HomeMy WebLinkAbout20240104.tiffRESOLUTION
RE: APPROVE AMENDMENT #1 TO INTERGOVERNMENTAL AGREEMENT FOR
DISABILITY PROGRAM NAVIGATOR AND AUTHORIZE CHAIR TO SIGN AND
SUBMIT ELECTRONICALLY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with Amendment #1 to the Intergovernmental
Agreement for the Disability Program Navigator between the County of Weld, State of Colorado,
by and through the Board of County Commissioners of Weld County, on behalf of the Department
of Human Services, and the Colorado Department of Labor and Employment, Division of
Vocational Rehabilitation, commencing December 1, 2022, and ending June 30, 2024, with further
terms and conditions being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that Amendment #1 to the Intergovernmental Agreement for the Disability
Program Navigator between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Human Services, and the
Colorado Department of Labor and Employment, Division of Vocational Rehabilitation, be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to electronically sign and submit said amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 10th day of January, A.D., 2024, nunc pro tunc December 1, 2022.
BOARD OF COUNTY COMMISSIONERS
ATTEST: dam)
Weld County Clerk to the Board
BY. (rS
APP
Deputy Clerk to the Board
County Attorney
I
Date of signature: /C-IZ5/24
WELD
COUNTY, COLO
Kevi oss, Chair
Perry L. Bu % , Pro-Tem
Mike eeman
Cc:I-(SD
0Z/23y
2024-0104
HR0096
Con�c���tk��oc�
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Intergovernmental Agreement Amendment #1 between Weld County Department of
Human Services and Colorado Department of Labor and Employment on behalf of Division of Vocational
Rehabilitation.
DEPARTMENT: Human Services
PERSON REQUESTING: Jamie Ulrich, Director, Human Services
DATE: January 2, 2024
Brief description of the problemlissue: The Department is requesting to enter into Amendment #1 to the
Intergovernmental Agreement (IGA) with the Colorado Department of Labor and Employment (CDLE) on behalf
of Division of Vocational Rehabilitation (DVR). The IGA is known to the Board as Tyler ID# 2022-3318, dated
November 30, 2022. Option Letter #1, known as Tyler ID# 2023-3213, to extended the term of this IGA
through June 30, 2024. The purpose of the Amendment is to redefine the Parties'
understandings and expectations regarding the operation of the Disability Program Navigator initiative.
This Amendment also modifies the Match requirements of the Agreement.
What options exist for the Board?
• Approval of Amendment #1 to the Intergovernmental Agreement with CDLE on behalf of DVR.
• Deny approval of Amendment #1 to the Intergovernmental Agreement with CDLE on behalf of DVR.
Consequences: Amendment #1 to the Intergovernmental Agreement with CDLE will not be
executed.
Impacts: Match requirements and expectations will not be changed.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
• Total Grant Award = $94,000.00.
• Funded through Coronavirus State and Local Recovery Funds (SLFRF).
Recommendation:
• Approval of Amendment #1 and authorize the Chair to sign electronically.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck, Pro-Tem
Mike Freeman, Chair
Scott K. James
Kevin D. Ross lv
Lori Seine
Pass -Around Memorandum; January 2, 2024 - CMS 7706
2024-0104
I/10
krtoctu
DocuSign Envelope ID: 5BC15962-741 E-4466-AC7F-E22F944B0BB1
INTERGOVERNMENTAL AGREEMENT, AMENDMENT #1
SIGNATURE AND COVER PAGE
State Agency
Colorado Department of Labor and Employment on behalf of
Division of Vocational Rehabilitation
Original Contract Number
KAVA CT 2023*2930(7582)
County
Board of County Commissioners of Weld County
Amendment Contract Number
KAVA CT 2023*2930(7582)-AMD#1
Current Contract Maximum Amount
Initial Term
State Fiscal Year 2023 $94,000.00
Extension Terms
State Fiscal Year 2024 $0.00
Total for All Federal Fiscal Years $94,000.00
Contract Performance Beginning Date
December 1, 2022
Current Contract Expiration Date
June 30, 2024
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment
and to bind the Party authorizine his or her sienature.
