Exhibit F - CDHS Personal Services Contract Template - Signature and Cover Pages.docx

State of Colorado Department of Human Services Contract v.4.13

Signature and Cover Pages

V 4.13

CMS #:

[Insert Full CMS # (FY ProgramCode CMS#)] State Agency Colorado Department of Human Services [Insert Office] [Insert Division] Contract Maximum Amount Initial Term [State Fiscal Year 20xx $0.00] Extension Terms [Edit/delete this section as needed, or put “None”

Maximum Amount for All Fiscal Years [$0.00] Pricing/Funding Price Structure: [Fixed Price or Cost Reimbursement or Fixed Unit Price or Other] Contractor shall invoice: [Monthly or Quarterly or Bi-Weekly (twice per month) or Upon delivery and acceptance of performance or As specified elsewhere] Fund Source: [Insert name of funding source, whether it’s state general funds, cash, Federal Program / Grant and Funds ID#, if none, put NA] eClearance#:

[Insert eClearance #] Contractor [Insert Contractor’s Full Legal Name, including “Inc.”, “LLC”, etc...] Contractor’s State of Incorporation: [Insert State] Contract Performance Beginning Date The later of the Effective Date or [Month Day, Year] Initial Contract Expiration Date [Month Day, Year] Except as stated in §2.D, the total duration of this Contract, including the exercise of any options to extend, shall not exceed [Insert Contract’s Maximum Amount of Years or Months as required by solicitation, or otherwise] Years from its Performance Beginning Date.

Options The State shall have the following options if indicated with “Yes,” as further described in §2.C and §5.B.v:

Option to Extend Term per §2.C: [Yes or No].

Option to Increase or Decrease Maximum Amount per §5.B.v: [Yes or No].

Insurance Contractor shall maintain the following insurance if indicated with “Yes,” as further described in §10:

Worker’s Compensation: Yes General Liability: Yes Automobile Liability: [Yes or No].

Protected Information: [Yes or No].

Professional Liability Insurance: [Yes or No].

Cyber/Net. Security-Privacy Liability Insurance: [Yes or No].

Crime Insurance: [Yes or No].

State Representative [Insert State Representative Name Title Department Street Address City, State Zip Phone Email]

Miscellaneous Authority to enter into this Contract exists in: [Insert statutory and/or other legal authority here.] Law-Specified Vendor Statute (if any): [Insert Statute, otherwise put NA] Procurement Method: [Exempt or Discretionary or Documented Quote (DQ) or Invitation for Bids (IFB) or Request for Proposals (REP) or Grant Specified or Law Specified or Competitive Negotiation or Price Agreement or Sole Source] Solicitation Number (if any): [Insert Solicitation #, otherwise put NA] Contractor Representative [Insert Contractor Representative Name Title Contractor name Street Address City, State Zip Phone Email] Exhibits The following Exhibits are attached and incorporated into this Contract:

[List Exhibits here] Contract Purpose [Insert brief description of the purpose of the Contract.] Signature Page Begins on Next Page The rest of this page is intentionally left blank.

The parties hereto have executed this contract Each person signing this Contract represents and warrants that he or she is duly authorized to execute this Contract and to bind the Party authorizing his or her signature.

Contractor [Insert Contractor’s Full Legal Name, including “Inc.”, “LLC”, etc...] By: [Name & Title of Person Signing for Contractor] Date: _________________________ [2nd State or Contractor Signature if Needed] By: [Name & Title of Person Signing for Signatory] Date: _________________________ State of Colorado Jared S. Polis, Governor Department of Human Services Michelle Barnes, Executive Director By: [Name & Title of Person Signing for CDHS] Date: _________________________ Legal Review Philip J. Weiser, Attorney General By: [Name], Assistant Attorney General Date: _________________________

In accordance with §24-30-202 C.R.S., this Contract is not valid until signed and dated below by the State Controller or an authorized delegate.

State Controller Robert Jaros, CPA, MBA, JD

By: Telly Belton/Toni Williamson/Amanda Rios/Nina Douglass Effective Date:_____________________ -- Signature and Cover Pages End --image1.png