HomeMy WebLinkAboutbocc.con.002.2007
CLERK'S CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR
SCANNING/ARCHIVING
CONTRACT #: 002-2007
Originating Department/Division: Social Services
Contact Person: Nan Sundeen
Project Name: Social Services Consultant
o BOCC AGENDA ITEM
(BOeC signature required)
Phone #: 5209
r:gJSTAFF AUTHORIZED SIGNATURE
(per Revised Procurement Code 7/2005)
Check procurement type:
r:gJNone OInformal OFormal OSole Source OEmergency OState Bid 0
Check Contract Tvpe:
Dollar Amonnt: 16,000
r:gJ Services/Maintenance
OLicense/Use
OLease
OConstruction
OGoods, Equipment, Supplies
OOther (e.g. revenue)
Contractor/Business
Contract Execution
Automatic Renewal
Kate Jangula
01-12-07
N
Budget Line Item/Ledger Number 112.4300000.82000
OEmployment (for county employees)
OIntergovernmental Agreement (Requires BOCC Action)
ONon-Profit
OQuasi -Public
OGrant Agreements (Requires BOCC Action)
OChange Order/Contract Amendment
Complete Name: Kate Jangula
Contract End Date: 08-12-07
Term of Contract: 7 mos
All Contracts should be proofed for the following:
r:gJNo Pages Missing
r:gJIf a Page is Left Intentionally Blank -Note on Page
r:gJPage numbered consecutively
r:gJAll Signatures Affixed
r:gJAll Dates Filled In
r:gJAll Other Blanks Filled In
r:gJAll Exhibits Attached
r:gJAll Legal Descriptions Attached (if appropriate)
r:gJNotice of Award/Proceed Attached (if appropriate)
r:gJSpecial Instructions for Finance Department:
[g]Sent to Clerk and Recorder for Scanning/Archiving
[g]Authorized Staff Person' s Name: Nan Sundeen
BY CHECKING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF
PERSON INDICATES THAT DOCUMENT HAS BEEN PROOFED AND READY
FOR SCANNING.
Note: Clerk's Office will keep original documents in compliance with Colorado State
Archives retainage schedule.
Amended 10_16_06
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CONTRACT FOR PROVISION OF SERVICES
Contract # 002-2007
Budget Line Item # 112.43 00000.82000
Rev8/28/06dq
THIS CONTRACT is made and entered by and between the Pitkin County Board of
County Commissioners ("County") and Kate Jangula 40] Dcvon Court, Basalt, CO 81621
(hereinafter "Contractor").
1. Term. The term of this contract is from _January 12, 2()07 to _August 12,2007
2. Contractor's Obligations. Contractor shall:
A. Provide approximately 1-2 hours weekly (as needed) of supervision to Social
Services Caseworker. This may be done by phone or in person. It will include
verbal consultation caseworker questions on protocol, case review, resource
review and management, regulation compliance, etc) and review of court
documents and assessments (to ensure compliance with state regulations) as
requested.
B. Weekly meetings (2 hours/week, or as needed) with Human Services Director
and/or other Human Services staff to provide on-going training on
administrative responsibilities, budgeting and compliance with state
regulations and expectations. The goal is to help us get through the 2008 state
budget process while teaching us how to do it!
C. Specific projects as determined including assisting with the development of a
three-year CORE plan and/or other projects/contracts that need to be executed.
D. By signing this agreement Contractor agrees to treat all client information as
confidential according to applicable statutes in the Colorado Children's Code
including but not limited to names and addresses, social and economic
conditions or circumstances, agency evaluation and/or medical, psychological,
or social evaluation including diagnosis or past history of disease or disability.
3. 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 2. It is expressly understood and agreed that in no event will the total compensation and
reimbursement to be paid hereunder exceed the sum of $16,000 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 at $80/hour, with payment expected within thirty (30) days of invoice, but any
payment by the County may be offset by any amount the Contractor owes the County for any reason.
4. Countv'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
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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.
5. Pitkin Countv's Obligations. Pitkin County shall administer this contract through
a County Representative. Nan Sundeen will manage the project as the County's Representative.
In the event that Nan Sundeen is not available, (Tom Jagow) 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.
6. 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. Not withstanding 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.
