Common use of PUBLIC CONTRACTS WITH NATURAL PERSONS Clause in Contracts

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 76.5-103 prior to the effective date of this contract. Revised 1-1-09 Contract Routing Number: 17 IHIA 89152 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor’s behalf and acknowledge that the State is relying on their representations to that effect. CONTRACTOR Blue Peaks Developmental Services, Inc. By: Xxxxxx Xxxxxx Title: Executive Director *Signature Date: STATE OF COLORADO Xxxx X. Xxxxxxxxxxxx, Governor Department of Human Services Xxxxxx Xxxxx, Executive Director By: Xxxx Xxxx Xxxxxx, Director, Office of Early Childhood Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Date: 2nd Contractor Signature if Needed By: INSERT-Name of Authorized Individual Title: INSERT-Official Title of Authorized Individual *Signature Date: LEGAL REVIEW Xxxxxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney General Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §00-00-000 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s).

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 76.5-103 prior to the effective date of this contract. Revised 10-10-09 Contract Routing Number00 Xxxxxxxx Xxxxxxx Xxxxxx: 17 IHIA 89152 00 XXXX 00000 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor’s behalf and acknowledge that the State is relying on their representations to that effect. CONTRACTOR Blue Peaks Developmental North Metro Community Services, Inc. By: Xxxxxx Xxxxxx Xxxxx Xxxxxxxxx Title: Executive Director *Signature Date: STATE OF COLORADO Xxxx X. Xxxxxxxxxxxx, Governor Department of Human Services Xxxxxx Xxxxx, Executive Director By: Xxxx Xxxx Xxxxxx, Director, Office of Early Childhood Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Date: 2nd Contractor Signature if Needed By: INSERT-Name of Authorized Individual Title: INSERT-Official Title of Authorized Individual *Signature Date: LEGAL REVIEW Xxxxxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney General Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §00-00-000 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s)Xxxxx County.

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 76.5-103 prior to the effective date of this contract. Revised 10-10-09 Contract Routing Number00 Xxxxxxxx Xxxxxxx Xxxxxx: 17 IHIA 89152 00 XXXX 00000 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor’s behalf and acknowledge that the State is relying on their representations to that effect. CONTRACTOR Blue Peaks Developmental Services, Inc. By: Xxxxxx Xxxxxx Title: Executive Director *Signature Date: STATE OF COLORADO Xxxx X. Xxxxxxxxxxxx, Governor Department of Human Services Xxxxxx Xxxxx, Executive Director By: Xxxx Xxxx Xxxxxx, Director, Office of Early Childhood Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Date: 2nd Contractor Signature if Needed By: INSERT-Name of Authorized Individual Title: INSERT-Official Title of Authorized Individual *Signature Date: LEGAL REVIEW Xxxxxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney General Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §00-00-000 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla Xxxxxxxx County area(s).

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 76.5-103 prior to the effective date of this contract. Revised 1-1-09 Contract Routing Number: 17 IHIA 89152 Choose an item. Choose an item. THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor’s behalf and acknowledge that the State is relying on their representations to that effect. CONTRACTOR Blue Peaks Developmental Services, Inc. INSERT-Legal Name of Contractor By: Xxxxxx Xxxxxx INSERT-Name of Authorized Individual Title: Executive Director INSERT-Official Title of Authorized Individual *Signature Date: STATE OF COLORADO Xxxx X. Xxxxxxxxxxxx, Governor Department of Human Services Xxxxxx Xxxxx, Executive Director By: Xxxx Xxxx Xxxxxx, Director, Office INSERT-Name & Title of Early Childhood Person Signing for Agency or IHE Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Date: 2nd Contractor Signature if Needed By: INSERT-Name of Authorized Individual Title: INSERT-Official Title of Authorized Individual *Signature Date: LEGAL REVIEW Xxxxxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney General Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §00-00-000 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s).Xxxxxx

