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HomeMy WebLinkAbout1999-14 Approving the Law enforcement Assistance Fund (LEAF) ContractRESOLION NO. 14 SERIES OF 1999 A RESOLUTION APPROVING THE LAW ENFORCEMENT ASSISTANCE FUND LEAF) CONTRACT # L-22-00. WHEREAS, the Vail Town, on behalf of the Vail Police Department, has submitted an application to the Colorado Department of Transportation, Office of Transportation Safety for funding a LEAF project for enforcement of laws pertaining to the driving under the influence of alcohol or other drugs, pursuant to Section 43-4-401 through 404, CRS and to LEAF Rules at 2CCR 602.1; and WHEREAS, the State has approved an application and has prepared LEAF Contract which provides $21,000; and WHEREAS, the Town of Vail has the authority and responsibility to fund the Vail Police Department and to sign contracts on behalf of the Vail Police Department; and WHEREAS, a resolution by the Town of Vail formally approving the LEAF Contract and authorizing the proper signature to be affixed to the Contract indicating such approval is required by the State of Colorado. NOW, THEREFORE, be it resolved the Town Council of the Town of Vail, Colorado hereby approves the terms, condition and obligations of LEAF Contract and hereby authorizes: 1. The Town Manager to sign the LEAF Contract on behalf of the Town of Vail. 2. This resolution shall take effect immediately upon its passage. INTRODUCED, READ, APPROVED AND ADOPTED ATTEST: A Donaldson, Town Clerk C:IRESOLU99.14 4 'day of October, 1999. Robert E. Ford, Mayor qt diDEPARTMENT OR AGENCY N `3ER: L-22-00 CONTRACT ROUTING NUMBER!' CONTRACT THIS CONTRACT, Made this (G 774 day of CX.,17.— , 199x, by and between the State of Colorado, for the use and benefit of the Colorado Department of Transportation, Office of Transportation Safety, 4201 East Arkansas Avenue, Denver, Colorado 80222 (hereinafter referred to as "the State") and the City of Vail, for the Vail Police Department, 75 South Frontage Road, Vail, CO. 81657 (hereinafter referred to as "the Contractor"). WHEREAS, authority exists in the Law and Funds have been budgeted, appropriated and otherwise made available and a sufficient unencumbered balance thereof remains available for payment in Fund Number 403, Appropriation Code 307, ORGN 0858, Contract Encumbrance Number 9586, FEIN# 84- 0571385 and GBL #; WHEREAS, required approval, clearance and coordination has been accomplished from and with appropriate agencies; and WHEREAS, the Legislature has created the Law Enforcement Assistance Fund (LEAF) for the prevention of drunken driving (43-4-401 through 43-4-404, CRS, replacement edition); and WHEREAS, LEAF has been established to provide funds to aid in the prevention of drunken driving and the enforcement of laws pertaining to driving under the influence of alcohol and drugs; and WHEREAS, pursuant to §43-4-404, C.R.S., the State is authorized to allocate LEAF funds by contract to local authorities (cities and counties) to benefit the health and safety of persons in Colorado by the implementation of local programs developed by the local authorities for drunken driving prevention and law enforcement improvements; and WHEREAS, the Contractor has submitted a LEAF project funding Application, which has been approved by the State; and WHEREAS, the Contractor has established a qualified program, consistent with current State Highway Safety rules at 2CCR 602-1, to coordinate efforts to prevent drunken driving and to enforce laws pertaining to driving under the influence of alcohol and drugs within its jurisdiction; and WHEREAS, the Contractor has available the technical ability to properly perform the project as described in the Approved Application and to address the LEAF objectives of the Legislature; and WHEREAS, this Contract is executed by the State under authority of 29-1-203, 43-1-106, 43-4-402 and 403, and 24-42-103 CRS, and by the Contractor under sections 29-1-203 and 30-11-101, 31-15-101 CRS or home rule charter, as applicable, and the attached resolution. Page 1 of 7 Pages NOW THE•FORE, it-is.hereby agreed as folio. 1. The Contractor's Approved LEAF Application, the LEAF Contract Management Manual dated August 1, 1992 and LEAF Application Guidelines dated July, 1992, the State Highway Safety Rules at 2CCR 602-1, and Attachments A, B and C are incorporated herein by this reference as terms and conditions of this contract. The Contractor acknowledges that it has received copies of the LEAF Contract Management Manual, the Application Guidelines, and the State Highway Safety Rules. The Contractor shall comply with all terms and conditions of this Contract. In the event of a conflict between the terms of this Contract and the terms of the incorporated materials, the following priority shall be used to resolve such conflict: A. State Highway Safety Rules; then B. LEAF Contract Management Manual and Guidelines; then C. This Contract; then D. Attachments A, B, C, in that order; then E. Approved Application. 