7. 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 her 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 confoml to all applicable
industry standard of care, skill and diligence in the performance of Contractor's obligations under
this contract.
D. Contractors role is that of consultant. Contractor shall not attempt to
oversee or supervise the work performance or actions of any Pitkin County employee, servant or
agent in the course of completing work under this contract.
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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.
8. 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.
9. Binding Arbitration. Any disputes arising out ofthis contract shall be subject to
binding arbitration. The parties agree that any disputes concerning the terms and conditions of this
contract shall be submitted and finally settled by arbitration. Arbitration shall be conducted
pursuant to the rules of the American Arbitration Association and shall be presided over by the
Pitkin County Hearing Officer appointed to arbitrate Pitkin County contract disputes. Costs ofthe
arbitration shall be awarded to the substantially prevailing party.
10. 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
1 1. 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.
12. Indemnity.
A. The Contractor (including, by definition here and hereinafter, its officials,
employees, agents and representatives, subcontractors and suppliers), shall and hereby does release,
discharge, indemnifY and hold harmless the County of Pitkin and its officials, employees, agents
and representatives from and against liability for any claim, demand, loss, damages, penalty, judg-
ment, expenses, costs (including costs of investigation and defense), fees (including reasonable
attorney and expert witness fees) or compensation in any form or kind whatsoever for any bodily
injury, death, personal injury or property damage arising out of or in connection with any negligent
act, intentional act, error or omission by the Contractor, and for any consequential liability alleged
to accrue against the County on account of the Contractor's acts, errors or .omissions; provided,
however, that such indemnity shall not be construed as an indemnity for bodily injury or property
damage arising from the sole negligence of the County or its employees.
B. The Contractor further shall investigate, process, respond to, adjust, provide
defense for and defend, payor settle all claims, demands, or lawsuits related hereto at its sole
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expense and shall bear all other costs and expenses related thereto, even if the claim, demand or
lawsuit is groundless, false or fraudulent.
13. Insurance.
A. In whole or in part, the Contractor shall secure and maintain for the term of its
contractual relationship with the County such insurance policies, from companies licensed in the
State of Colorado, as will protect itself, the County and others as specified from claims for bodily
injuries, death, personal injury or property damage, which may arise out of or result from the
Contractor's acts, errors or omissions. The following insurance coverage, at or above the limits
indicated and including such endorsements as are indicated by an "X", are required:
1. Statutory Workers' Compensation: Colorado statutory minimums
2. Commercial General Liability - ISO 1998 Form or equivalent
(With County named additional insured)
Each Occurrence Limit
3.
4.
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General Aggregate Limit
Products/Completed Operations Aggregate Limit
$1.000.000.00
$2,000,000.00
$2.000.000.00
Comprehensive Form (All risks) to include (place X by applicabie
provisiom):
l Premises/Operations
Underground, Explosion & Collapse Hazard
Products/Completed Operations
Contractual Liability
Independent Contractors and Subcontractors
Broad Form Property Damage
Personal Injury
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Business Auto Coverage:
Combined Single Limit Liability (each accident) $1.000.000.00
Including all owned. non-owned, and hired vehicles.
Special Coverages (check as appropriate and insert amount):
(1 ) Performance Bond
Labor and Material
Payment Bond
(2) Professional Errors and Omissions
(3) Aircraft Liability
(4) Owner's Protective
(5) Builder's Risk
(6) Boiler and Machinery
(7) Loss of Use Insurance
(8) Pollution Liability
(9) Crime, including Employee Dishonesty Coverage, or Fidelity Bond
j
B. Proof of Insurance:
1. To provide evidence of the required insurance coverage, copies of
Certificates of Insurance in a form acceptable to the County shall be filed with the County through
the representative identified in Paragraph 5, no later than ten (10) calendar days prior to com-
mencement of operations affecting the County. Failure to file or maintain acceptable Certificates
of Insurance with the County is agreed to be a material breach of any contract. These Certificates
of Insurance shall contain a provision that coverage afforded under the policies will not be
canceled or materially altered unless at least thirty (30) calendar days prior written notice by
certified mail, return receipt requested (effective upon proper mailing), has been sent to the
Procurement Officer. (For purposes of this provision, "materially altered" shall mean a change
affecting the coverage's required herein, including a change to policy limits as set out in the then-
current policy declarations page).
