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HomeMy WebLinkAboutbocc.con.amended.121.20 D8/30/2021 CDD Contract Information Contract Number Project Name Contractor Budget Line Item 11234342.531000.10082 Procurement Method: Type: Contract Start Date Contract End Date Contract Type Retainage If this is a new contractor, please enter the New Vendor information into Munis for workflow approval. Contact Information: Department County Representative Matt McGaugh County Representative Phone (970) 429-2042 Provide a brief description of the Contract or Change Order: Contract Value Summary: $ 10,000.00 $ 35,000.00 $ 15,000.00 $ 60,000.00 Adult & Family Svcs Contract extension for the continued provision of Translation/Interpretation Services. Allocation of funding not to exceed $15,000.00 for the renewal term. Amendment to Contract terms to incorporate State requirements. Original Contract Amount Previous Change Order/Amendment Amount This Change order/Amendment amount Contract Total No Translation / Interpretation Services David Perez $ 15,000.00 Additional Budget Line Item(s) (Please fully allocate New Contract Total) $ - $ - $ - $ 15,000.00 None Services/Maintenance 6/1/2020 5/31/2024 Change Order/Contract Amendment 121.20 D 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 Contract #: 121.20 Rev. 2018.06.13 btf Budget Line Item #: 111234342.531000.10082 *Increases over $25,000 and/or 10% (single increase or accumulative) of original contract must have County Manager signature. 1 CHANGE ORDER / CONTRACT AMENDMENT Change Order Number: 121.20 D OWNER: Pitkin County, Colorado 530 E. Main St., Suite #302 Aspen, CO 81611 CONTRACTOR: David Perez PO Box 6871 Snowmass Village, CO 81615 The Provision of Translation/Interpretation Services (the “Contract”) dated June 1, 2020 between the Board of County Commissioners of Pitkin County, Colorado (the “County”) and David Perez (the “Contractor”), is hereby amended as follows: Description of Change: 1. Extension of Contract term for one (1) additional year; new expiration date is hereby established as May 31, 2024; 2. Allocation of funding in the amount not to exceed $15,000.00 for any and all services provided within the renewal term, billable only as incurred; 3. Incorporation of Contractor Scope of Work (“Attachment A”) for the renewal term; and 4. Amendment to Contract terms to incorporate the terms and conditions required by the State of Colorado (“Attachment B”). Reason for Change: Extension of contract for continuation of services. 1. Extension for continuation of services pursuant to the updated Contractor Scope of Work and Contract terms. 2. Allocation of funds for the renewed term. Original Contract Amount $ 10,000.00 Previous Change Order/Amendment Amount $ 35,000.00 This Change Order/Amendment Amount $ 15,000.00 New Contract Total $ 60,000.00 Contract #: 121.20 Rev. 2018.06.13 btf Budget Line Item #: 111234342.531000.10082 *Increases over $25,000 and/or 10% (single increase or accumulative) of original contract must have County Manager signature. 2 In all other respects, the Contract is in full force and effect and remains unchanged by this Amendment. DAVID PEREZ ________________________________________________ !#VENDOR SIGNATURE#! Date PITKIN COUNTY, COLORADO _________________________________________________ !#DEPARTMENT REPRESENTATIVE#! Date 11/7/2022 Matt Mcgaugh Oct-25-2023 David Perez CMI & PI Oct-26-2023 Pitkin County Adult and Family Services Core Services Program Scope of Service David Perez Service Area: Pitkin County, Colorado Service Time Frame: June 1 st, 2023- May 31 st, 2024 Pitkin County Adult and Family Services staff will refer individuals and families to David Perez; as needed for: ●Face to Face Interpretation Services for Pitkin County Staff working with Spanish speaking clients. ●Phone Call Interpretation Services for Pitkin County Staff working with Spanish speaking clients. ●Written translation services, when Pitkin County Staff are needing assistance with translation of English documents, case plans, and/or meeting notes when needed. Rate for Translation Services:$100 per hour Average Caseload per week: 1-4 (Caseload will vary depending on need and provider availability.) Pitkin County Staff will provide the following information at referral: ●CORE Services referral form – completed with family/individual information. ●A copy of the signed release of information form. ●Copy of DHS treatment plan (when applicable) *Caseworkers are encouraged to call and speak with providers when referring clients. If you have not heard from them when receiving a referral, feel free to call them. Their information will be on the referral form. Contractor will: 1.) Provide Therapeutic services for all accepted clients; 2.) Provide Monthly invoices by the 5 th of each month; 3.) Conduct self in professional and respectful manner with families and partners congruent with Pitkin County Mission (attached); 4.) Agree to and sign Confidentiality Statement (attached); Attachment A PURCHASE OF SERVICE CONTRACT Core Services Program 1. THIS CONTRACT, made this ______day of______, 20 __by and between the ______ County Department of Human/Social Services at , hereinafter called “County” and _____(address), (name) , (address), hereinafter called “Contractor”. _____(Tax I.D. or Social Security Number) 2. This contract will be effective from ________________ until ________________. 