HomeMy WebLinkAboutbocc.con.124.248/30/2021 CDD
Contract Information
Contract Number
Project Name
Contractor
Budget Line Item 11234341.531000.10056
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 Lindsay Maisch County Representative
Phone (970) 920-5766
Provide a brief description of the Contract or Change Order:
Contract Value Summary:
$ 24,999.00
$ -
$ -
$ 24,999.00
124.24
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
Summer Camp Day Care
Aspen School District, The Cottage
$ 24,999.00
Additional Budget Line
Item(s)
(Please fully allocate New Contract Total)
$ -
$ -
$ -
$ 24,999.00
None
Services/Maintenance
7/1/2024
6/30/2025
New Contract
Human Services
Contract to provide childcare services for children enrolle in the Summer Camp Daycare program.
Original Contract Amount
Previous Change Order/Amendment Amount
This Change order/Amendment amount
Contract Total
Contract # 124.24 Revision: 2023.12.15 CDD
PITKIN COUNTY CONTRACT FOR PROVISION OF SERVICES
THIS CONTRACT, made May 23, 2024 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 Aspen School District, The Cottage, 235 High School Road,
Aspen, CO 81611 (hereinafter called the “Contractor”) to perform the following work:
Summer Camp Day Care (“Project”).
I. Term of Contract: The term of this Contract is from July 1, 2024 to June 30, 2025.
Optional Contract Extension.
II. Contractor’s Obligations. The Contractor shall provide staff to deliver quality child
care for Pitkin County children enrolled in the Summer Camp Daycare program,
located at 235 High School Road, Aspen, CO 81611. The Contractor will provide a
safe, well-organized, and structured learning environment, on behalf of the County, as
described in Exhibit “A” to this agreement, attached hereto and incorporated herein as
though fully set forth. Contractor will also need to specify that every family will need
to complete the affidavit form to justify the low income families services, see
Exhibit “B ”.
III. Compensation and Expenses, Invoicing, Payment and Offset. The County shall
compensate Contractor 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 Twenty four thousand nine hundred ninety nine and zero cents ($24,999.00)
for all services rendered. By contract or amendment, the County and Contractor may
reallocate the budget among project tasks if the total budget amount remains
unchanged. Contractor shall invoice for the project monthly based on hours worked,
with payment expected within thirty (30) days of invoice. Any payment by the
County may be offset by any amount the Contractor owes the County for any reason.
Pitkin County will not release any payment to Contractor prior to receipt of a
complete and valid W9. Contractor’s address and the as-filed, legal entity name
provided within this Contract must match the information provided with the
submitted W9. Doing Business As (“DBA”) entity titles, as applicable, must be
preceded by Contractors legally filed business name. Failure to provide a complete
1
Contract # 124.24 Revision: 2023.12.15 CDD
and valid W 9 may result in delayed and/or past due payment from the County to
Contractor and will in no event obligate the County to recognize or pay penalties for
any past due balances withheld as a result of such. Contractor may submit completed
W 9 forms electronically by emailing pdf copies to AP@PitkinCounty.com with the
County Project Contact listed within this Contract in copy.
IV. County’s Exclusive Ownership of Work Product. Drawings, specifications,
guidelines and other documents prepared by Contractor in connection with this
Contract shall be the property of the County. However, Contractor shall have the
right to utilize such documents in the course of its marketing, professional
presentations, and for other business purposes. Contractor assigns to County the
copyrights to all work prepared, developed, or created pursuant to this Contract,
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. The Contractor shall have the right to use materials produced in the
course of this Contract for marketing purposes and professional presentations,
articles, speeches and other business purposes.
V. Pitkin County’s Obligations. Pitkin County shall administer this Contract through
a County Representative. Norma Avila, Economic Assistance Manager will manage
the project as the County’s Representative. In the event that Norma Avila is not
available, Lindsay Maisch, Human Services Director shall assume the County
Representative’s duties. The services provided and products delivered by the
Contractor under this Contract will be subject to review by the County’s
Representatives, or a designee, for compliance with Contractor’s obligations prior to
final payment.