Simultaneously with the Certificates of Insurance, the Contractor shall
file with the Procurement Officer 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.
following clauses:
2. In addition, these Certificates of Insurance shall contain the
a. The clause "other insurance provisions," in a policy in which the
County of Pitkin holds a Certificate, shall not apply to the County of Pitkin.
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 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 ofthis 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.
14. Exemptions. All purchases of construction, 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.
15. 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,
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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.
16. 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.
17. Attorney's Fees. In the event that legal action is necessary to enforce any of the
provisions of this contract beyond the arbitration described in Paragraph 9, the substantially
prevailing party shall be entitled to its costs and reasonable attorney's fees.
18. 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 $150,000.00 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.
19. 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.
20. Notice. Any written notice required by this contract shall be deemed delivered
through any of the following: (1) hand delivery to the person at the address below; (2) delivery by
facsimile with confirmation of receipt to the fax number below; or (3) within three (3) days of
being sent certified first class mail, postage prepaid, return receipt requested addressed as
follows:
A.
To Pitkin County
Nan Sundeen
530 East Main Strcet
Aspen, CO 81611
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with copies to:
Pitkin County Attorney's Office
530 E. Main Street, #302
Aspen, Colorado 81611
B. To Contractor:
Kate Jangula
401 Devon Court
Basalt, CO 81621
21. Compliance with House Bill 06-1343.
A. In compliance with House Bill 06-1343, amending Title 8 ofthe Colorado
Revised Statutes by the addition of Article 17.5, Illegal Aliens-Public Contract for Services,
enacted by the General Assembly of the State of Colorado, the Contractor shall not:
1. Knowingly employ or contract with an illegal alien to perform work under
this contract or;
2. Enter into a contract with a subcontractor that fails to certify to the
Contractor that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this contract.
B. In compliance with House Bill 06-1343 enacted by the General Assembly of the State of
Colorado:
1. The Contractor shall verifY or attempt to verify through participation in the
Basic Pilot Program [created in Public Law 208, 104th Congress, as amended and
expanded in Public Law 156, 10Sth Congress, as amended, that is administered by the
United States Department of Homeland Security] that the Contractor does not employ any
illegal aliens and, if the Contractor is not accepted into the Basic Pilot Program prior to
entering into this contract, the Contractor shall apply to participate in the Basic Pilot
Program every three months until the Contractor is accepted or this contract has been
completed, whichever is earlier. This provision shall not be required or effective ifthe
Basic Pilot Program is discontinued.
2. The Contractor shall be prohibited from using Basic Pilot Program
procedures to undertake pre-employment screening of job applicants while this contract is
being performed.
3. If the Contractor obtains actual knowledge that a subcontractor performing
work under this contract knowingly employs or contracts with an illegal alien, the
Contractor shall be required to:
a. Notify the subcontractor and the County within three days that the
Contractor has actual knowledge that the subcontractor is employing or
contracting with an illegal alien; and
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b. Terminate the subcontract with the subcontractor if within three
days of receiving the notice required pursuant to subparagraph (a) of this
paragraph (3) the subcontractor does not stop employing or contracting with the
illegal aliens; except that the Contractor shall not terminate the contract with the
subcontractor if during such three days the subcontractor provides information to
establish that the subcontractor has not knowingly employed or contracted with an
illegal alien.
4. The Contractor shall comply with any reasonable request by the Department
of Labor and Employment made in the course of an investigation that the Department of
Labor and Employment is undertaking pursuant to the authority established in Subsection
(5) ofC.R.S. 9 8-17.5-102.
IN WITNESS WHEREOF, the parties have executed this contract as ofthe date first set out
herein above.
CONTRACT
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By:
Title CJJif'J?J.-CfA
PITKIN COUNTY:
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Date
By:
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Nan Sundeen
11
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Print on letterhead
Date:
NOTICE OF AWARD
(OPTIONAL)
TO:
The Owner, having duly considered the Proposal submitted on , for the work covered by the
Contract Document titled in the amount of
, and it appearing that the Price and other information in your Proposal Form is fair,
equitable and to the best interest of the Owner, the offer in your Proposal Form is hereby accepted.