COUNTY
Weld County, CO
Board of County Commissioners
U, V. foss
STATE OF COLORADO
Jared S. Polis, Governor
Colorado Department of Labor and Employment
Joe M. Barela, Executive Director
rishk, (eras(,
By: Kristin Corash, Director Division of Vocational
Rehabilitation
1/10/2024
Date:
By: Kevin D. Ross, Chair
1/10/2024
Date:
In accordance with §24-30-202 C.R.S., this Amendment is
not valid until signed and dated below by the State Controller
or an authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
os1
By:
Kelly Smith-Biesemeyer, State Controller Delegate
1/12/2024
Amendment Effective Date:
Amendment Contract Number:7582 Page 1 of 3
1. PARTIES
This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover
Page for this Amendment (the "Contract") is entered into by and between the County, and the
State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract.
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date shown
on the Signature and Cover Page for this Amendment. The State shall not be bound by any
provision of this Amendment before that Amendment Effective Date, and shall have no
obligation to pay Contractor for any Work performed or expense incurred under this Amendment
either before or after the Amendment term shown in §3.B of this Amendment.
B. Amendment Term
The Parties' respective performances under this Amendment and the changes to the Contract
contained herein shall commence on the Amendment Effective Date shown on the Signature and
Cover Page for this Amendment and shall terminate on the termination of the Contract.
4. PURPOSE
The purpose of the Contract is to outline the Parties' understandings and expectations regarding
the operation of the Disability Program Navigator initiative. This Amendment modifies the
Match requirements of the Contract.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Maximum Amount table on the Contract's Signature and Cover Page is hereby
deleted and replaced with the Current Contract Maximum Amount table shown on the
Signature and Cover Page for this Amendment.
B. Exhibit A: Statement of Work, Section 6. Required Contributions and Allowable
Expenditures, subsection A is hereby deleted and replaced with the following:
The Local Workforce Areas will provide DVR with non-federal funds totaling 50% of any
approved invoices for work completed prior to the Effective Date of this Amendment
("Match"). For any approved invoices for work completed on and after the Effective Date
of this Amendment, no other Local Workforce Area Match will be required. Local
Workforce Area's Match must be received by DVR prior to payment of any invoices. Once
the Local Workforce Area's Match has been received, invoices will be paid by DVR per the
terms of the Contract. For any approved invoices for work completed on and after the
Amendment Contract Number:7582 Page 2 of 3
Effective Date of this Amendment, no other Local Workforce Area Match will be required.
The Local Area will receive payment for the full approved amount of the invoice.
6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments or other modifications to the Contract, if any, remain in full force and effect except
as specifically modified in this Amendment. Except for the Special Provisions contained in the
Contract, in the event of any conflict, inconsistency, variance, or contradiction between the
provisions of this Amendment and any of the provisions of the Contract or any prior modification
to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and
control. The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment specifically
modifies those Special Provisions.
Amendment Contract Number:7582 Page 3 of 3
DocuSign Envelope ID: 5BC15962-741E-4466-AC7F-E22F944B0BB1
*0
COLORADO
Lamar and Emptoyrnast
Purpose:
Executive Summary/Contract Approval i
Vendor Name:
Board of Count Commissioners of Weld Coun
PCS Contract Owner:
Joel Knotts
Routin No:
KAVA CT 2023'2930 7582
PCS Director:
Renee Kennedy
CORE #:
KAVA CT 2023'2930
CORE T e:
CT
Agreement Name:
KAVA CT 2023'2930(7582)-AMD#1
Division Owner:
Eric Clark
Division:
KAVA
Routing Date:
0110012024
New/Amendment:
Amendment
Agreement Type:
External Agreement
Vendor Selection Method:
History:
Original Contract Value:
Value of this Transaction:
Scope Value Increase/Decrease:
Contract Start Date:
The purpose of the Contract is to outline the Parties' understandings and
expectations regarding the operation of the Disability Program Navigator
initiative. This Amendment modifies the Match requirements of the Contract.