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 24-76.5-103 prior to the effective date of this contract. Revised 1-1-09 This page left intentionally blank. SIGNATURE PAGE Contract Routing Number: 17 IHIA 89152 Insert CMS # THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons DELETE BLUE TEXT BEFORE PRINTING Each person signing for Contractor hereby swear this Contract represents and affirm warrants that they are he or she is duly authorized to act on Contractor’s behalf execute this Contract and acknowledge that to bind the State is relying on their representations to that effectparty authorizing his or her signature. CONTRACTOR Blue Peaks Developmental Services, Inc. By: Xxxxxx Xxxxxx Title: Executive Director *Signature Date: INSERT-Contractor Name Insert-legal entity type STATE OF COLORADO Xxxx X. Xxxxxxxxxxxx, Governor Colorado Department of Human Services Xxxxxx XxxxxPublic Health and Environment Xxxxx Xxxx, MD, MSPH, Executive Director and Chief Medical Officer Print Name of Authorized Individual By: Print Title of Authorized Individual Xxxx Xxxx Xxxxxx, XxXxxxxx Purchasing and Contracting Section Director, Office CDPHE Signature of Early Childhood Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Date: 2nd Contractor Signature if Needed By: Authorized Individual Date Date PROGRAM APPROVAL Colorado Department of Public Health and Environment INSERT-Name of Authorized Individual Title: INSERT-Official Title of Authorized Individual *Signature Date: LEGAL REVIEW Xxxxxxx X. Xxxxxxx, Attorney General By: By: Signature - of Authorized CDPHE Program Approver Signature – Senior Assistant Attorney General Date: ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS Date Date In accordance with §00-00-000 requires the State Controller to approve all State Contracts. This C.R.S., this Contract is not valid until signed and dated below by the State Controller or an authorized delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the Ensure State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunderController’s signature and date lines remain on this page. STATE CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Effective Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s).:

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 24‐76.5‐101 et seq., and (c) has produced one form of identification required by CRS §24- 76.5-103 24‐76.5‐103 prior to the effective date of this contractAgreement. Revised 1-1-09 Contract Routing Number: 17 IHIA 89152 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor’s behalf and acknowledge that the Colorado State University‐Pueblo is relying on their representations to that effecteffect and accept personal responsibility for any and all damages the University may incur for any errors in such representation. CONTRACTOR Blue Peaks Developmental Services, Inc. CONTRACTOR: Insert Legal Name of Contractor By: Xxxxxx Xxxxxx *Signature Name: Title: Executive Director *Signature Date: STATE OF COLORADO Xxxx X. XxxxxxxxxxxxXxxxxxxxxxxx GOVERNOR Board of Governors of the Colorado State University System, Governor Department of Human Services Xxxxxx Xxxxxacting by and through Colorado State University Xxxxx X. Xxxx, Executive Director Interim President By: Xxxx Xxxx XxxxxxXxxxxxxxx Xxxxxxxx‐Xxxxxxxx, Director, Office of Early Childhood Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Procurement Director Name: Title: Date: 2nd Contractor Signature if Needed REQUIRED APPROVALS: By: INSERT-Name of Authorized Individual *Signature Name: Title: INSERT-Official Title of Authorized Individual *Signature [Xxxx, Director or Dept. Head] Date: LEGAL REVIEW Xxxxxxx Xxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney Xxxxx Xxxxxxx, Deputy General Counsel Date: ALL EXPENDITURE CONTRACTS REQUIRE APPROVAL BY THE by the COLORADO STATE UNIVERSITY CONTROLLER CRS §00-00-000 requires 24‐30‐202 and University policy require the State University Controller to approve all State expenditure Contracts. This Contract is not valid until signed and dated below by the State University Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado University is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. COLORADO STATE UNIVERSITY CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD Xxxxx By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx *Signature Name: Xxxxxxx Xxxxxx, Interim Vice President for Finance and Administration Date: Fiscal Year (FY) 2016-17 EXHIBIT A CONTRACTOR DISCLOSURE STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Contract Performance Outside the United States or Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant Pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer Statute 24‐102‐206 To the statewide Early Intervention (EI) Colorado program and is designated as extent the lead agency for Part C of vendor/contractor has not disclosed the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development following information in the areas Statement of cognitionWork, speechthis form shall be completed and returned to the University. This applies to all University contracts and solicitation for services executed after August 3, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s)2007.

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 24-76.5-103 prior to the effective date of this contract. Revised 1-1-09 Contract SIGNATURE PAGE Routing Number: 17 IHIA 89152 17-HA2-XC-00110 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT AGREEMENT * Persons signing for Contractor The Local Agency hereby swear and affirm that they are authorized to act on ContractorThe Local Agency’s behalf and acknowledge that the State is relying on their representations to that effect. CONTRACTOR Blue Peaks Developmental Services, Inc. ByLOCAL AGENCY CITY OF PUEBLO Name: Xxxxxx Xxxxxx (print name) Title: Executive Director (print title) *Signature Date: STATE OF COLORADO Xxxx X. Xxxxxxxxxxxx, Governor . GOVERNOR Colorado Department of Human Services Xxxxxx XxxxxTransportation Xxxxxxx Xxxxx , Executive Director By: Xxxx Xxxx XxxxxxXxxxxx Xxxxxxx, Director, Office of Early Childhood Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Chief Engineer Date: 2nd Contractor Additional Local Agency Signature if Needed By(If Necessary) Name: INSERT-Name of Authorized Individual (print name) Title: INSERT-Official Title of Authorized Individual (print title) *Signature Date: LEGAL REVIEW Xxxxxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney General Date: ALL CONTRACTS AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §00-00-000 requires the State Controller to approve all State ContractsAgreements. This Contract Agreement is not valid until signed and dated below by the State Controller or delegate. Contractor The Local Agency is not authorized to begin performance until such time. If Contractor The Local Agency begins performing prior thereto, the State of Colorado is not obligated to pay Contractor The Local Agency for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Xxxxxx Xxxxx, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHSExhibit A Roadway Plans Exhibit A Exhibit A Exhibit B Legal Description(s), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s).

