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HomeMy WebLinkAboutbocc.con.080.258/30/2021 CDD Contract Information Contract Number Project Name Contractor Budget Line Item 11234342.559000.10082 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 Keli Kirkpatrick County Representative Phone (970) 429-2049 Provide a brief description of the Contract or Change Order: Contract Value Summary: $ 10,000.00 - - $ 10,000.00 Adult & Family Svcs Contract to provide individual therapeutic, psychiatric, and behavioral health services. Original Contract Amount Previous Change Order/Amendment Amount This Change order/Amendment amount Contract Total No Individual Therapeutic, Psychiatric, and Behavioral Health Services. Midvalley Family Practice $ 10,000.00 Additional Budget Line Item(s) (Please fully allocate New Contract Total) $ - $ - $ - $ 10,000.00 None Services/Maintenance 6/1/2025 5/31/2026 New Contract 080.25 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 # 080.25 Revision: 2023.12.15 CDD 1 PITKIN COUNTY CONTRACT FOR PROVISION OF SERVICES THIS CONTRACT, made June 1, 2025 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 Midvalley Family Practice, PO Box 25301, Belfast , ME 04915 (hereinafter called the “Contractor”) to perform the following work: Individual Therapeutic, Psychiatric, and Behavioral Health Services (“Project”). I. Term of Contract: The term of this Contract is from June 1, 2025 to May 31, 2026. II. Contractor’s Obligations. Contractor shall provide the Individual therapeutic, psychiatric, and behavioral health services described in the attached Contractor Scope of Work (“Attachment A”). 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 Ten Thousand dollars and Zero cents ($10,000.00) 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 and valid W9 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 W9 forms electronically by emailing pdf copies to AP@PitkinCounty.com with the County Project Contact listed within this Contract in copy. Contract # 080.25 Revision: 2023.12.15 CDD 2 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. Contractor shall have 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. Keli Kirkpatrick, Adult and Family Services Manager will manage the project as the County’s Representative. In the event that Keli Kirkpatrick is not available, an alternate representative will be designated who 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 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. Contract # 080.25 Revision: 2023.12.15 CDD 3 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, 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 Contract # 080.25 Revision: 2023.12.15 CDD 4 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 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 Contract # 080.25 Revision: 2023.12.15 CDD 5 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 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 $ Contract # 080.25 Revision: 2023.12.15 CDD 6 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. 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. Contract # 080.25 Revision: 2023.12.15 CDD 7 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 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 Contract # 080.25 Revision: 2023.12.15 CDD 8 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 pre-paid to the mailing addresses set forth below. Each party by notice sent under this paragraph may change the address to which future notices should be sent. Electronic delivery of notices shall be considered delivered upon receipt of confirmation of delivery on the part of the sender. Nothing contained herein shall be construed to preclude personal service of any notice in the manner prescribed for personal service of a summons or other legal process. To Pitkin County: Keli Kirkpatrick 0405 Castle Creek Road Aspen, CO 81611 Email: keli.kirkpatrick@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: Midvalley Family Practice PO Box 25301 Belfast , ME 04915 Phone: ( ) - Email: JRollins@mvfpsportsmed.com XX. Colorado Department of Human Services Contract Requirements. In addition to the requirements and obligations established herein, the Contractor agrees to abide by the requirements and obligations set forth in the attached Colorado Department of Human Services contract terms (“Attachment B”). Contract # 080.25 Revision: 2023.12.15 CDD 9 IN WITNESS WHEREOF, the parties have executed this Contract as of the date first set out herein above. MIDVALLEY FAMILY PRACTICE ________________________________________________ !#VENDOR SIGNATURE#! Date PITKIN COUNTY, COLORADO _________________________________________________ !