Public Health to develop measures that will be reported quarterly. 3. CHS shall notify Pitkin County Public Health as soon as reasonably possible if the Tuberculosis work will outpace the reimbursement amount to allow for possible adjustments to the budget. 4. CHS shall also operate per the MOU with Pitkin County IT a. Attachment B: Pitkin IT MOU 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 CHS Contract Manager, or designee. The meetings will be a forum to provide updates and to discuss accomplishments, challenges, and barriers. 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 total compensation under this Agreement shall not exceed $12,000 for the term ending December 31, 2022. Notify Pitkin County Public Health within 30 days of acknowledgment of any grants or other funding that will offset costs related to Tuberculosis work. Invoices are to be emailed to Pitkin County Public Health no later than the 15th of April, July, October, and January 2023. Attachment A �� 1IN 000NT*r 'Ili PUBLIC HEALTH / (..5X1 7 STATEMENT OF WORK L Entity Name:Pitkin County Public Health Agency II' Project Description: This project serves to provide diagnostic,patient education and treatmem services for individuals with suspected/known latent Tuberculosis(TB)infection(LTBI)and those classified with Class A and Class B TB status or who are suspected of having active TB.Also for individuals who are identified as newly arrived refugees,asylees and other high-risk persons with LTBI. IlL Definitions: I. AFB smear-Acid-Fast Bacilli;a rapid test used to detect infectious mycobacteria 2. Asylee-individuals who,on their own,travel to the United States and subsequently apply for and receive a grant of asylum. 3. CDPHE-Colorado Department of Public Health and Environment 4. Class A-Pulmonary TB,the applicant has an abnormal chest radiograph suggestive of active TB disease,and one or more sputum smears positive for acid-fast bacteria 5. Class 131 -Immigrant with an abnormal CXR with evidence of TB,and/or the individual has a history of treatment for active TB disease. 6. Class B2-The individual was diagnosed with latent TB infection(LTBI).These are typically children whose TST result was positive and CXR was normal. 7. DOT-Directly Observed Therapy S. HIV-Human Immunodeficiency Virus 9. IGRA-interferon gamma(y)release assay(whole blood TB test) 10. LEP-limited English proficiency(Over-the-Phone Interpretation(OPI)provider only) II. LTBI-Latent Tuberculosis Infection 12. OP1-over-the-phone interpretation 13. Refugee-any person who is outside his or her country of nationality or habitual residence and is unable or unwilling to return to or seek protection of that country due to a well-founded fear of persecution based on race,religion,nationality,membership in a particular social group,or political opinion 14. RVCT-Report of Verified Case of Tuberculosis 15. TB-Tuberculosis 16. TB-18-CDPHE's TB surveillance form 17. TBdb- CDPHE Tuberculosis Data Base 18. TST-Tuberculin Skin Test IV. Work Plan: Goal ML: Prevent and control tuberculosis infection and active TB disraw•throughout the Contractor's jurisdiction Objective#1: No later than the expiration date of the Contract,the Contractor shall assist in supporting tuberculosis prevention and control activities throughout the agency's jurisdiction. Primary Activity HI f The Contractor shall locate all patients with suspected or confirmed TB Schultz Public Health and N uman Se rvlces BuIldlnN 1040S Caine Creek Road 4 Sulte 112 I Aspen,CO 31611 Pare t oft Vcr.01 11 19 I. The Contractor shall provide,or arrange for,chest x-rays and interpretations for individuals with suspected or confirmed TB. 2. The Contractor shall provide interpretations for individuals with suspected or confirmed TB,as necessary. 3. The Contractor shall collect specimens for mycobacteriology testing on all persons suspected of having TB. 4. The Contractor shall arrange for the transportation of the specimens to the CDPHE laboratory for testing. 5. The Contractor shall arrange for the placement of patients who require isolation. a.The Contractor shall contact CDPHE TB Program for assistance. b.The Contractor shall contact CDPHE to request reimbursement from CDPHE for those costs incurred by the Contractor in isolating a patient. 