In accordance with the terms of the Contract Documents, you are required to execute the Agreement in
one (1) copy within ten (10) consecutive days from and including the date of this Notice of Award.
In addition you are required to furnish in the said time Certificates ofInsurance evidencing compliance
with the requirement for insurance as stated in the Contract Documents to Procurement ofJicer, address,
l~iX.
PITKIN COUNTY
By:
Procw'crnent Officer
~==~==~~==~==~===~======~=ACCEPT ANCE OF NOTICE~~==~==~~==~==~~==~===~==~
Receipt ofthe above Notice of Award is hereby acknowledged
Bv
this _ day of
,2007.
Title
12
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Print on letterhead
Date:
NOTICE OF AWARD
(OPTIONAL)
TO:
The Owner, having duly considered the Proposal submitted on , for the work covered by the
Contract Document titled in the amount of
, and it appearing that the Price and other information in your Proposal Form is fair,
equitable and to the best interest of the Owner, the offer in your Proposal Form is hereby accepted.
In accordance with the terms of the Contract Documents, you are required to execute the Al,'Teement in
one (1) copy within ten (10) consecutive days from and including the date ofthis Notice of Award.
In addition you are required to furnish in the said time Certificates of Insurance evidencing compliance
with the requirement for insurance as stated in the Contract Documents to Procurement oftlcer, address,
fax.
PITKIN COUNTY
By:
Procurement Officer
=~=~===============~=====ACCEPT ANCE OF NOTICE=========~========~=~===~=
Receipt of the above Notice of Award is hereby acknowledged
Bv
this _ day of
,2007.
Title
12
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M:/county/procurement/ $10,000 to $49,999/contract_services
SERVICES - such as: Goats, striping, weed spraying, tree trimming, landscaping, consulting, mailing,
internet services, haulers, testing, professional services, processing, routine services.
Policv: For purchases costing from $10,000 to less than $50,000, the County does not require formal
requests for proposals but does require written contracts.
Purpose: The formality of a written contract is required at this level due to increased risks associated
with purchases of this amount. The procurement procedures allow for some competition without
requiring formal requests for proposals.
CH}:CKLIST:
~ Obtain budget and approval for project/purchase; determine budget line item number
VObtain contract number from clerk's office
~etermine scope of work and criteria for selection (this will assure all proposers will receive the
same information)
JDetermine selection method and begin completion of required forms (on m:lcounty/procurement/other
procurement):
. informal procurement;
. outside agencv bid;
. emergency;
_For informal procurement, proceed with soliciting informal proposals, with documentation (memo attached).
~ Select and notify proposer and complete necessary forms
. For new service providers or providers who use a social security number for taxpayer
identification, Finance will need a completed W-9 before any invoice will be paid.
(m:/ county/procurement/forms)
. Work Comp waiver form, when needed (m:/county/procurement/forms). See Risk Management
Narrative under m:/county/procurement/forms.
. Complete the form for method of procurement (informal, sole source, emergency, outside agency).
~Prepare written contract (including sequential page numbers) and include scope of work
(m;/county/procurement/standard contracts/contract for services), provide to selected proposer for
signature.
_Notify other proposers of selection (by telephone or Sorry letter under :/county/procurement/forms)
_Contract with required signatures and insurance are received back from the proposer and routed to
the necessary internal staff for signature
>- if the project is over budget or the scope changes significantly - MOl will need to go to the BOCC
for approval before contract is signed
Y if using the standard contract forms without any changes there is no need for Risk or Attorney
signature. If anything non-standard is in the contract you must add Risk and Attorney to signature
\. J page of contract.
~The fully executed original contract with all attachments must be sent to Clerk's Office (Jeanette
Jones) for scannmg; complete Clerk's Checklist and attach to contract.
(m:/ county/procurement/forms)
_All Contract Amendments must be sent to the Clerk's office for scanning, with the original contract
number and a letter identifying the amendment..
_Final service received (Do not authorize final payment until you are satisfied that the contract has
been fully and satisfactorily completed.)
_Final invoice received, approved by procurement officer, and paid by Finance.
.
sole source; or
other exception (see Section 1-102(3) of the Procurement Code).
.