Intergovernmental Agreement
Selection # if Competitive:
Date Sole Source Signed by PCS Director:I
Date Special Circumstance Approved by DPA:
Date of Emergency Declaration:I
Executed (12/01/2022) -The purpose of this Agreement is to establish a
Disability Program Navigator between DVR and Weld County.
Option Letter#1- extended the term date until June 30th, 2024
$94,000.00
$0.00
Current Contract Value:
New Total Value of Contract:
$94,000.00
$94,000.00
This Amendment #1 does not increase or decrease any funds.
12/01/2022
Waivers/Pre-approvals Obtained:
Cost Savings:
Were there changes from the
template contract language?
No
Does this agreement have an IT
component?
No
Current Contract End Date:
06/30/2024
Maximum Contract End Date:
06/30/2024
DVR
N/A
N/A
N/A
Revision Date 9/8/2022
Page 1 of 2
DocuSign Envelope ID: 58C15962-741E-4466-AC7F-E22F944B0BB1
COLORADO
lstwoct and €mpioysnant
Executive Summary/Contract Approval
Vendor Name:
Board of Count Commissioners of Weld Coun
PCS Contract Owner:
Joel Knots
Routin No:
KAVA CT 2023*2930 7582
PCS Director:
Renee Kennedy
CORE #:
KAVA CT 2023*2930
CORE T e:
CT
Agreement Name:
KAVA CT 2023*2930(7582)-AMD#1
Div. Contract Owner:
Eric Clark
Division:
KAVA
Date:
01/08/2024
New/Amendment:
Amendment
Agreement Type:
External Agreement
!tequired
ctRevlC
Io"tldila
Contuui
Business Unit Representative or Program Contract Mgr:
Eric Clark
PCS Grants Unit Supervisor:
James Ponder
PCS Unit Director:
Renee Kennedy
Personal Services Review:
CORE Coding Check by Program Accountant:
OIT (for all IT and telephony): Includes the OIT required
internal approvals
Program Budget Analyst:
Counter Party:
Weld County
Non-CDLE Approvers :
z
Executive Director or Delegate:
Kristin Corash
Delegated State Controller:
Kelly -Smith Biesemeyer
I/S
OIT Approvals - Executive Director / OIT Controller:
Central Approvers:
Revision Date 9/8/2022
Page 2 of 2
DocuSign Envelope ID: 56C15962-741 E-4466-AC7F-E22F94460661V vil - DVR KAVA Requisition Request Form #3128 (1) Needs Your Review
STATE OF
COLORADO
Knotts - CDLE, Joel <joel.knotts@state.co.us>
DVR KAVA Requisition Request Form #3128 (1) Needs Your Review
1 message
Requisition Request, CDLE_PCS_RQS <cdle_pcs_rgs@state.co.us> Fri, Dec 15, 2023 at 8:57 AM
To: joel.knotts@state.co.us
REQUEST #3128/1 I RECIPIENTS: 5 of 9 I DEC 11, 2023
Requisition Request Form
This form is ready to be assigned to PCS for action. Please set up the assignment in Salesforce and take
action on the form to complete. Thank you.
You have been requested to approve the following:
Requestor: linda.wray@state.co.us
Full name of Requestor: Linda Wray
Full name of Contract Manager Eric Clark
Supervisor email: eric.clark@state.co.us
Select your Division/Unit: DVR
Provide a short title for the Employment Services of Weld County agreement amendment
request:
Brief description of request: Request amendment for CT KAVA 2023-2930 whereby the match
requirements of the contract are modified.