6. The Contractor shall provide,or arrange for,the treatment of patients with suspected or Sub-Activities#1 confirmed active TB,including DOT. 7. The Contractor shall ensure patients'adherence to TB treatment. 8. The Contractor shall inform those individuals whom refuse testing of the risks associated with 111V/IB co-infection. 9. A minimum of once a month,the Contractor shall monitor those persons with suspected or confirmed active TB disease by in-person assessment. a.The Contractor shall evaluate those persons with suspected or confirmed active TB disease by in-person assessment. 10. As needed,the Contractor shall offer limited English proficiency services via an accredited Over-the-Phone Interpretation(OPI)provider to be reimbursed using TB DOT/Diagnostic reimbursement invoice template by the CDPHE TB Program at a rate not to exceed S0.75/minute. a.The instructions are incorporated and made part of this Contract by reference and is available on the following website under the Over-the-phone(OPI)section, u,J,i cm, putill< Ile;,. i. Primary Activity#2 The Contractor shall ensure that all contacts to newly identified infectious TB cases are identified,investigated,and receive appropriate evaluation. 1. The Contractor shall provide,or arrange for the following for individuals with newly identified infectious,suspected,confirmed,and LTBI TB cases: a.Chest x-rays b.Chest x-ray interpretations 2. The Contractor shall provide,or arrange for,the treatment of patients,including DOT, and ensure the completion of therapy for infected patients. 3. The Contractor shall provide,or arrange for,an HIV antibody test for all persons with LTBI with HIV risk factors or who originate from an HIV-endemic area. Sub-Activities#2 4. The Contractor shall inform all individuals whom refuse testing of the risks associated with HIV/TB co-infection. 5. A minimum of once a month,the Contractor shall monitor and evaluate persons with LTBI during treatment. 6. The Contractor shall ask all TB clients about current health insurance enrollment and offered materials to become insured if not currently insured. 7. The Contractor shall complete a preliminary Tuberculosis Contact Investigation Record. a.The instructions are incorporated and made part of this Contract by reference and is available at the following link, to the CDPHE TB Program after initiation of each contact investigation. Primary Activity#3 The Contractor shall provide or arrange for newly arrived refugees,asylees and other eligible individuals with Class B TB designation to complete a TB screening. Schulte Public Health and Human Services Building 1 0405 Castle Creak[toad 1 Suite 112 1 Aspen,CO 81611 Page 2 of Vcr.01 AI.19 I. A minimum of 30 calendar days of the Contractor's receipt of written notification from CDPHE of the arrival of a Class B immigrant or refugee,the Contactor shall provide,or arrange for a TB screening that includes the following: a. medical evaluation b. tuberculin skin test or IGRA c. chest radiograph d. three spontaneous sputum specimens for AFB smear and culture collected on Sub-Activities#3 consecutive days 2. Upon completion of testing and examination,the Contractor shall complete,sign,and date the CDC'75.17 form or Class B tuberculosis Follow Up worksheet,and return it within ninety(90)days to: Colorado Department of Public Health and Environment Tuberculosis Program Attn: Class B Coordinator 4300 Cherry Creek Drive South Denver,CO 80246 The Contractor shall identify,investigate,and evaluate persons with a high risk of LTBI. Primary Activity#4 I. The Contractor shall offer an HIV antibody test to I00%of persons with LTBI and provide,or arrange for.HIV antibody test with a test result rate>80%. a.The Contractor shall record 80%of all HIV antibody testing result rates for LBTI patients into the CDPHE TBdb. b. The Contractor shall record 95%of all HIV testing result rates among suspect and confirmed rases of active TB disease,and enter that information into the CDPHE TBdb. 2. The Contractor shall offer an HIV antibody test to 100%of persons diagnosed Sub Activities#4 with active TB disease. a.The Contractor shall provide an HIV antibody test for those clients with a test result rate>95%,regardless of their age or the apparent absence of risk factors for HIV infection. 3. A minimum of once a month,the Contractor shall monitor and evaluate persons with LTBI during treatment for all such patients. 