PUBLIC CONTRACTS WITH NATURAL PERSONS. CRS §24-76.5-101. Contractor, if a natural person eighteen (18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a) is a citizen or otherwise lawfully present in the United States pursuant to federal law, (b) shall comply with the provisions of CRS §24-76.5-101 et seq., and (c) has produced one form of identification required by CRS §24- 24-76.5-103 prior to the effective date of this contract. Revised 1-1-09 Contract Routing Number: 17 IHIA 89152 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT * Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor’s behalf and acknowledge that the State College is relying on their representations to that effecteffect and accept personal responsibility for any and all damages the College may incur for any errors in such representation. CONTRACTOR Blue Peaks Developmental Services, Inc. By: Xxxxxx Xxxxxx Title: Executive Director *Signature DateCONTRACTOR: STATE OF COLORADO Xxxx COLORADO: XXXX X. XxxxxxxxxxxxHICKENLOOKER, Governor GOVERNOR Department of Human Services Xxxxxx XxxxxHigher Education, Executive Director By: Xxxx Xxxx Xxxxxx, Director, Office of Early Childhood Signatory avers to by the State Controller or delegate that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules Date: 2nd Contractor Signature if Needed By: INSERT-Board for Community Colleges and Occupational Education, for the use and benefit of the Community College of Denver Legal Name of Authorized Individual Title: INSERT-Official Title Contracting Entity Signature of Authorized Individual *Signature DateOfficer Xx. Xxxxxxxx X. Freeman President Print Name Date LEGAL REVIEW: LEGAL REVIEW Xxxxxxx Date Xxxx X. Xxxxxxx, Attorney General By: Signature - Assistant Attorney General Date: Xxxxx Xxxx or Xxxxxxxx Xxxxxxx Date ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §00-00-000 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER Xxxxxx XxxxxXXXXXX XXXXX, CPA, MBA, JD By: Xxxxx Xxxxxxxx / Xxxxx Xxxxxx Date: Fiscal Year (FY) 2016-17 STATEMENT OF WORK FOR EARLY INTERVENTION SERVICES The Colorado Department of Human Services (CDHS), Office of Early Childhood, Division of Community and Family Support (DCFS) is authorized, pursuant to 27-10.5-102(12) Colorado Revised Statutes (C.R.S.) (2014) and 27-10.5-703 C.R.S. (2014), to administer the statewide Early Intervention (EI) Colorado program and is designated as the lead agency for Part C of the Individuals with Disabilities Education Act (IDEA). The Community Centered Boards (CCBs) have been designated by the CDHS as Certified EI Service Brokers as defined under Section 27-10.5-702 (3) (2014), C.R.S. The EI Colorado program is administered by the CDHS, OEC, DCFS, hereafter referred to as DCFS, through contracts with CCBs. CCBs deliver community-based EI services to infants and toddlers, birth through two (2) years of age, who have been determined to have a developmental delay or disability, who have been diagnosed with a physical or mental condition that has a high probability of resulting in a significant delay in development, or who are living with a parent who has a developmental disability. CCBs are responsible for intake, eligibility determination, Individualized Family Service Plan (IFSP) development, arrangement for services, the delivery of services, monitoring and other functions. The EI Colorado program provides eligible infants and toddlers, and their families, with services and supports to enhance child development in the areas of cognition, speech, communication, physical development, motor development, vision, hearing, social or emotional development, and self-help skills. EI services are funded through state funds, private insurance dollars, federal Part C funds and other funds. The contract sets forth the requirements to be met by the Contractor for satisfactory contract performance, and specifies those remedies that may be invoked in the event that the Contractor does not comply with the terms of the contract. In accordance with applicable statutes and rules, the Contractor has been designated as a CCB and as a Certified EI Service Broker serving Sagauche, Mineral, Rio Grande, Alamosa, Conejos and Costilla County area(s).X. Xxxxx