HomeMy WebLinkAboutbocc.con.071.252025.05.08 CDD
Contract Number
Project Name
Contractor
Budget Line Item 11234342.531000 !#BUDG $ 20,000.00
$ -
$ -
$ -
$ 20,000.00
Procurement Method:
Form:
Contract Effective 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:
Project Lead:Keli Kirkpatrick Phone:(970) 429-2049
Provide a brief description of the Contract or Change Order:
Contract Value Summary:
$ 20,000.00
$ -
$ -
$ 20,000.00
071.25
Pitkin County
Procurement Cover Sheet
Cover Sheets are to be included with the contract record to provide an accurate summary of the Contract type,
amounts, budget(s), and dates.
Contract Information
No
Medicaid Program Capability Assessment and Implementation
Left Hand Management
Additional Budget Line
Item(s)
(Please fully allocate Contract Total if multiple
lines apply)
Sole Source
Services/Maintenance
5/14/2025
5/14/2026
New Contract
Adult & Family Svcs
Contract to evaluate and support the capability of Pitkin County Human Services to effectively implement and
operationalize a Medicaid program.
Original Contract Amount
Previous Change Order/Amendment Amount
This Change order/Amendment amount
Contract Total
Rev 2023.12.15 CDD
1
PITKIN COUNTY
SOLE SOURCE PROCUREMENT
JUSTIFICATION REQUEST
TO: County Manager
DATE: May 6, 2025
FROM: Keli Kirkpatrick, Manager Adult and Family Services Proposed Contractor: Left Hand Management Product/Service: Medicaid Program Capability Assessment
Estimated expenditure for the above Product/Service: $ 20,000.00
This form is required in documenting a Sole Source exception from an otherwise competitive bidding process when sufficient competition does not exist, a single vendor represents a clear and best value to Pitkin County,
or other factors are present that preclude other vendors from being able to provide the product(s), service(s),
and/or construction. This purchase is clearly and legitimately limited to a Single or Sole Source. (Examples: original manufacturer, no regional distributor, standardization etc): Explain:
Enrolling with Medicaid, operationalizing Medicaid requirements and integrating those services with
existing services in Pitkin County is a task that requires specific knowledge about the Behavioral Health
Administration and the Colorado Department of Human Services. Left Hand Management will
collaborate with the Human Services team to assess and conceptualize a potential program model and
offer guidance around compliance and braided funding issues. Lefthand will complete individual
Medicaid enrollments as needed for the licensed providers on staff, Complete organizational enrollment
through the Department of Health Care Policy and Financing and relevant Regional Accountability
Entities. They offer training in groups or individually to leaders and staffers within the department as well
as ongoing support. Left Hand Management is able to provide ongoing billing services at a reasonable
rate.
Pitkin County Adult and Family Services contacted two other vendors, neither of which were local to
Colorado. Left Hand Management is the only vendor available to provide the specialized knowledge
needed, within a reasonable price. They are also the only organization offering ongoing billing support if
the department becomes a Medicaid eligible site. For those reasons, Left Hand Management will be the
sole source provider for this contract.
Rev 2023.12.15 CDD
2
The undersigned requests that Pitkin County waive other procurement requirements and recognize this transaction as a sole source exception to the Pitkin County Procurement Code. Department Representative Department Director
!#COUNTY REPRESENTATIVE#! Date !#SECTION LEADER#! Date
County Manager Reason for Denial:
________________________________________ !#COUNTY MANAGER SOLE#! Date
Keli Kirkpatrick
May-22-2025
Pitkin County Adult and Family Services Manager
May-22-2025
Human Services Director
Lindsay Maisch
Deputy County Manager
Kara
May-23-2025
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
1
PITKIN COUNTY CONTRACT FOR PROVISION OF SERVICES
THIS CONTRACT, made May 14, 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 Left Hand Management, 88 Inverness Circle East Suite D-103, Englewood, CO
80112 (hereinafter called the “Contractor”) to perform the following work: Medicaid Program
Capability Assessment and Implementation (“Project”).
I. Term of Contract: The term of this Contract is from May 14, 2025 to May 14, 2026.
II. Contractor’s Obligations. Contractor shall provide the Medicaid Program Capability
assessment as described in the attached 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
Twenty Thousand dollars and Zero cents ($20,000.00) 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 # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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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 & Family Services Manager will
manage the project as the County’s Representative. In the event that Keli Kirkpatrick
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 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 # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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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 # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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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.
C. Accessibility Indemnification
Contractor shall indemnify, save, and hold harmless the Indemnified Parties,
against any and all costs, expenses, claims, damages, liabilities, court awards and
other amounts (including attorneys’ fees and related costs) incurred by any of the
Indemnified Parties in relation to Contractor’s failure to comply with §§24-85-
101, et seq., C.R.S., or the Accessibility Standards for Individuals with a
Disability as established by OIT pursuant to Section §24-85-103 (2.5), C.R.S.
XII. Accessibility.
i. Contractor shall comply with and the Work Product provided under this Contract
shall be in compliance with all applicable provisions of §§24-85-101, et seq., C.R.S.,
and the Accessibility Standards for Individuals with a Disability, as established by
OIT pursuant to Section §24-85-103 (2.5), C.R.S. Contractor shall also comply with
all State of Colorado technology standards related to technology accessibility and
with Level AA of the most current version of the Web Content Accessibility
Guidelines (WCAG), incorporated in the State of Colorado technology standards.
The State may require Contractor’s compliance to the State’s Accessibility Standards
to be determined by a third party selected by the State to attest to Contractor’s Work
Product and software is in compliance with §§24-85-101, et seq., C.R.S., and the
Accessibility Standards for Individuals with a Disability as established by OIT
pursuant to Section §24-85-103 (2.5), C.R.S.