4. For those persons identified with LTBI or active TB.the Contractor shall initiate treatment in accordance with CDC guidance found at the following links, incorporated and made part of this Contract by reference: The Contractor shall offer printed resource and referral materials to clients that direct them to Primary Activity#5 the nearest community Medicaid and Connect for Health Colorado enrollment location(s), including online enrollment options. I. The Contractor shall discuss current health insurance enrollment status with each client for the purposes of becoming insured if not currently insured. a.The Contractor shall guide each client to following websites: and ,incorporated and made part of this Contract by reference. Sub Activities#5 b.The Contractor shall ask all TB clients about current health insurance enrollment status,including Medicaid and offer resource materials no later than the last business day of each month. c.The Contractor shall document that all TB clients were asked about current health insurance enrollment and offered materials no later than the last business day of each month. ''; u'. • . c'ea'% and'urns r 11•ing r•SCas Cree Roa• Su .112 • • n, • : • __3 Page 3 of ti Vcr.01.11.19 I. The content of electronic documents located on CDPHE and non-CDPHE websites and information contained on CDPHE and non-CDPHE:websites may be updated periodically during the Contract term.The Contractor shall monitor documents and websitc content for updates and comply wills all updates. 2. The Contractor shall complete the appropriate treatment as stated in the(.'UPI TB Manual.The CDPHE TB Manual is available on the State of Colorado websitc and is incorporated and made part of this Contract by reference. 3. CUPIIE shall provide templates and instructions for any additional information requests. Report forms are subject to revision and the Contractor agrees to use the most recent version. 4. The Contractor shall increase the percentage of persons that complete LTBI treatment to meet the state objective of 84%by the last day of the contract term and maintain or improve on that rate thereafter. 5. The Contractor shall develop reports of suspected or confirmed active TB disease results, and include the following information: a.reason for initiating b.patient name c.date of birth d.country of birth e.date arrived in U.S. f.demographic information g.locating information h.provider information i. TB risk factors Standards and j. results of diagnostic testing Requirements k.results of mycobacteriology including susceptibility results I. dates of infectious period m.treatment information n_changes in patients'status o.diagnosis p. any other information as appropriate 6. For those persons identified with LTBI or active TB,the Contractor shall report to C DPI I E: a. patient name b. date of birth c. country of birth d. date arrived in the U.S. e. demographic information f. locating information g. provider information h. TB risk factors i. results of diagnostic testing j. treatment information k. any other information deemed appropriate by the Contractor 7. The Contractor shall complete tests including the following: a. smears for acid-fast bacilli,(using concentrated fluorescent method) b. isolation of mycobacteria(using rapid methods) c. identification of Mycobacterium tuberculosis complex(MTB)(using rapid methods) d. susceptibility testing(isoniazid,rifampin,ethambutol,and pyrazinamide)on isolates of MTB. Schultz Public Health and Human Services Building 10405 Castle Creek Road I Suite 112 I Aspen,CO 81611 Page 4oft Vcr 01.11.19 8. The CDPHE TB Program will notify the Contractor of all newly arrived Class B TB immigrants/refugees via a CDC 75.17 form which is incorporated herein by this reference,or Follow-up worksheet which is incorporated herein by this reference,made a part of this Contract,and available on the following website: ruI,ii. I..hlI.,1$ $. 9. The Contractor shall record 95%of all HIV antibody testing result rates among suspect and confirmed cases of active TB disease,and enter that information into the CDPHE TBdb. a.The Contractor shall record 95%of all HIV antibody testing result rates among suspect and confirmed cases of active TB disease into the CDPHE TBdb no later than the day before TB treatment begins,and no later than the end date of this Contract. 