2. The Contractor shall carry out the program and shall perform the activities which are specifically described in the Approved Application and are generally described in Attachment A (collectively, "the project"). 3. The Contractor shall submit quarterly reports to the State detailing the performance of this Contract according to the reporting criteria described in Attachment B. 4. Project Funding Provisions. The total budget amount authorized by this Contract for the actual costs of the project work is $21,000, as described in Attachment C. The State shall participate in the payment as provided herein. State's maximum (from LEAF) $21,000 TOTAL AMOUNT $21,000 The State shall use LEAF funds exclusively to pay for the actual costs incurred by the Contractor for the project work up to the State's maximum. If the Contractor incurs project costs which exceed the Attachment C budget amount without first obtaining an approval in that amount by written contract amendment, the Contractor shall be solely responsible for the payment of such excess costs. The State budget amount will be provided solely from LEAF funds. Any obligation of the State under this Contract is contingent upon LEAF funds being available for this Contract. The State will pay the Contractor for actual costs incurred on a quarterly basis, subject to prior review and approval by the State of work performance and pursuant to payment procedures contained in the LEAF Contract Manual. The Contractor shall maintain an itemized accounting of all billings and other records to support all costs charged to the Contract and shall present same to the State upon request. 5. The effective date of this contract shall be the date the Controller of the State of Colorado approves this contract, or such later date specified herein. The Contract shall begin January 1, 2000, and shall terminate on December 31, 2000. Page 2 of 7 Pages 6. The Contractor agrees that any subcontracts entered into by the Contractor under this Contract must meeifill applicable State and Federal regements and must be approved by *Office of Transport n Safety prior to execution by the Mntractor. 7. a) Termination Due to Loss of Funding. The parties hereto expressly recognize that the Contractor is to be paid, reimbursed, or otherwise compensated solely with certain funds provided to the State for the purpose of contracting for the services provided for herein. Therefore, the Con- tractor expressly understands and agrees that all its rights, demands and claims to compensation arising under this Contract are contingent upon receipt of such funds by the State. In the event that such funds or any part thereof are not received by the State, the State may immediately terminate this Contract. b) Termination for Cause. If, through any cause, the Contractor shall fail to fulfill in a timely and proper manner the obligations under this Contract, or shall violate any of the covenants, agreements or stipulations of this Contract, the State shall thereupon have the right to terminate this Contract for cause by giving written notice to the Contractor such termination and specifying the effective date thereof, at least thirty (30) days before the effective date of such termination. In that event, all finished or unfinished documents, data, studies, surveys, drawings, maps, models, photographs, and reports of other material prepared by the Contractor under this Contract shall, at the option of the State, become its property, and the Contractor shall be entitled to receive just and equitable compensation for any satisfactory work completed on such documents and other materials. Notwithstanding the above, the Contractor shall not be relieved of liability to the State for any damages sustained by the State party by virtue of a breach of the Contract by the Contractor, and the State may withhold any payments to the Contractor for the purpose of setoff until such time as the exact amount of damages due the State from the Contractor is determined. c) Termination for Convenience. The State may terminate this Contract at any time that it determines that the purpose of the distribution of monies under the Contract would no longer be served by completion of the Project. The State shall effect such termination by giving written notice of termination to the Contractor and specifying the effective date thereof, at least twenty (20) days before the effective date of such termination. 8. The Contractor shall adopt a resolution substantially in the form presented by the State, which approves this Contract and authorizes a signatory to execute this Contract. A copy of such resolution shall be attached to and made a part of this Contract. 