Type of PCS action requested: Amendment/Modification of Existing Agreement (includes purchase
orders)
Enter CORE and contract number CT KAVA 2023"2930(7582)
from PO/CT/DO/MA/CTGG1:
Describe what this Amendment Edited 12.11.23 @ 1706 Iw Modifications: A. The contract maximum
will do: amount table on the contract's signature and cover page is deleted
and replaced with the current contract maximum amount table shown
on the signature and cover page of the amendment. B. Exhibit A:
https://mail.g oog le.com/mail/u/0/?ik=a30514755a&view=pt&search=all&permthid=th read-f:1785364084573467130&sim pl=msg-f:17853640845734671... 114
DocuSign Envelope ID: 56C15962-741 E-4466-AC7F-E22F944B0BB1 - DVR KAVA Requisition Request Form #3128 (1) Needs Your Review
Statement of Work. Section 6 Required contributions and allowable
expenditures, subsection A is deleted and replaced with the following:
The Local Workforce Areas will provide DVR with non-federal funds
totaling 50% of any approved invoices for work completed prior to the
Effective Date of this Amendment ("Match"). Local Workforce Area's
Match must be received by DVR prior to payment of any invoices.
Once the Local Workforce Area's Match has been received, invoices
will be paid by DVR per the terms of the Contract.
For any approved invoices for work completed on and after the
Effective Date of this Amendment, no other Local Workforce Area
Match will be required. The Local Area will receive payment for the full
approved amount of the invoice.
Upload SOW and other
applicable documents:
Term of Project (beginning and
end dates):
Please provide ship to address:
Total purchase costs:
Is this going to be a recurring
cost? (options to renew/software
subscriptions):
Explain your previous answer:
Funding Types:
File Upload 1
File Upload 2
Original contract effective date December 1, 2022 through June 30,
2024
CORE VC VC00000000014294 Address code AD019
$94,000.00
Maybe
We wish to renew annually for maximum additional years allowed at
end of this current contract
Federal Funds
If your answer included Federal no
Funds, please read the below
linked memo to see if you need to
complete the Subrecipient vs
Contractor Determination Form.
Do you need to complete this
form?:
State Fiscal Year:
Unknown Coding:
Fund Code:
Department Code:
Unit Code:
Sub Unit:
2024 2025
N/A
1000
KAVA
7101
N/A
https://m ail.g oogle. com/mail/u/0/?ik=a30514755a&view=pt&search=all&permthid=thread-f:1785364084573467130&simpl=msg-f:17853640845734671... 2/4
DocuSign Envelope ID: 5BC15962-741 E-4466 AC7F-E22F944B0661 .2 - DVR KAVA Requisition Request Form #3128 (1) Needs Your Review
Appropriation Unit Code: KFABR7220
Object Code: 2820
Activity Code:
Location Code:
Program:
Program Period:
Commodity Code:
$ Amount to be Encumbered
Under this Coding Only:
Will you utilize more than one
accounting string?:
Does this Project include any of
the following? [Yes]:
Upload any additional
documentation:
Provide any additional
information necessary to
complete this request:
Requestor email:
Does this Amendment or the
original Agreement include
Information Technology?:
Are the total purchase costs
greater than $500,000.00?:
DPN
ADMN
VDPNVR24
FFY24
952
$94,000.00
No
None
File Upload 1
File Upload 2
Original CT attached as well as option letter 1 to extend contract end
date. This requisition request is specifically to modify the match
component. Thank you. Add'I input re: edited response - 12.11.23 @
1709 - paragraph for Exhibit A SOW is as per that agreed to with
Weld County, which will read: The Local Workforce Areas will provide
DVR with non-federal funds totaling 50% of any approved invoices for
work completed prior to the Effective Date of this Amendment
("Match"). Local Workforce Area's Match must be received by DVR
prior to payment of any invoices. Once the Local Workforce Area's
Match has been received, invoices will be paid by DVR per the terms
of the Contract.