3. County agrees to purchase, and Contractor agrees to provide (Core Service) To_____at _____at other such (population to be served)_____ (location service is to be provided)_____ location as shall facilitate the provision of such services. This service is described in Rule Manual Volume 7, Section 7.303.1_____, and, if appropriate, the State-approved County Core Service Plan. 4. County agrees to purchase, and the contractor agrees to furnish _____units of _____service at the cost of _____per unit of service for a maximum amount of this contract of $_____. 5. The parties agree that the Contractor’s relationship with the county is that of an independent Contractor. 6. The parties agree that payment pursuant to this Contract is subject to and contingent upon the continuing availability of funds for the purpose thereof. 7. County agrees: a) To determine child eligibility and, as appropriate, to provide information regarding rights to fair hearings. b) To provide the Contractor with written prior authorization on a child or family basis for services to be purchased. c) To provide the Contractor with referral information, including name and address of family, social, medical, and educational information as appropriate to the referral. d) To monitor the provision of contracted service. e) To pay the Contractor after receipt of billing statements for services rendered satisfactorily and in accordance with this Contract. 8. Contractor agrees: a) Not to assign any provision of this Contract to a subcontractor. b) Not to charge clients any fees related to services provided under this contract. c) To hold the necessary license(s) which permits the performance of the service to be purchased, and/or to meet applicable Colorado Department of Human Services qualification requirements. d) To comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation Act of 1973 concerning discrimination on the basis of race, color, sex, age, religion, political beliefs, national origin, or handicap. Page 1 Attachment B e)To provide the service described herein at a cost not greater than that charged to other persons in the same community. f)To submit a billing statement in a timely manner,no later than forty-five (45)days after services.failure to do so may result in non-payment. g)To safeguard the information and confidentiality of the child and the child’s family in accordance with the rules of the Colorado Department of Human Services and the County Department of Human/Social Services. h)To provide County with reports on the provision of services as follows: ▪Within _____weeks of enrollment/participation,submission of a treatment plan for the child/child’s family with specific objectives and target dates.The treatment plan is subject to county approval. ▪At intervals of _____months,from the time of enrollment/participation, submit reports that include progress and barriers in achieving provisions of the treatment plan. i)To provide access for any duly authorized representative of the County or the Colorado Department of Human Services until the expiration of five (5)years after the final payment under this Contract,involving transactions related to this Contract. j)Indemnify the County and the Colorado Department of Human Services from the action based upon or arising out of damage or injury,including death,to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby,or based upon any violation of any statute,regulation,and the defense of any such claims or actions. 9.In addition to the foregoing,the County and Contractor also agree: 10.Termination:Either party may terminate this Contract by thirty (30)days prior notification in writing. 11.All payments will be paid through the State’s approved automated system,as appropriate. Core Services Program expenditures will not be reimbursed when the expenditures may be reimbursed by some other source.