9. The contractor shall perform its duties hereunder as an independent contractor and not as an employee. Neither the contractor nor any agent or employee of the contractor shall be, or shall be deemed to be, an agent or employee of the state, and they shall have no authorization, express or implied, to bind the state to any agreements, settlements, liability, or understanding except as expressly set forth herein. The contractor shall be responsible to the state for the ultimate results of performance required hereunder but shall not be subject to the direction and control of the state as to the means and methods of accomplishing the results. The specifications in this contract of particular performance standards the state deems essential to proper performance and contract value shall in no event be deemed to alter this relationship. Contractor shall pay when due all required employment taxes and income tax withholding, including all federal and state income tax on any moneys paid pursuant to this grant contract. Page 3 of 7 Pages s The contractor shall provide and keep in force worker's compensation (and show proof of such insurance d unemployment compensation irance in the amounts required by Land shall be solely ressible for the acts of the contractor, employees and agents. The contr for acknowledges that contractor and its employees are not entitled to the benefits of worker's compensation insurance or unemployment insurance unless the contractor or a third party provides such coverage and that the state does not pay for or otherwise provide such coverage. 10. The Special Provisions are attached hereto and hereby made a part hereof as terms and conditions of this contract. 11. Pursuant to CRS 24-30-202.4 (as amended), the state controller may withhold debts owed to state agencies under the vendor offset intercept system for: (a) unpaid child support debt or child support arrearages; (b) unpaid balance of tax, accrued interest, or other charges specified in Article 22, Title 39, CRS, unpaid loans due to the student loan division of the department of higher education; (d) owed amounts required to be paid to the unemployment compensation fund; and (e) other unpaid debts owing to the state or any agency thereof; the amount of which is found to be owing as a result of final agency determination or reduced to judgment as certified by the controller. Page 4 of 7 Pages IN WITNESS WHEREOF, the parties hereto have caused the foregoing contractto'be executed by their duly ,orized officers the day and year fSabove written. City of Vail Contractor: Position: TOWN MANAGER Contractor: Position: Chie APPROVED TO FORM: l City of Vail Attorney 1`q,` y, ; f; OF i,,,,, , Q %' k A E, SEAL i= ATTEST 1IS of ail "" ;;;,<< ", z Chief Clerk Colorado Department of Transportation STATE OF COLORADO BILL OWENS, GOVERNOR By: Tom E. Norton Executive Director Colorado Department of Transportation By: TOM E. TALMADGE Director of Staff Services Colorado Department of Transportation Clerk APPROVALS FOR THE STATE CONTROLLER KEN SALAZAR Attorney GeneralCliffordW. Hall By: GEORGE MCCULLAR, Controller Colorado Department of Transportation By (WAIVED ON F4-17-98) BARRY B. RYAN Assistant Attorney General Civil Litigation Section Page 5 of 7 Pages SPECIAL PROVISIONS CONTROLLER'S APPROVAL 1. This contract shalt not be deemed valid until it shall have been approved by the Controller of the State of Colorado or such assistant as he may designate. This provision it applicable to any contract involving the payment of money by the State. FUND AVAILABILITY 2. Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being appropriated. budgeted. and otherwise made available. BOND REQUIREMENT 3. if this contract involves the payment of more than fifty thousand dollars for the construction, erection. repair, maintenance, or improvement of any building. road. bridge. viaduct. tunnel. excavation or other public work for this State, the contractor shall, before entering upon the performance of any such work includedisthiscontract. duly execute and deliver to the State official who will sign the contract. a good and sufficient bond or other acceptable surety to be approved bysaidofficialinapenalsumnotlessthinone -hallo( the total amount payable by the terms of this contract. Such bond shall be duly executed by a qualified corporatesuretyconditioneduponthefaithfulperformanceofthecontractandinaddition. shall provide that if the contractor or his subcontractors fail to duly pay for anylabor. materials. team hire. sustenance. provisions. provendor or other supplies used or consumed by such contractor or his subcontractor in performance of the workcontractedtohedontorfailstopayanypersonwhosuppliesrentalmachinery. tools. or equipment in the prosecution of the wont the surely will pay the same inanamountnotexceedingthesumspecifiedinthebond. together with interest at the rate of eight per cent per annum. Unless such band is executed. delivered andfiled. no claim in favor of the contractor arising under such contract shall be audited. allowed