For any approved invoices for work completed on and after the
Effective Date of this Amendment, no other Local Workforce Area
Match will be required. The Local Area will receive payment for the full
approved amount of the invoice.
linda.wray@state.co.us
No
No
https://mail.google.com/m ail/u/0/?ik=a30514755a&view=pt&search=all&permthid=th read-f:1785364084573467130&simpl=msg-f:17853640845734671... 3/4
DocuSign Envelope ID: 5BC15962-741 E-446tC7F-E22F944B0BB1� - DVR KAVA Requisition Request Form #3128 (1) Needs Your Review
Approval history
In progress
Approved by eric.clark@state.co.us
Approved by kristin.corash@state.co.us
Approved by cdle_budget_ofce@state.co.us
Approved by cdle_dvr_accounting@state.co.us with comment
Accounting Approve - MAF - Coding looks good
Respond to the request
This is an automated email sent by formapprovals.com; do not reply to or forward this email. You are receiving
this email because you are a workflow participant of this request. Your form administrator is
cdle_pcs_rqs@state.co.us
https://mail.g oogle.com/mail/u/0/?ik=a30514755a&view=pt&search=all&permthid=thread-f:1785364084573467130&simpl=msg-f:17853640845734671... 4/4
DocuSign Envelope ID: 5BC15962-741E-4466-AC7F-E22F944B0BB1
AUTOMATIC RISK ASSESSMENT FORM
CORE #
CMS #
Contract Type
Vendor Name
CT KADA 2022*2930
7582
Inter -Governmental Agreement
Board of County Commissioners of Weld County
Instructions: PCS Contract Managers should complete this form for each contract or contract modification
(including option letters and task orders) and include a copy of the completed form in the contract file.
Check all boxes that apply to your contract or contract modification. If a contract or contract modification falls
into more than one automatic risk category, use the following rules to make your automatic risk determination:
(1) High Risk and Low Risk = High Risk
(2) High Risk and No Risk = No Risk
(3) Low Risk and No Risk = No Risk
(4) High Risk, Low Risk and No Risk = No Risk
Check
Automatic High Risk Categories
all
Contracts and contract modifications that fall within the following categories shall always be determined to be high
that
apply
risk unless it also falls within one of the automatic no risk categories.
Certificates of participation for shares of lease revenues.
Contingency contracts, as defined in CRS §24-17-203.
Contracts and modifications that are subject to a Statutory Violation that has not been ratified.
Contracts concerning the operation of prisons.
Contracts containing a limitation of liability, including limits on actions for which the contractor is liable, limits on the
dollar amount of damages, the types of damages, the source of damage payments, or some combination thereof, unless
OSC has determined the limitation of liability does not make the contract automatic high risk in writing.
Contracts containing modifications to provisions that require a fiscal rule waiver, such as changes to the special provisions,
unless OSC has determined the fiscal rule waiver does not make the contract automatic high risk in writing.
Contracts where a party is a Native American tribe, unless on an unchanged OSC model contract form specifically
designed for use with that Native American tribe.
Dangerous activities contracts for services that are inherently dangerous that are likely to result in strict liability if the
activity causes harm or that can cause significant harm even if performed properly.
Debt collection contracts associated with any services for the collections or recovery of amounts due to the State.
Employee voluntary separation agreements for either classified or non -classified employees.
Energy performance contracts under CRS §§24-30-2003.
Federal government contracts with agencies of the federal government unless on an unchanged OSC model contract form.
Financing contracts where a third party will provide financing to the State, such as where the third party provides a loan to
the State or provides the initial funding money that the State will repay to the third party from later revenues.
Financial systems contracts for the acquisition of new or the replacement of existing financial systems.
DocuSign Envelope ID: 5BC15962-741E-4466-AC7F-E22F944B0BB1
Legal issues contracts with technical legal issues requiring an opinion from the Colorado Attorney General.
Lease purchase contracts.
Hazardous materials contracts involving the handling, removal, treatment, movement, installation, and disposal of
hazardous materials; any other materials, substances or wastes that are subject to increased liability under any state or
federal environmental laws; or materials, substances or wastes that are dangerous instrumentalities. This does not include
contracts for the discovery, analysis, study, and review of such materials.
Information technology services contracts, except for purchases of consumer off- the -shelf software licenses, maintenance
agreements for consumer off -the -shelf software or licenses to access databases or web content. This rule also applies to
contracts for information technology goods if they are provided in conjunction with services.
Master contracts by the Department of Personnel and Administration for the entire State (i.e, the RTD Eco Pass Program).