9. The Contractor shall record 80%of all HIV antibody testing result rates for LBTI patients into the CDPHE TBdb. a.The Contractor shall record 80%of all HIV antibody testing result rates for LBTI patients into the CDPHE TBdb no later than the end date of this Contract. 10. The Contractor shall provide culturally appropriate patient education and information pertaining to TB treatment and the follow-up plan. 11. The Contractor shall provide services in patient's preferred language using medical interpretation resource. 12. The Contractor shall report to CDPHE via(CDPHE TBdb)or via Tuberculosis Surveillance and Case Management Report(TB-18)when a TB patient completes treatment,moves,or transfers out of the Contractor's service area. a.The Contractor shall complete 100%of all TB-I8 and RVCT CDPHE TBdb fields no later than the last business day of each month,and by the end date of this contract. 13. The Contractor shall discuss current health insurance enrollment and offer materials with the client for the purposes of becoming insured if not currently insured. a.The Contractor shall ask all TB clients about current health insurance enrollment including Medicaid,and offer resource materials no later than the last business day of each month. 14. The Contractor shall provide or arrange for treatment and ensure completion of therapy. 15. The Contractor shall provide a final report via email or CDPHE TBdb to the TB Program's Data Coordinator when a contact investigation is completed. 16. The Contractor shall provide all other necessary laboratory testing and medical evaluation services to identify TB. 17. The Contractor shall report all known HIV antibody test results to CDPHE. 18. The Contractor shall report information via web-based TB case/contact management system(CDPHE TBdb)or via "Tuberculosis Surveillance and Case Management Report"(TB 18),which is incorporated herein by this reference,made a part of this Contract and is available at the following link: . 19. For confirmed cases of TB,the Contractor shall include all data elements identified in the"Report of Verified Case of Tuberculosis(RVCT)",which is incorporated herein by this reference,made a part of this Contract and is available at the following link: and is incorporated and made part of this contract by reference. 20. The Contractor shall use the CDPHE Laboratory for testing. 21. The CDPIIE Laboratory will,at no charge to the Contractor,supply specimen containers and perform the above testing for the Contractor. 22. The Contractor shall order TB medications through the CDPHE TB Program. 23. The Contractor shall provide CDPHE with the medical insurance information for those patients who have medical insurance. 24. The Contractor shall provide consultation services,as needed,to providers in its service area regarding TB reporting,screening,treatment,and follow-up. 25. The Contractor shall comply with TB specimen shipping guidelines.See TB Sputum Collection Kit and Shipping Instructions I which is Schultz Public Health and Human Services Building 10405 Castle Creek Road I Sulte 112 I Aspen,Co 81611 Page 5 oft Vet.01.11.19 incorporated and made part of this Contract by reference. 26. The Contractor shall provide printed resource,referral and Medicaid and Connect for Health Colorado enrollment materials for clients with Limited English Proficiency (LEP). a.Contractors that routinely offer enrollment services on-site are exempt from this requirement because the services provided go beyond this minimum requirement. 27. The Contractor shall use LEP,Over-the-Phone Interpretation(OPI)to communicate with clients telephonically or in-person(when a live in-person interpreter is not warranted). a. The Contractor shall provide a monthly reimbursement DOT/Diagnostic/OPI invoice according to the following criteria: i.The monthly DOT/Diagnostic invoice must be provided with supporting documentation confirming use is TB-related. ii. The Contractor shall request monthly DOT/Diagnostic reimbursement no later than the last business day of each month. 28. The Contractor shall complete the Semi-Annual Progress Report per the following criteria: a. The Semi-Annual Progress Reports must cover July-December and January- June. b. The Contractor shall complete the Semi-Annual Progress Report using the following websitc: which is incorporated and made part of this Contract by reference. 