XIII. 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
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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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
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
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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• 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 $
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
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
7
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.
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.
XIV. 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.
XV. 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.
XVI. 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.
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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XVII. 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.
XVIII. 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.
XIX. 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.
XX. 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.
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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To Pitkin County: Keli Kirkpatrick 0405 Castle Creek Rd
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: Left Hand Management
88 Inverness Circle East Suite D-103
Englewood, CO 80112 Phone: (303) 637-9000 Email: Stephanie@lefthandmgmt.com
Contract # 071.25 Revision: 2024.10.08 iso8601 CDD iso 8601
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IN WITNESS WHEREOF, the parties have executed this Contract as of the date first set out
herein above.
LEFT HAND MANAGEMENT
________________________________________________ !#VENDOR SIGNATURE#! Date
PITKIN COUNTY, COLORADO RECOMMENDED FOR APPROVAL:
_________________________________________________
!#DEPARTMENT REPRESENTATIVE#! Date
May-22-2025
May-23-2025
Scope of Work: Medicaid Program Capability Assessment
Objective: Evaluate and support the capability of Pitkin County Human Services (PCHS) to
effectively implement and operationalize a Medicaid program. If it is recommended for PCHS to
utilize Medicaid as an enhancement to current services, the applicant will assist in the full
implementation, and potential ongoing services needed to sustain this option.
Services:
1.Program Conceptualization and Integration:
○Collaborate to conceptualize a Medicaid program model.
○Offer compliance guidance and address braided funding issues.
○Include a clear communication, staff engagement, and phased implementation
plan.
2.Provider and Organizational Enrollments:
○Facilitate individual Medicaid enrollments for licensed providers.
○Complete organizational Medicaid enrollments, including Type 2 NPI registration,
HCPF applications, and RAE affiliations.
3.Training and Capacity Building:
○Provide individual or group training on:
■Scope of practice and credentialing.
■Service codes, clinical documentation, and electronic medical record
(EMR) systems.
■Billing and braided funding practices.
4.Billing and Revenue Management:
○Set up and maintain billing processes, including EFT/ERA setup, claims
submission, payment reconciliation, and eligibility verification.
Deliverables:
●Assessment and recommendations for a Medicaid program.
●Comprehensive Medicaid enrollment for providers and organizations.
●Structured workflows and financial modeling for program implementation.
●Tailored training sessions and ongoing support.
●Optimized billing system setup and management.
Attachment A
Timeline:
● By December, 2025 recommendations and potential implementation to begin.
Pricing:
● Any bids will be reviewed
This scope ensures a structured and supported approach to implementing and sustaining a
Medicaid program, tailored to the organization's needs and compliance requirements.
Attachment A
Certificate Of Completion
Envelope Id: 1897F019-6DF4-4544-8958-8C914357AE47 Status: Completed
Subject: Left Hand Management| Pitkin County Contract 071.25 for Review and Signature
Source Envelope:
Document Pages: 15 Signatures: 5 Envelope Originator:
Certificate Pages: 6 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
5/15/2025 1:53:40 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: 5/15/2025 1:58:46 PM
Viewed: 5/15/2025 2:04:00 PM
Signed: 5/15/2025 2:06:06 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: 5/15/2025 2:06:07 PM
Viewed: 5/22/2025 9:43:39 AM
Signed: 5/22/2025 9:44:12 AM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
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: 5/22/2025 9:44:14 AM
Viewed: 5/22/2025 9:46:42 AM
Signed: 5/22/2025 9:47:54 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
Kara
kara.silbernagel@pitkincounty.com
Deputy County Manager
Pitkin County Colorado
Security Level: Email, Account Authentication
(None)
Signature Adoption: Drawn on Device
Using IP Address: 73.203.8.247
Sent: 5/22/2025 9:54:37 AM
Viewed: 5/23/2025 10:14:36 AM
Signed: 5/23/2025 10:15:28 AM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Signer Events Signature Timestamp
Stephanie Farrell
Stephanie@lefthandmgmt.com
CEO/Chief Consultant
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 96.84.240.58
Sent: 5/23/2025 10:15:30 AM
Viewed: 5/23/2025 10:16:15 AM
Signed: 5/23/2025 10:16:24 AM
Electronic Record and Signature Disclosure:
Accepted: 5/23/2025 10:16:15 AM
ID: 9216bd53-8c80-4344-a179-dd7f93eeeb5a
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
Jon Peacock
jon.peacock@pitkincounty.com
Rich Englehart
rich.englehart@pitkincounty.com
Kara Silbernagel
kara.silbernagel@pitkincounty.com
Deputy County Manager
Pitkin County Colorado
Signing Group: County Manager Group
Security Level: Email, Account Authentication
(None)
Sent: 5/22/2025 9:54:39 AM
Viewed: 5/27/2025 10:15:17 AM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Pitkin County Procurement
procurement@pitkincounty.com
Procurement Specialist
Pitkin County
Security Level: Email, Account Authentication
(None)
Sent: 5/23/2025 10:16:26 AM
Resent: 5/23/2025 10:16:32 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: 5/23/2025 10:16:26 AM
Viewed: 5/23/2025 11:33:21 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 5/15/2025 1:58:46 PM
Envelope Updated Security Checked 5/15/2025 2:02:02 PM
Envelope Updated Security Checked 5/15/2025 2:02:02 PM
Envelope Updated Security Checked 5/15/2025 2:02:02 PM
Certified Delivered Security Checked 5/23/2025 10:16:15 AM
Signing Complete Security Checked 5/23/2025 10:16:24 AM
Completed Security Checked 5/23/2025 10:16:26 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, Stephanie Farrell
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.