Master task order contracts and task orders issued under those contracts.
Gutsource contracts as defined in Fiscal Rule 3-1.
Settlement agreements that settle claims between the State and individuals and between the State and contractors.
Statewide price agreement contracts and information technology enterprise agreements.
Water rights contracts involving the purchase or sale of water rights. This does not apply to: 1) the purchase or sale of water
rights and/or shares of stock in an irrigation district, a water district, a mutual ditch company, a water company, or similar
entities included as part of or associated with the purchase or sale of real property; 2) participation in substitute water
supply plans or in plans for augmentation of water resources; 3) the purchase or sale of fully consumable water.
Check
all
that
apply
Automatic Low Risk Categories
Contract and contract modifications that fall within the following categories shall always be determined to be low
risk unless it also falls within a high risk or no risk category.
X
Amendments that restate a contract to include all prior amendments and modifications in one updated document, that make
changes required by and consistent with State law, that do not materially change the scope or requirements of the contract,
or that reduce the scope and cost of the contract.
Contracts for a specific program for which CDLE has received prior written approval from OSC for a specific template
agreement, and CDLE uses that template agreement without modification. This includes any contracts that were authorized
under the State Controller Policy entitled "Phase I Waivers."
Grant Funding Change Letters in compliance with the OSC Policy "Modification of Contracts — Tools and Forms."
State-wide pm -approved contract forms, such as Office of the State Architect capital construction and controlled
maintenance work authorizations, change orders, supplements, code reviews, and architect and engineering base
agreements used without modification.
Automatic High Risk contracts or contract modifications that OSC has determined in writing to be low risk or has granted
us a waiver making low risk. If you select this category, include the waiver or written approval from OSC in the contract
file.
Check
all
Automatic No Risk Categories:
Contracts and contract modifications that fall within the following categories shall always be considered to be no
DocuSign Envelope ID: 5BC15962-741E-4466-AC7F-E22F944B0BB1
that
apply
risk regardless of whether the contract is also included as an automatic high risk or automatic low risk contract.
Option letters used in accordance with the State Controller Policy entitled "Modification of Contracts —Tools and Forms,"
unless the contract the option letter modifies is subject to a Statutory Violation that has not been ratified (See State
Controller Policy entitled "Statutory Violations").
Amendments that do nothing than more than the following, unless the contract that the amendment modifies is subject to a
Statutory Violation that has not been ratified (See State Controller Policy entitled "Statutory Violations"): 1) extend the
term of a contract at rates and for a maximum amount already included in the contract, so long as such extension does not
exceed any term included in a solicitation that was used to procure the contract; 2) increase or decrease the quantity of
existing goods or services under the contract at the rates already included in the contract, so long as such increase is in
compliance with the requirements and limits included in a solicitation that was used to procure the contract; 3) authorize
the beginning of a phase of the contract, so long as all requirements and payments for that phase are already included in
the contract; and/or 4) modify contract rates as specifically described within a contract.
Interagency Agreements where all parties are Agencies of the State or are State Institutions of Higher Education. This does
not apply if any of the parties are separate authorities or other governmental entities or political subdivisions.
Undetermined Risk Contracts and Contract Modifications
Any contract or contract modification that is not automatic high risk, automatic low risk or automatic no risk contract shall be
considered to be undetermined risk.
If a contract or contract modification is considered to be undetermined risk, PCS should work with the program to complete either the
"Risk Analysis for All New Contracts and Agreements" or the "Risk Analysis for all Modifications" form. PCS should make a final
risk determination on the basis of the completed Risk Analysis form and include copies of both this form and the completed Risk
Analysis form in the contract file.
Name of PCS Representative:
Joel Knolls
Auto Risk Determination:
Auto High Auto Low X Auto No Undetermined
All low risk and no risk contracts and contract modifications should be routed to CDLE's controller delegate for
signature. All high risk contracts and contract modifications should be routed to the Office of the State Controller
for OSC's signature.