VI. Termination Prior to Expiration of Contract Term. The County has the right to
terminate this Contract, with or without cause, by giving written notice to the
Contractor 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 Contractor pursuant to this Contract shall become the County’s property.
Contractor shall be entitled to receive compensation in accordance with the Contract
for any satisfactory work completed pursuant to the terms of this Contract prior to the
date of termination. Notwithstanding the above, Contractor shall not be relieved of
liability to the County for damages sustained by the County by virtue of any breach of
the Contract by the Contractor.
VII. Independent Contractor Status.
a. The parties to this Contract intend that the relationship between them
contemplated by the Contract is that of independent contractor. Contractor, and
2
Contract # 124.24 Revision: 2023.12.15 CDD
any agent, employee, or servant of Contractor shall not be deemed to be an
employee, agent, or servant of Pitkin County.
b. Contractor is not required to offer his services exclusively to Pitkin County under
this Contract. Contractor may choose to work for other individuals or entities
during the term of this Contract, provided that the basic services and deliverable
products required under this Contract are submitted in the manner and on the
schedule defined under this Contract.
c. Contractor warrants that all work produced will conform to all applicable industry
standard of care, skill and diligence in the performance of Contractor’s
obligations under this Contract.
d. Contractor 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 Contract.
e. Contractor 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 Contract is not assignable by either party. Any use of
subcontractors by the Contractor for performance of this Contract must be accepted in
writing by the County.
IX. Severability . In the event that any provision of this Contract shall be held to be
invalid or unenforceable, the remaining provisions of this Contract shall remain valid
and binding upon the parties hereto.
X. Integration and Modification .
a. This Contract represents the entire and integrated Contract between the County
and the Contractor and supersedes all prior negotiations, representations, or
contract, either written or oral. This Contract may be amended only by written
contract signed by both the County and the Contractor.
b. The County may, from time to time, request changes in the scope of services of
the Contractor to be performed hereunder. Such changes, including the increase
or decrease in the amount of the Contractor’s compensation, which are mutually
agreed upon between the County and the Contractor, shall be in writing and upon
execution shall become part of this Contract.
XI. Indemnity.
a. The Contractor 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
suits and claims, including attorney's fees and cost of litigation, actions, loss,
3
Contract # 124.24 Revision: 2023.12.15 CDD
damage, expense, cost or claims of any character or any nature arising out of the
work done in fulfillment of the terms of this Contract or on account of any act,
claim or amount arising or recovered under workers' compensation law or arising
out of the failure of the Contractor to conform to any statutes, ordinances,
regulation, law or court decree. It is agreed that the Contractor will be responsible
for primary loss investigation, defense and judgment costs where this Contract of
indemnity applies. In consideration of the award of this Contract, the Contractor
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 Contractor for the County.
b. The Contractor 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. Contractor and subcontractors shall procure and maintain until all of their
obligations have been discharged, including any warranty periods under this Contract
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 Contractor, its agents, representatives, employees or subcontractors.
The insurance requirements herein are minimum requirements for this Contract and in
no way limit the indemnity covenants contained in this Contract. 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 Contractor even if those limits
of liability are in excess of those required by this Contract.
The County in no way warrants that the minimum limits contained herein are
sufficient to protect the Contractor from liabilities that might arise out of the
performance of the work under this Contract by the Contractor, its agents,
representatives, employees, or subcontractors. The Contractor shall assess its own
risks and if it deems appropriate and/or prudent, maintain higher limits and/or broader
coverages. The Contractor is not relieved of any liability or other obligations
assumed or pursuant to the Contract 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.
a. Coverage and Limits of Insurance. Contractor 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
4
Contract # 124.24 Revision: 2023.12.15 CDD
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 Contract (including defense costs assumed
under contract)
● 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)
● 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
5
Contract # 124.24 Revision: 2023.12.15 CDD
insured with respect to liability and defense of suits arising out of the activities
performed by, or on behalf of the Contractor, including completed operations”.