#DEPARTMENT REPRESENTATIVE#! Date Pitkin County Adult and Family Services Manager Jun-11-2025 Keli Kirkpatrick Jun-18-2025 Director of Behavioral Health Jarid Rollins Pitkin County Adult and Family Services Core Services Program Scope of Service MidValley Family Practice Service Area: Pitkin County, Colorado Service Time Frame: June 1st, 2025 - May 31st, 2026 Pitkin County Adult and Family Services staff will refer individuals and families to MidValley Family Practice; as needed for Individual therapeutic, psychiatric, and behavioral health services. These services include: ●Individual Psychotherapy: $150/hour ●Group Psychotherapy: $50/hour ●Care Coordination: $25/hour ●Psychiatric Assessment: $350 for each assessment ●Medication Management: $200/hour and prorated ●Blood Work: $600 or less dependent on lab rates The above services will be compensated at an additional $25/hour for in-home service delivery, though in-home services are not required by the county. ●Case Management Services: $50/hour ○Documentation time (Monthly Summaries will be provided for all referred clients.) ○Participation in Treatment Team and Family Engagement Meetings 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; Attachment A 2.) Provide Monthly invoices by the 5th of each month; 3.) Provide Monthly client updates by the 5th of each month; 4.) Conduct self in professional and respectful manner with families and partners congruent with Pitkin County Mission (attached); 5.) Agree to and sign Confidentiality Statement (attached); Attachment A PURCHASE OF SERVICE CONTRACT EXAMPLE Core Services Program 1.THIS CONTRACT, made this ______day of__________, 20 bySelect from dropdown and between the ___________________ County Department of Human/Social Services at _____________________________(address), hereinafter called “County” and ______________________ (name) at _________________________________(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______________(population to be served) at _____________ (location service is to be provided). This service is described in Rule Manual Volume 7, Section 7.303.1 , and, if appropriate, the State-approved County CoreSelect from dropdown 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. Attachment B 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. 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. Attachment B 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 Original to Contractor Copy to the Case File Copy to County Bookkeeping Attachment B Certificate Of Completion Envelope Id: A43D2860-D3DF-40EC-BA7C-617097D99C56 Status: Completed Subject: Midvalley Family Practice | Pitkin County New Contract 080.25 for Review and Signature Source Envelope: Document Pages: 15 Signatures: 2 Envelope Originator: Certificate Pages: 5 Initials: 1 Pitkin County Procurement AutoNav: Enabled EnvelopeId Stamping: Disabled Time Zone: (UTC-07:00) Mountain Time (US & Canada) 530 East Main Street Suite 203 Aspen, CO 81611 Procurement@PitkinCounty.com IP Address: 65.38.144.66 Record Tracking Status: Original 6/11/2025 12:10:48 PM Holder: Pitkin County Procurement Procurement@PitkinCounty.com Location: DocuSign Signer Events Signature Timestamp Connie Baker connie.baker@pitkincounty.com Budget Director Pitkin County Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 65.38.144.66 Sent: 6/11/2025 12:14:05 PM Viewed: 6/11/2025 12:17:56 PM Signed: 6/11/2025 12:18:07 PM Electronic Record and Signature Disclosure: Not Offered via Docusign Keli Kirkpatrick keli.kirkpatrick@pitkincounty.com Pitkin County Adult and Family Services Manager Pitkin County Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 65.38.144.66 Sent: 6/11/2025 12:18:09 PM Viewed: 6/11/2025 1:11:48 PM Signed: 6/11/2025 1:11:56 PM Electronic Record and Signature Disclosure: Not Offered via Docusign Jarid Rollins jrollins@mvfpsportsmed.com Director of Behavioral Health Midvalley Family Practice Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 209.133.101.70 Sent: 6/11/2025 1:11:57 PM Resent: 6/17/2025 9:15:47 AM Viewed: 6/18/2025 8:26:34 AM Signed: 6/18/2025 8:27:30 AM Electronic Record and Signature Disclosure: Accepted: 6/18/2025 8:26:34 AM ID: cfc2a07b-ba13-4cae-8456-9fe4136f8f81 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: 6/18/2025 8:27:32 AM Resent: 6/18/2025 8:27:40 AM 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: 6/18/2025 8:27:33 AM Viewed: 6/18/2025 9:55:39 AM Electronic Record and Signature Disclosure: Not Offered via Docusign Brett Boehman brett.boehman@pitkincounty.com Caseworker Pitkin County Security Level: Email, Account Authentication (None) Sent: 6/18/2025 8:27:34 AM 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 6/11/2025 12:14:05 PM Certified Delivered Security Checked 6/18/2025 8:26:34 AM Signing Complete Security Checked 6/18/2025 8:27:30 AM Completed Security Checked 6/18/2025 8:27:34 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. 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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: Jarid Rollins 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.