DocuSi grr
Certificate Of Completion
Envelope Id: 5BC15962741E4466AC7FE22F944B0BB1
Subject: Complete with DocuSign: KAVA CT 2023*2930(7582)-AMD#1
Source Envelope:
Document Pages: 12
Certificate Pages: 5
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-07:00) Mountain Time (US & Canada)
Record Tracking
Status: Original
1/8/2024 11:31:45 AM
Security Appliance Status: Connected
Storage Appliance Status: Connected
Signer Events
Eric Clark
eric.clark@state.co.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 1/19/2022 10:48:18 AM
ID:976e4bd2-4152-41b5-a134-657bbd69a8a6
James Ponder
james.ponder@state.co.us
Purchasing Agent
PCS - State of Colorado (CDLE)
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Renee Rita Kennedy
reneerita.kennedy@state.co.us
PCS Director
Colorado Department of Labor and Employment
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kevin D. Ross
BoCC-Contracts@co.weld.co.us
Chair
County of Weld, Colorado
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 1/9/2024 11:04:22 AM
ID: b30fa719-878a-486c-a6fe-412149a12c34
Signatures: 3
Initials: 5
Status: Completed
Envelope Originator:
Joel Knotts
joel.knotts@state.co.us
IP Address: 156.108.172.100
Holder Joel Knotts Location: DocuSign
joel.knotts@state.co.us
Pool: FedRamp
Pool: CDLE - Procurement and Contract Services Location: DocuSign
Signature
nc
Signature Adoption: Pre -selected Style
Using IP Address: 174.51.49.3
pJ
Signature Adoption: Pre -selected Style
Using IP Address: 156.108.172.100
Signature Adoption: Pre -selected Style
Using IP Address: 174.212.39.6
Signed using mobile
≥`.t wile. V, IebSS
Signature Adoption: Pre -selected Style
Using IP Address: 204.133.39.9
Timestamp
Sent: 1/8/2024 11:54:24 AM
Viewed: 1/8/2024 1:16:49 PM
Signed: 1/8/2024 1:16:57 PM
Sent: 1/8/2024 1:16:58 PM
Viewed: 1/9/2024 7:25:20 AM
Signed: 1/9/2024 7:27:02 AM
Sent: 1/9/2024 7:27:04 AM
Viewed: 1/9/2024 8:40:41 AM
Signed: 1/9/2024 8:40:52 AM
Sent: 1/9/2024 8:40:54 AM
Viewed: 1/9/2024 11:04:22 AM
Signed: 1/10/2024 1:44:05 PM
Signer Events
Kristin Corash
kristin.corash@state.co.us
Kristin Corash, Director
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 1/10/2024 2:57:51 PM
ID.84ab7a93-2518-4557-89d1-62dbc56acde8
Kelly Smith-Biesemeyer
kelly.smith-biesemeyer(gstate.co.us
Controller
LA RAZA SERVICES INC dba Servicios DE LA
RAZA INC
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 3/28/2021 4:26:42 PM
ID:bbe9a4d8-da6e-4f50-a864-4a68ae642eac
in Person Signer Events
Editor Delivery Events
Signature
YisfitA, (,orate,
Signature Adoption: Pre -selected Style
Using IP Address: 172.59.225.205
Signature Adoption: Pre -selected Style
Using IP Address: 156.108.172.100
Signature
Status
Agent Delivery Events Status
intermediary Delivery Events Status
Certified Delivery Events''
Status
Carbon Copy Events Status
Contract Management
HS-ContractManagement@co.weld.co.us
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events
Notary Events
COPIED
Signature
Signature
Envelope Summary Events Status
Envelope Sent Hashed/Encrypted
Certified Delivered Security Checked
Signing Complete Security Checked
Completed Security Checked
Payment Events Status
Electronic Record and Signature Disclosure
Timestamp
Sent: 1/10/2024 1:44:07 PM
Viewed: 1/10/2024 2:57:51 PM
Signed: 1/10/2024 2:58:19 PM
Sent: 1/10/2024 2:58:21 PM
Viewed: 1/12/2024 8:54:55 AM
Signed: 1/12/2024 8:55:47 AM
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Sent: 1/12/2024 8:55:49 AM
Viewed: 1/12/2024 9:09:11 AM
Timestamp
Timestamp
Timestamps
1/8/2024 11:54:24 AM
1/12/2024 8:54:55 AM
1/12/2024 8:55:47 AM
1/12/2024 8:55:49 AM
Timestamps
Electronic Record and Signature Disclosure created on: 4/8/2020 10:22:47 AM
Parties agreed to: Eric Clark, Kevin D. Ross, Kristin Corash, Kelly Smith-Biesemeyer
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, OIT — CDLE (we, us or Company) may be required by law to provide to you
certain written notices or disclosures. Described below are the terms and conditions for providing
to you such notices and disclosures electronically through the DocuSign system. Please read the
information below carefully and thoroughly, and if you can access this information electronically
to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please
confirm your agreement by selecting the check -box next to 'I agree to use electronic records and
signatures' before clicking `CONTINUE' within the DocuSign system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents 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 copies of any such documents from our office to you, you will be charged a
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procedure described below.