29. The Contractor shall use information on enrollment resources,referral locations,LEP and outreach and promotional materials is available at which is incorporated and made a part of this Contract by reference. 30. In order to facilitate and improve client access and enrollment in health insurance,CDPHE is asking all state contractors and sub-recipients who contract with the department for direct patient care clinical service programs to provide Colorado Medicaid and Connect for Health Colorado information to clients presenting for services at their agencies.At a minimum,CDPHE Contractors must offer clients printed resource and referral materials that direct them to the nearest community Medicaid and Connect for Health Colorado enrollment location(s),including online enrollment options.These materials must be available for clients with limited English proficiency(LEP).To help locate the nearest enrollment locations in the community,the following websites arc available: ,and are incorporated and made part of this Contract by reference. 31. The Contractor shall allow all existing staff designated to TB activities to attend the latest CDPHE Baseline TB 101 training at least once during the contract period,and allow all new staff designated to TB activities to attend this training TB 101 Baseline within 3 months of hire,and during the contract period. I. New TB cases shall be diagnosed,documented and treated. Expected Results of the 2. Patients with existing or newly diagnosed TB or LTBI shall be treated,as appropriate. Activity 3. Newly arrived refugees,asylees and other eligible individuals with Class B TB designation receive treatment. Measurement of Expected I.Data contained in the CDPHE TBdb. Results 2.Data in Semi-Annual Progress Reports. Completion Date Deliverables 1. The Contractor shall submit the Semi-Annual Progress Report No later than seven covering July-December and January-June to the CDPHE Contract (7) and 13 months Monitor via email. after execution of this contract Schultz Public Health and Human Services Building 10405 Castle Creek Road I Suite 112 I Aspen,CO 81611 Page 6 oil Vcr.01.11.19 Attachment B 2021 MEMORANDUM OF UNDERSTANDING For Information Technology Infrastructure Services and Support Pitkin County,Colorado and Community Health Services This Memorandum of Understanding is made this 1st day of January, 2021, between Pitkin County, Colorado (the County) and Community Health Services (Community Health)called,respectively,(the Parties). The Parties understand and agree that the Information Technology Infrastructure Services and Support(IT Support)outlined in this MOU are subject to available appropriations by the County who will not be obligated to provide these services if adequate appropriations have not been made. Pitkin County Business Information Technology Services(BITS)will provide IT support as listed below: Item Unit Cost Network Infrastructure(servers, switches, Internet, help desk,etc) $75 Workstations, PCs, Tablets, Smart Phones 525 Phone System 520 Monthly Per Capita Cost 5120 Item Unit Cost Totals Network Infrastructure (servers, switches, Internet,help desk,etc) S75 Per Capita Monthly Cost $120 Phone System $20■Per Capita Annual Cost $1,440 Workstations,PCs, Tablets, Smart Phones $25 8 Employees Annual Cost $11,520 The following terms are agreed to by the Parties: 1. TERM The term of this MOU will be from January I.2021 through December 31,2021. 2. CLAUSES By mutual agreement Clauses may be added to this MOU. 3. SEVERABILITY To the extent that this MOU is executed,and performance of the obligations of the Parties may be accomplished within the intent of the MOU,the terms of the MOU are severable. "Thus,should any Clause or provision herein be declared invalid or become inoperative for any reason,such invalidity or failure shall not affect the validity of any other Clause or provision herein. The waiver of any breach of term herein shall not he construed as a waiver of any other term,or of the same term upon subsequent breach. 2 4. INTEGRATION OF UNDERSTANDING This MOU is intended as the complete integration of the understanding between the Parties concerning the matters negotiated between them and incorporated in this MOU. No prior or contemporaneous addition,deletion,or other amendment hereto shall have any force or effect whatsoever unless embodied in writing. No subsequent notation, renewal,addition,deletion,or other amendment hereto shall have any force or effect unless embodied in a written amendment executed by the parties. 