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Foem W-9
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev. January 2005)
D"paliment 01 the Treasury
Internal Revenue Service
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Name (as shown on your income tax return)
KATHLEEN M. JANGULA
Business name, if different from above
IVl Individual!
Check appropriate box: iK.J Sole proprietor
Address (number, street, and apt. or suite no.)
401 Devon Court
City, state, and ZIP code
Basalt, CO 81621
List account number(s) here (optional)
o Corporation
Taxpayer Identification Number (TIN)
O 0 0 Exempt from backup
Partnership Other II>- withholding
Requester's name and address (optional)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number
to enter.
Certification
Under penalties of perjury, I certify that;
1. The number shown on this form is my correct taxpayer identification number (or r am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than irjterest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. {See the instruct~ns on page 4~ '
Sign
Here
Signature of - .:,//1f"j-t-','
U.S. person ...-- '. '.-x.:\/
Date ...
Purpose of Form l
A person who is required to file an information return ~ith"the
IRS, must obtain your correct taxpayer identification ri~er
(TIN) to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA
U.S. person. Use Form W-9 only jf you are a U.S. person
(including a resident alien), to provide your correct TIN to the
person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding,
or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
For federal tax purposes you are considered a person if you
are:
. An individual who is a citizen or resident of the United
States,
. A partnership, corporation, company, or association
created or organized in the United States or under the laws
of the United States, or
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Cat. No.
. Any estate (other than a foreign estate) Or trust. See
Regulations sections 301.7701-6{a) and 7(a) for additional
information.
Foreign person. If you are a foreign person, do not use
Form W-9. Instead, use the appropriate Form W-8 (see
Publication 515, Withholding of Tax on Nonresident Aliens
and Foreign Entities).
Nonresident alien who becomes a resident alien.
Generally, only a nonresident alien individual may use the
terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties contain a
provision known as a "saving clause." Exceptions specified
in the saving clause may permit an exemption from tax to
continue for certain types of income even after the recipient
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an
exception contained in the saving clause of a tax treaty to
claim an exemption from U.S. tax on certain types of income,
you must attach a statement to Form W-9 that specifies the
following five items:
1. The treaty country. Generally, ttlis must be the same
treaty under which you claimed exemption from tax as a
nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
10231X Form W-9 (Rev. 1-2005)
\J
INFORMAL PROCUREMENT
MEMORANDUM*
TO:
File
FROM:
Nancy Sundeen
RE:
$10,000 to under $50,000 project/purchase selection form
Social Services Consultant
DATE:
Description of Proj ectlPurchase (It is recommended that the specific scope of work be included in this
memorandum prior to soliciting the bids to assure that each proposer is given the same information):
Budget:
Line item #:
Contractors Contacted: (who and how) Kate Jangulal Sole Source (see attachment)
Proposals Received: (amounts, timelines, and references)
Firms chosen: (who and why)
(\ f\ S v lo\.A 0 o_~
Authorized Signer
M:lcountylprocurement/other procurement/informal bid memo
* For sole source, emergency procurement or outside agency bid, use designatedforms on the
m/drive under "Other procuremenl" instead of this form.
2
\y
L'l
MEMORANDUM
TO:
File
FROM:
Nan Sundcen
RE:
Social Serviccs Consultant - SOLE SOURCE
DATE:
January 12,2007
SOLE SOURCE PROCUREMENT
A contract may be awarded for a property, service, or construction item without competition
when the authorized procurement officer and the County Manager or his/her designee determine in
writing that there is only one acceptable source for the required property, service, or construction
item. The County Manager's approval must be obtained in advance of any sole source
project/purchase. Pitkin County Procurement Code Section 3-104.
Description ofProjectlPurchase: Social Services Consultant
Budget: $16,000
Budget line item #: 112.43 00000.82000
Reason for Sole Source:
Ms. Jangula has 23 years of experience as the Pitkin County Director of Social Services.
Her intimate knowledge and experience managing Pitkin's interest with the State department of
Human Services make her a unique and sole source for training the acting Director of Social
Services. In addition, there is a need to have a certified Child Welfare Supervisor oversee Lisa
Griggs. Ms. Jangula holds all the appropriate certificates to qualify her for this role.