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If you 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
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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,
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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 the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, 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 OIT — CDLE:
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: bailey.eirish@state.co.us
To advise OIT — CDLE of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at bailey.eirish@state.co.us and in
the body of such request you must state: your previous email address, your new email
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If you created a DocuSign account, you may update it with your new email address through your
account preferences.
To request paper copies from OIT — CDLE
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to bailey.eirish@state.co.us and in the
body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with OIT — CDLE
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your signing session, and on the subsequent page,
select the check -box indicating you wish to withdraw your consent, or you may;
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your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: https://support.docusign.com/guides/signer-guide-
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Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check -box next to 'I agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to 'I agree to use electronic records and signatures', you confirm
that:
You can access and read this Electronic Record and Signature Disclosure; and
You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
Until or unless you notify OIT — CDLE as described above, you consent to receive
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to you by OIT — CDLE during the course of your relationship with OIT -
CDLE.
Contract Form
Entity Information
Entity Name *
COLORADO DEPARTMENT OF
LABOR & EMPLOYMENT
Entity ID*
@00010497
Contract Name* Contract ID
CDLE ON BEHALF OF DVR (WCWDB, ESWC, AND CDLE 7706
ON BEHALF OF DVR) MOU AMENDMENT #1
Contract Status
CTB REVIEW
Contract Lead *
WLUNA
O New Entity?
Parent Contract ID
20232545
Requires Board Approval
YES
Contract Lead Email Department Project #
wluna@weldgov.com;cob
bxxlk@weldgov.com
Contract Description*
COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT ON BEHALF OF DIVISION OF VOCATIONAL
REHABILITATION MEMORANDUM OF UNDERSTANDING AMENDMENT #1 WITH WCWDB, ESWC . TERM: DECEMBER
1, 2022 THROUGH JUNE 30, 2024.
Contract Description 2
APPROVED PA ROUTING WITH CMS/ONBASE ENTRY. ETA TO CTB 12/27/2023. THIS WILL BE ROUTED VIA
DOCUSIGN.
Contract Type* Department Requested BOCC Agenda Due Date
AGREEMENT HUMAN SERVICES Date* 01/06/2024
01/10/2024
Amount* Department Email
$0.00 CM- Will a work session with BOCC be required?*
HumanServices@weldgov. NO
Renewable*
NO
Automatic Renewal
Grant
IGA
com
Department Head Email
CM-HumanServices-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
Does Contract require Purchasing Dept. to be
included?
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date*
04/30/2024
Committed Delivery Date
Renewal Date
Expiration Date*
06/30/2024
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JAMIE ULRICH CHRIS D'OVIDIO BYRON HOWELL
DH Approved Date Finance Approved Date Legal Counsel Approved Date
01/03/2024 01/04/2024 01/04/2024
Final Approval
BOCC Approved Tyler Ref #
AG 011024
BOCC Signed Date Originator
WLUNA
BOCC Agenda Date
01/10/2024
Hello