5. NO THIRD PARTY BENEFICIARY This MOU is binding on the Parties,as well as their respective successors and assigms. It is agreed that the enforcement of the terms and conditions of this MOU arc reserved for the Parties,to the extent permitted by law.Nothing contained in this MOU allows a claim or right of action by a third party.Any third party receiving benefits under the provisions of this MOU is deemed an incidental beneficiary. 6. DISPUTE RESOLUTION Subsequent to the execution of this document,both parties will work in good faith to resolve any dispute arising from any provision of the Clauses of this executed MOU.If the parties are unable to resolve such dispute,binding arbitration will be effected. 3 MOU for Information Technology Shared Services Clauses PITKIN COUNTY COMMUNITY HEALTH SERVICES Carrie K Fleischman,Director of IT Liz Sta Executive Director C KFE ra i Date: 6/11/2021 Date: /) 7I7 ( 4 DocuSign Certificate Of Completion Envelope Id: B5E1FF76CF8C45CF8DEAFCCOEAO3D24E Status:Completed Subject:Community Health Services I Pitkin County Change Order 271.19 D for Review and Signature Source Envelope: Document Pages: 14 Signatures:2 Envelope Originator: Certificate Pages:5 Initials:0 Pitkin County Procurement AutoNav: Enabled 530 East Main Street Envelopeld Stamping: Disabled Suite 203 Time Zone: (UTC-07:00)Mountain Time(US&Canada) Aspen,CO 81611 Procurement@PitkinCounty.com IP Address:216.237.91.144 Record Tracking Status:Original Holder:Pitkin County Procurement Location: DocuSign 1/13/2022 2:20:50 PM Procurement@PitkinCounty.com Signer Events Signature Timestamp Jordana Sabella /I � Sent: 1/13/2022 3:45:34 PM Jordana.Sabella@PitkinCounty.com jOr4 Salat,lt.a Viewed: 1/18/2022 3:59:40 PM Interim Public Health Director Signed: 1/27/2022 9:58:33 AM Pitkin County Security Level: Email,Account Authentication Signature Adoption: Pre selected Style (None) Using IP Address:73.95.153.34 Electronic Record and Signature Disclosure: Not Offered via DocuSign Logan Hood Sent: 1/27/2022 9:58:35 AM logan.hood@aspencommunityhealth.org ()Oita& &OO,4 Viewed: 1/27/2022 11:44:06 AM Executive Director Signed: 1/27/2022 11:44:21 AM Security Level: Email,Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address:67.164.181.99 Electronic Record and Signature Disclosure: Accepted: 1/27/2022 11:44:06 AM ID:706fcacf-c67a-4b16-b965-120a87041162 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 Kurt Dahl VIEWED Sent: 1/13/2022 2:23:35 PM kurt.dahl@pitkincounty.com Viewed: 1/13/2022 3:45:33 PM Security Level: Email,Account Authentication (None) Using IP Address:73.3.201.217 Electronic Record and Signature Disclosure: Accepted: 1/20/2022 6:30:05 AM ID:4a056628-aeb7-43b1-9ad2-b9fc281ae7f0 Company Name:Pitkin County,Colorado Carbon Copy Events Status Timestamp Pitkin County Procurement COPIED Sent: 1/27/2022 11:44:22 AM procurement@pitkincounty.com Resent: 1/27/2022 11:44:25 AM Procurement Viewed: 1/27/2022 1:06:35 PM Pitkin County Security Level: Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Accounts Payable COPIED Sent: 1/27/2022 11:44:22 AM AP@pitkincounty.com Accounts Payable Pitkin County Security Level: Email,Account Authentication (None) 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 1/13/2022 2:23:35 PM Certified Delivered Security Checked 1/27/2022 11:44:06 AM Signing Complete Security Checked 1/27/2022 11:44:21 AM Completed Security Checked 1/27/2022 11:44:22 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on:3/20/2020 3:28:13 PM Parties agreed to:Logan Hood,Kurt Dahl ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, Pitkin County(we, us or Pitkin County)may be required by law to provide you with certain written notices or disclosures. 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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 Helpdesk@provelocity.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 Helpdesk@provelocity.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 Helpdesk@provelocity.com and in the body of such a request, you must state your e-mail, full name, Postal Address, telephone number, and account number.