3) Auto Liability: Bodily injury and property damage for any owned,
hired and non-owned vehicles used in the performance of this Contract.
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
Contract 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/Contractor 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 Contractor 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 contractor’s insurance shall be primary and non-contributory
with any insurance or self-insurance purchased by the County.
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.
6
Contract # 124.24 Revision: 2023.12.15 CDD
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 Contractor.
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
Contract 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
Contract.
XIII. Exemptions and Preferences. All purchases of construction or building or any
other materials for this Contract 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 Contractor shall maintain comprehensive, complete and accurate
books, records, and documents concerning its performance relating to this Contract
for a period of three (3) years after final payment under the Contract 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 Contract and applicable law.
XV. Contract Made in Colorado. The parties agree that this Contract 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 Contract, the substantially prevailing party shall be entitled to its
costs and reasonable attorney’s fees.
XVII. Governmental Immunity. Contractor agrees and understands that Pitkin County is
relying on and does not waive, by any provision of this Contract, 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
in this Contract shall be construed or interpreted to require or provide for
indemnification of the Contractor by the County for any injury to any person or any
7
Contract # 124.24 Revision: 2023.12.15 CDD
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 Contract 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 Contract
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 Contract 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 Contract 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 Contract 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 Contract 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 prepaid 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:
Norma Avila
405 Castle Creek Rd Ste 103
Aspen , CO 81611
Email: norma.avila@pitkincounty.com
with copies to:
Pitkin County Attorney’s Office
530 E. Main St., Suite #301
Aspen, Colorado 81611
Email: Attorney@pitkincounty.com
To Contractor:
Aspen School District, The Cottage
235 High School Road
Aspen, CO 81611
Phone: (970) 925-3760
Email: lbixel@aspenk12.net
8
Contract # 124.24 Revision: 2023.12.15 CDD
IN WITNESS WHEREOF, the parties have executed this Contract as of the date first set out
herein above.
ASPEN SCHOOL District, The Cottage
Leslie Bixel, Director
________________________________________________
!#VENDOR SIGNATURE#!
Date
PITKIN COUNTY, COLORADO
RECOMMENDED FOR APPROVAL:
_________________________________________________
!#DEPARTMENT REPRESENTATIVE#! Date
9
May-23-2024
Human Services Director
Lindsay Maisch
Preschool Director
Leslie Bixel
May-23-2024
EXHIBIT A
Scope of Work
The Cottage, 235 High School Road,
Aspen, CO 81611
1. Intents and Purposes
Pitkin County Department of Human Services (PCDHS) will utilize allocated TANF funds to ensure
quality child care for Pitkin County children enrolled in the Aspen School District, The Cottage. This is a
near-by licensed child-care center and is one of two sources of quality summer child-care for Pitkin
County families. Aspen School District, The Cottage, provide diverse, educative, experiential, and
culturally expansive programming for Infants (8 weeks-18 months), Toddler (12 months-3 years), and
Preschool/Prek (2.5 years to entering Kindergarten).
TANF funds are intended to "Provide assistance to needy families so that children may be cared for in
their own homes or in the homes of relatives" (Purpose 1) and "Prevent and reduce the incidence of
out-of-wedlock pregnancies" (Purpose 3). Aspen School District, The Cottage, meets Purpose 1 by
allowing parents to engage in work activities while their children are well-cared for, and Purpose 3 as it
provides preventive and enrichment programs that address risk and protective factors for children and
teens that will reduce out-of-wedlock births. As such, TANF is the correct vehicle for addressing this need
for quality child-care in the summer months.