(As set forth in Rule Manual Volume 7,at 7.414,B (12 CCR 2509-5). ADDITIONAL PROVISIONS: __________________________________________ County Director’s Signature Date __________________________________________ Contractor’s Signature Date ______________________________________ Contractor’s Title Page 2 Certificate Of Completion Envelope Id: 57ECCEF9FC0742289206A355B7850E9E Status: Completed Subject: David Perez | Pitkin County Contract Renewal 121.20 D for Review and Signature Source Envelope: Document Pages: 6 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: 216.237.91.144 Record Tracking Status: Original 10/25/2023 11:31:08 AM Holder: Pitkin County Procurement Procurement@PitkinCounty.com Location: DocuSign Signer Events Signature Timestamp Matt Mcgaugh matt.mcgaugh@pitkincounty.com 11/7/2022 Pitkin County Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 65.38.144.66 Sent: 10/25/2023 11:33:45 AM Viewed: 10/25/2023 1:02:47 PM Signed: 10/25/2023 1:02:52 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign David Perez J_David_Perez@yahoo.com CMI & PI Security Level: Email, Account Authentication (None)Signature Adoption: Drawn on Device Using IP Address: 98.50.36.101 Sent: 10/25/2023 1:02:53 PM Viewed: 10/26/2023 7:57:29 PM Signed: 10/26/2023 7:59:11 PM Electronic Record and Signature Disclosure: Accepted: 6/10/2022 10:37:53 AM ID: b4803638-5aa9-4736-b092-1c5e5b316438 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 Pitkin County Procurement procurement@pitkincounty.com Procurement Specialist Pitkin County Security Level: Email, Account Authentication (None) Sent: 10/26/2023 7:59:12 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Accounts Payable AP@pitkincounty.com Accounts Payable Pitkin County Security Level: Email, Account Authentication (None) Sent: 10/26/2023 7:59:13 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 10/25/2023 11:33:45 AM Certified Delivered Security Checked 10/26/2023 7:57:29 PM Signing Complete Security Checked 10/26/2023 7:59:11 PM Completed Security Checked 10/26/2023 7:59:13 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 you with certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically when we send you documents for electronic signature. Acknowledging your Access, Intent, and Consent to Receive and Sign Materials Electronically To confirm that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please verify that you were able to read this electronic disclosure and that you also were able to print on paper or electronically save this page for your future reference and access or that you were able to e-mail this disclosure and consent to an address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receive notices and disclosures exclusively in electronic format on the terms and conditions described above, please let us know by clicking the 'I agree' button below. By checking the 'I Agree' box, I confirm that:  I am establishing my intent to be bound to the transaction, and indicating that I am fully aware of the purpose for which the signature is being provided.  I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and  I can print on paper the disclosure or save or send the disclosure to a place where I can print it, for future reference and access; and  Until or unless I notify Pitkin County as described above, I consent to receive from exclusively through electronic means all notices, disclosures, authorizations, acknowledgments, and other documents that are required to be provided or made available to me by Pitkin County during the course of my relationship with you. Signing Documents without a Pitkin County DocuSign Account: Pitkin County may not require all document signers to be authorized users of the Pitkin County DocuSign Account. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of this document. When you don't have a DocuSign account, you will be provided the opportunity to agree to the Legal Disclosure each time you open an "envelope" for signing, at this time, you can download and retain this disclosure. Pitkin County will forward completed documents that you've reviewed, processed or signed via email. Should you require copies of these signed documents (e.g., if they get deleted from your email account) 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. Signing Documents with a Pitkin County DocuSign Account: Electronic Record and Signature Disclosure created on: 3/20/2020 3:28:13 PM Parties agreed to: David Perez Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of this document. Getting paper or electronic copies At any time, you may request from us a paper or electronic copy of any record provided or made available electronically to you by us. For such copies, as long as you are an authorized user of the DocuSign system you will have the ability to download and print any documents we send to you through your DocuSign user account for a limited period of time (usually 30 days) after such documents are first sent to you. 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 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.