HomeMy WebLinkAboutC01-310 Contract renewal letter #4 with State of ColoradoC6
STATE OF COLORADO
Bill Owens, Governor
Jane E. Norton, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr. S.
Laboratory and Radiation Services Division
Denver, Colorado 80246 -1530
8100 Lowry Blvd.
Phone (303) 692 -2000
Denver, Colorado 80230 -6928
TDD Line (303) 691 -7700
(303) 692 -3090
Located in Glendale, Colorado
http: / /www.cdphe.state.co. us
November 19, 2001
State Fiscal Year 2001 -2002
Contract Renewal Letter No. 4
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1876
Colorado Department
of Public Health
and Environment
Contracting Routing Number
FLA 0200188
In accordance with Paragraph 10 of the contract with routing number t»nm RR an,i V n n M10 n0AIrcc
hereinafter referred to as the Original Contract (copy attached and t of
Colorado, Department of Public Health and Environment EMSP Di tf�— ` - ' ,Z%� ale
County, the parties hereby agree the Original Contract is hereby ren ' amber
2002. The parties agree that the maximum amount payable by the id is
FIFTEEN THOUSAND EIGHT HUNDRED FORTY -SIX DOLLA
i. The
terms of conditions of the Original Contract are hereby reaffirmed a i (� r�!t.v (pis
renewal period unless otherwise stated.
This amendment to the Original Contract is intended to be effective
until it shall have been approved by the State Controller or such assi
Please sign, date and return all three originals of this letter as soon
Laurie Borgers, Grants Manage]
Colorado Department of Public
HPDP Division
Mail Code: HPDPD- PCP -A2
4300 Cherry Creek Drive South
Denver, Colorado 80246 -1530
One original of this letter will be returned to you when fully approved.
Contractor: Board of County Commissioners,
846000762 N
By:
gnature V w't ;`•
Print Name:
Title: Cha' erson Board of Count) Co 4 d c 0-
Eagle County
APPROVALS:
PROGRAM
By:
State of Colorado:
Bill Owens, Governor
Lo
r z4lle /
For the Executive Director
Colorado Department of Public Health
And Environment
APPROVALS:
STATE CONTROLLER
By:
Arthur L. Barnhart
31,
COUNTY SUBSIDY PAYMENT DISTRIBUTION FORM
COLORADO EMERGENCY MEDICAL SERVICES SUBSIDY PROGRAM FOR COUNTIES
In accordance with the provision of CRS 23 -3.5 -605, the undersigned hereby requests and EMS
county subsidy distribution payment for the improvement and expansion of prehospital EMS. It is
understood that payment is contingent upon approval of the statutory reporting requirement by the
state advisory council on EMS.
Payment to: Board of County Commissioners, Eagle County
Name of Board of County Commissioners ( payee)
PO Box 850
Address
Eagle Colorado 81631 -0850
(City) (State) (Zip)
Chairperson Board of Coun Commissioners
SIGNATURE:
Printed Name: �
o -oat w
SIGN AND RETURN THIS FORM ALON ALL REPORTING DOCUMENTATION
For use only by Department of Public Health and Environment
Amount: 15,846.95
Approved by: Date:
Grants Manager
Fiscal Officer
Fund A enc OOr
408 FLA 8300
Original Contract Number:
Renewal Routing#:
Vendor #:
9807555
Date:
Avor Code Func Obi
839 FLWT 5120
200188
846000762 N
GBL
0025