Protective factors addressed by the program include:
a. Self-regulation
b. Secure attachment
c. Mastery of communication and language skills
d. Ability to make friends and get along with others
e. Reliable support and discipline from caregivers
f. Protection from harm and fear
g. Opportunities to resolve conflict
h. Support for Early Learning
k. Regulatory systems that support high quality of care
I. Following rules for behavior
m. Good peer relationships
n. Language-based rather than physically based discipline
p. Positive partnering between program and family
q. Positive physical development
r. High self-esteem
s. Emotional self-regulation
t. Good coping skills and problem-solving skills
u. Engagement with new community members
v. Clear expectations for behavior and values
w. Positive norms
x. Physical and psychological safety
Developmental factors addressed by the program include:
a. Enhancement of fine and gross motor development
b. Enhancement of cognitive development
c. Enhancement of communication skills
d. Enhancement of Human and emotional development
Aspen School District, The Cottage employs one (1) full time, year-round and 10 summer seasonal staff
as follows. Staff requirements fully complies with all Colorado child care licensing requirements.
An affidavit provided by PCDHS is attached to the Aspen School District, The Cottage, enrollment
packet. As those affidavits are collected through the enrollment process, a quantitative analysis of
the percentage of TANF eligible families will be conducted and provided.
PCDHS will designate staff which will provide programmatic direction and partnership to Aspen
School District, The Cottage staff, connected to this project. The designated PCDHS staff will be
the principal contact between Aspen School District, The Cottage, PCDHS, the State of Colorado
Department of Human Services, and if necessary the Federal Government and will be primarily
responsible for oversight of project compliance with all TANF requirements for data collection,
storage, compilation, assessment, and reporting.
2. General Description of Work Performed by Aspen School District, The Cottage
Aspen School District, The Cottage, programs all center from the Aspen School District, The Cottage,
235 High School Road, Aspen, CO. Sign-in/sign-out is conducted at that site. Programming, snacks, and
activities are also provided at the Aspen School District, The Cottage. Programming/ Activities include
hiking, climbing, swimming, canoeing, arts and crafts, ropes course, field games, team building, archery.
All activities take place in the Aspen School District, The Cottage facility and the adjacent National
Forest.
The programs for Infants (8 weeks-18 months), Toddler (12 months-3 years), and Preschool/Prek
(2.5 years to entering Kindergarten) are run from 7:30 am - 4:00 pm, Tuesday through Friday (with a
3-day week, Monday- Wednesday, for the week of July 4th) , June 17th to August 2nd , 2024 Day
Camp is run in up to three (3) age-appropriate groups. Infant and Toddler max 8 children per day,
and preschool max is 16 children per day. Each group has a developmentally appropriate schedule of
activities.
Aspen School District, The Cottage will serve any TANF-eligible children. All activities are designed
with educative, interactive, kinesthetic, and human components.Outcomes from activities include
increased skills in all areas of development, self-esteem, expanding comfort zones, and education. These
skills allow children to receive high quality child care while parents and caregivers are working or
engaged in other work activity. All activities are offered for TANF eligible and non-TANF eligible
children.
Aspen School District, The Cottage, will maintain necessary staff to perform the following:
● Provide same, or greater level of Program services to TANF-eligible families as provided to
non-TANF-eligible residents
● Send a one-time itemized reimbursement request to PCDHS after the end of the last session
● Provide PCDHS with an end of program report
● Maintain accurate bookkeeping records.
3. Deliverables, Budget & Budget Narrative
The agreed service deliverables and budget caps for this agreement are described in Table 1 below. The
costs per month for individual line items in the above table may be modified, with approval of PCDHS.
Table 1:
Up to 10 slots for Pitkin County Youth per week: Up to $20,817
● Infant $80/day -3 slots
● Toddler $77/day -3 slots
● Preschool $75/day -4 slots
Reimbursement over contract period: Up to $20,817 for contract
period
Families are being asked to submit the Colorado Works Eligibility Affidavit with respect to their
income levels, along with their enrollment packet. All families with income under $75,000 per
year need assistance with child care costs..
4. Reporting Requirements
Reporting requirements of Aspen School District, The Cottage will be as follows:
● Provide wrap up report and statistics by the end of August to include:
○ Number of families in program
○ Number of children in program
○ Number of families determined TANF-eligible
Submit all invoices and reports to the designated PCDHS staff: (norma.avila@pitkincounty.com)
PCDHS will:
● Be available on an as needed basis regarding programmatic services coordination and direction
● work with Aspen School District, The Cottage, to provide affidavit finalize reporting parameters
and format, and ensure the services are provided as outlined
● Review and approve all invoices for payment. Pay Aspen School District, The Cottage, for the
agreed upon contracted services as stipulated in this agreement
● Monitor activities by conducting a site visit per session.