Contractor Contacted: Kate Jangula, 401 Devon Court, Basalt - Contact in person before the
conclusion of her employment with Pitkin County.
l\llA (...L1 ,"---(,;. ; \A & 0 0 v'\
Authorized Sign\ture
I!
fll/fi, , <fit .J I~/
County M~nager
\)
c'
Note: When a contract is obtained, complete the Clerk's check list.
3
1-5
CERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ^
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Madison, Wisconsin 53783-0001
Insured's Name and Address Agent's Name, Address and Phone Number (Agt./Dist.)
Kathleen Jangula Cindy Kenney (970) 927-6596
401 Devon Court 207 Basalt Center Circle Ste 103
Basalt, CO 81621 PO Box 3950
Basalt, CO 81621 (164!307)
This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
This certificate does not amend, extend or alter the coverage afforded by the policies listed below.
COVERAGES
This is to certify That policies of insurance listed below have Deen issued to the insuretl named above for the policy period indicated, notwithstanding any requirement. term or condition of any contract or other
document with respect to which this certificate may be issued or may pertain. the insurance afforded by (he policies describetl herein Is subject to all the terms, exclusions, and conditions of such policies.
TYPE OF INSURANCE POLICY NUMBER EFFECnvE ExPIRATION LIMITS OF LIABILITY
Mo. Da Yr Mo, Da . Yr
Bodily Injury and Property Damage
Homeowners) $
000
Mobilehomeowners Liability Eacn occurrence
,
Bodily Injury and Property Damage
Boatowners Liability $
000
,
Each Occurrence
Bodily Injury antl Property Damage
Personal Umbrella Liability g
000
h
,
Occurrence
Eac
Farm Liability & Personal Liability
FarmlRanch Liability Eacn occurrence $ ,000
Farm Employer's Liability
Each Occurrence $ 000
statumry ..+x..+.«,.~•
Workers Compensation and
lo
e
s Liabilit
Em
t EacnAccment $ ,000
y
y
p
r Disease-Each Employee $ ,000
Disease Polwy Limit $ ~QC)~
General Aggregate $ ,000
General Liability 00
$
^ Commercial General ,0
Products -Completed Operations Ag regale
Liability (occurrence) Personal andAdven~sin Inu $ 000
^ Each Occurzerrce $ ,gl)~
^ Dama a to Premises Rented to You $ Oil)
Medical Expense (Any One Person) $ 000
Each Oaurrencet t $ 2,000 ,000
Businessowners Liability PENDING 1/16/2007 1/1612008 4ggregatetl• $ 2,000 ,000
Common Cause Limit $ ,~~~
liquor Liability Aggregate Limit ~ ~~~~
Automobile Liability eoaay Inlury. Eacn Person $ ,000
^ Any Auto
^ All Owned Autos
Bodily Injury-Each Accident $ ,QQg
^ Scheduled Autos Property Damage $ ,000
^ Hired Auto
^ Nonowned Autos
Bodily Injury and Property Damage Combined $
000
^ ,
Excess Liability
^ Commercial Blanket Excess Each OmunencalAggregate $ ,~~~
Other (Miscellaneous Coveraaesl
DESCRIPTION OFOPERATIONS / LOCATIONS I VEHICLES /RESTRICTIONS /SPECIAL ITEMS t The indrvldual or partners shown as insuretl ^ Have ^ Have not
elected to be covered as employees under Ihis policy
t t Protlucts-Completed Operahons aggregate Is equal to each
occurrence limit and is included in policy aggregate.
CERTIFICATE HOLDER'S NAME AND ADDRESS CANCELLATION
Should any of the above described policies be cancelled before the
. Piti<in County expiration date thereof, the company will endeavor to mail'( days)
Main Street
506 E written notice to the Certificate Holder named, but failure to mail such
.
CO 81611
A notice shall impose no obligation or liabilityy of any kind upon the
s different
le
'10 d
t
spen, ays un
s
atives.
company, its agents or represen
s shown
number of da
.
y
® This certifies coverage on the date of issue only The above
described policies are subject to cancellation in conformity with their
terms and by the laws of the state of issue.
DATE ISSUED AUTHORI D REP E EN TIVE
1(16(2007
U-201 Ed. 5/00 Certificate Holder S oc No. 06668 Rev. 7102
1