HomeMy WebLinkAbout871219.tiff mtmoRAnDum
hiDe Gordon E. Lacy, Chairman
ro Board of County Commissioners Date September 14, 1987 Ij
COLORADO From Walter J. Speckman, Executive Director, Human Resources (2/
Subject: JTPA Master Contract Grant Settlement Forms
Enclosed for board approval are the Job Training Partnership Act Grant
Settlement Forms. The three forms are:
1. Grant Recipient Release Form - This form outlines the total expentitures
of Master Contract 390-509 which totalled $1,141,401.00.
2. Grant Recepient's Assignment of Refunds, Rebates, and Credits - This
form certifies that any refunds of unspent JTPA funds will be forwarded
to the Governor's Job Training Office.
3. Contract Closeout Tax Certification - This form certifies that the Weld
County Division of Human Resources has complied with all requirements
of law and the Governor's Job Training Office regarding taxes.
If you have any questions, please feel free to telephone me at 353-0540.
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7 871219
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Attachment #12-2
GOVERNOR'S JOB TRAINING OFFICE
GRANT RECIPIENT'S RELEASE
Pursuant to the terms of Contract No. 390-509 and in consideration of
the- sum of Ono million, one hundred fourtv one thousand, four hundred and one
Total of amounts paid and payable
Dollars (Si 141 4n1 nn )
which has been or is to be paid under the said contract to Weld County nivicinn of
Human Resources, P.O. Box 1805, Greeley, Colorado 80632
Contractor's Name and Address
hereinafter called the Grant Recipient or to its assignees, if any, the Grant
Recipient, upon payment of the said sum by the GOVERNOR'S JOB TRAINING OFFICE here-
inafter called GJTO, does remise, release, and discharge GJTO, its officers,
agents, and employees, of and from all liabilities, obligations, claims, and de-
mands whatsoever under or arising from the said contract except:
1. Specified claims in stated amounts or in estimated amounts where the
amounts are not susceptible of exact statement by the Grant Recipient, as follows:
None
if none so state
2. Claims, together with reasonable expenses incidental thereto, based upon
the liabilities of the Grant Recipient to third parties arising out of the perfor-
mance of the said contract, which are not known to the Grant Recipient on the date
of the execution of this release and of which the Grant Recipient gives notice in
writing to the GJTO within the period specified in the said contract.
3. Claims after closeout, for costs which results from the liability to pay
Unemployment Insurance costs under a reimbursement system or to settle Worker's
Compensation claims.
This release has been executed this 14th day of Sertember 19 87 BY Go d� . Lacy
Title Chairman. Weld ntv Board of County
Local Elected OuficialCommissioners
871219
Attachment #12-3
GOVERNOR'S JOB TRAINING OFFICE
GRANT RECIPIENT'S ASSIGNMENT OF REFUNDS, REBATES AND CREDITS
Grant Recipient's Name Weld County Division of Human Resources Contract No.
Street Address P.O. Box 1805
City and State Greeley, CO 80632 390-509
Pursuant to the terms of Contract No. 1q0-r,Oq and in consideration of
the reimbursement of costs and payment of fee, as provided in the said contract
and any assignment thereunder, the Weld County Division of Human Resources, P.O. Box 1805,
Greeley, Colorado 80632 Grant Recipient's Name and Address
(hereinafter called the Grant Recipient) does hereby:
1. Assign, transfer, set over and release to the Governor's Job Training
Office (hereinafter called GJTO) , all right, title and interest to all refunds,
rebates, credits or other amounts (including any interest thereon) arising out of
the performance of the said contract, together with all the rights of action
accrued or which may hereafter accrue thereunder.
2. Agree to take whatever action may be necessary to effect prompt collection
of all such refunds, rebates, credits or other amounts (including any interest
thereon) due or which may become due, and to forward promptly to the GJ'It.
3. Agree to cooperate fully with GJTO as to any claim or suit in connection
with such refunds, rebates, credits or other amounts due (including any interest
thereon): to execute any protest, pleading, application, power of attorney or other
papers in connection therewith; and to permit GJTO to represent it at any hearing,
trial or other proceeding arising out of such claim or suit.
This assignment has been executed this 14th day of September 19 87
GRANT RECIPIENT
Weld County Division of Human Resources, P.O. Box 1805, Greeley, CO 80632
LEO NAME AND TITLE
Gordon E. Lacy, Chairman, Weld County Board of County COmmissioners
LEO SIGNATURE
LEO = Local Elected Officil/
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Attachment #12-4
GOVERNOR'S JOB TRAINING OFFICE
CONTRACT CLOSEOUT TAX CERTIFICATION
In the performance of Contract No. 390-509 , I certify that I have
complied with requirements of the law and the Governor's Job Training Office, re-
garding the obtaining of employer identification/account numbers; collection, pay-
ment, deposit, and reporting of Federal, State, and local taxes; and the provision
of W-2 forms to employees/enrollees who are not now my employees. For present
employees/enrollees, (formerly employed under the contract) , W-2 forms will be
furnished as specified in Circular E. Employer's Tax Guide.
LOCAL ELECTED OFFICIAL SIGNATURE
•
NAME OF GRANTEE Weld County Division of an Resources
ADDRESS p.0. Box 1805
Greeley. CO 80632
EMPLOYER'S IDENTIFICATION NO. R4-6000873
•
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871219
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