TANF/Colorado Works Affidavit of Eligibility
Pitkin County service/program is provided in partnership with Colorado Works/TANF funds. Participation requires certain broad eligibility requirements. Eligibility information collected will be used specifically and only for determining eligibility to receive services and/or participate in this program. Information is kept strictly confidential and will not affect the level of services provided to you. Thank you for your cooperation.
___________________________________________________________________________________________________________
Residency in the United States
Please Check Appropriate Choice Below
____ I am citizen of the United States, or
____ I am a Permanent Resident of the United States, or legally present in the United States
____ My Child/Children are citizens of the United States or lawfully present in the United States
____ None of the above
_________________________________________________________________________________________
Family Income:
___ Less than $75,000/year ___ Greater than $75,000/year
Family:
# of adult (18 and over) members in household ______ # of children (under age 18) ______________________ # of biological or legally adopted children (under age 18) who do not live in your house ___________________
County of Residence: ____________________________
AFFIDAVIT
I, ________________________________________, do hereby declare and represent the information provided above to be TRUE and
CORRECT to the best of my knowledge on this date signed below.
Signature: _____________________________________________ Date: _________________________
Exhibit B
Certificate Of Completion
Envelope Id: 07AA126C126D4E79AB1279BE500156EF Status: Completed
Subject: Aspen School District | Pitkin County Contract 124.24 for Review and Signature
Source Envelope:
Document Pages: 14 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: 69.170.199.165
Record Tracking
Status: Original
5/23/2024 11:09:25 AM
Holder: Pitkin County Procurement
Procurement@PitkinCounty.com
Location: DocuSign
Signer Events Signature Timestamp
Lindsay Maisch
Lindsay.Maisch@pitkincounty.com
Human Services Director
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 65.38.144.66
Sent: 5/23/2024 11:12:02 AM
Viewed: 5/23/2024 11:14:24 AM
Signed: 5/23/2024 11:14:40 AM
Electronic Record and Signature Disclosure:
Accepted: 4/4/2022 5:26:47 PM
ID: 7763213c-286f-4430-943b-eb745fb39f68
Company Name: Pitkin County, Colorado
Leslie Bixel
lbixel@aspenk12.net
Preschool Director
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 96.5.177.114
Sent: 5/23/2024 11:14:42 AM
Viewed: 5/23/2024 11:41:26 AM
Signed: 5/23/2024 11:42:04 AM
Electronic Record and Signature Disclosure:
Accepted: 5/23/2024 11:41:26 AM
ID: f3c36c35-16a9-4c33-ae2d-ec18833766b0
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: 5/23/2024 11:42:05 AM
Resent: 5/23/2024 11:42:09 AM
Carbon Copy Events Status Timestamp
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Accounts Payable
AP@pitkincounty.com
Accounts Payable
Pitkin County
Security Level: Email, Account Authentication
(None)
Sent: 5/23/2024 11:42:06 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Norma Avila
norma.avila@pitkincounty.com
Pitkin County
Security Level: Email, Account Authentication
(None)
Sent: 5/23/2024 11:42:06 AM
Viewed: 5/23/2024 11:43:16 AM
Electronic Record and Signature Disclosure:
Accepted: 1/3/2023 1:54:58 PM
ID: 66186d46-8e98-4b37-8211-03c302fcc473
Company Name: Pitkin County, Colorado
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 5/23/2024 11:12:02 AM
Certified Delivered Security Checked 5/23/2024 11:41:26 AM
Signing Complete Security Checked 5/23/2024 11:42:04 AM
Completed Security Checked 5/23/2024 11:42:07 AM
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: Lindsay Maisch, Leslie Bixel, Norma Avila
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.