or paid. A certified or cashier's check or a bank money order payabletotheTreasureroftheStateofColoradomaybeacceptedinlieuofabond. This provision is in compliance with CRS 38-26-106. INDEMNIFICATION 4. To the extent authorized by law. the contractor shall indemnify. save. and hold harmless the State, its employees and agents, against any and all claims. damages. liability and court awards including costs. expenses, and attorney fees incurred as a result of any act or omission by the contractor. or its employees. agents. subcontractors. or assignees pursuant to the terms of this contract. DISCRIMINATION AND AFFIRMATIVE ACTION S. Tante contractor agrees to comply with the letter and spirit of the Colorado Antidiscrimination Act of 1957. as attended. and other applicable kw respectingdiscriminationandunfairetnploymentpractices (CRS 24-34-402), and as required by Executive Order. Equal Opportunity and Affnnati a Action. dated April 16. 1975. Prrrsirant thereto. the following provisions shall be contained In all State contracts or sub -contracts. During the performance of this contract. the contractor agrees as follows: a) The contractor will not discrltainate against any employee or applicant for employment because of race. on so tri calor. plicants attionaanationalorii yidn. sex. marital status. religion, ancestry. mental or physical handicap. or age. The contactor will tale affirmative au that anployees are treated during employ/nem. without regard to the above mentioned acs. Sul# action brad include, but not be limited to the following: employmer upgrading, demotion. or transfer. recruitment or recnduraent advertisings: lay-offs or termination= sties of pay or other forms of compc:tsation: andselectionfortraining, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment. notices to be provided by the contracting officer setting forth provisions of this non-discrimination clause. b) The contractor will. in all solicitations or advertisements for employees placed by or on behalf of the contractor. state that all qualified applicants willreceiveconsiderationforemploymentwithoutregardtorace. creed, color. national origin, sex. marital status. religion, atncestty. mental or physical handicap. or age. c) The contractor will send to each labor vier or representative of workers with which he has a collective bargaining agreement or other contract orunderstanding. notice to be provided by the contracting officer. advising the labor union or workers' representative of the contractor's couuntitiuent under theExecutiveOrder. Equal Opportunity and Affirmative Action, dated April 16, 1975. and of the rules.regulations. and relevant Orders of the Governor. d) The contractor and labor unions wilt furnish all information and reports required by Executive Order. Equal Opportunity and Affirmative Action of April16. 1975, and by the rules. regulations and Orders of the Governor, or pursuant thereto. and will permit access to his books. records, and accounts by thecontractingagencyandtheofficeoftheGovernororhisdesigneeforpurposesofinvestigationtoascertaincompliancewithsuchrules. regutatioas and orders. e) A labor organisation will not exclude any individual otherwise qualified from full membership rights in such labor organization. or expel any such individualfrommembershipinsuchlabororganizationordiscriminateagainstanyofitsmembersinthefullenjoymentofworkopportunitybecauseofrace. creed. color. sex. national origin, or ancestry. f) A labor organization. or the employees or members thereof will not aid. abet. incite. compel or coerce the doing of any act defined in this contract to bediscriminatoryorobstructorpreventanypersonfromcomplyingwiththeprovisionsofthiscontractoranyorderissuedthereunder: or attempt, either directly or indirectly. to commit any act defined in this contract to be discriminatory. Form 6•AC.02a Revised 1/'43 31S-53-01-1022 page__1-- of —2— pages g) In the evt the contractor's non-compliance with the non -disc don clauses of this contract or with any of such reguiations. or orders, this contract may be canceled. terminated or suspended in whole or in art and the contractor may be declared ineligible fo er State contracts in accordance with procedures. authorized in Executive Order. Equal Opportunity and Affirmative Action of April 16. 1975 and the rules, regulations. ororderspromulgatedinaccordancetherewith, and such other sanctions as may be imposed and remedies as may be invoked as provided in Executive Order, Equal Opportunity and Affirmative Action of April 16. 1975. or by rules, regulations, or orders promulgated in accordance therewith, or as otherwise provided by Iaw. h) The contractor will include the provisions of paragraphs (a) through (h) in every sub -contract and subcontractor purchase order unless exempted byrules. regulations. or orders issued pursuant to Executive Order. Equal Opportunity and Affirmative Action of April 16, 1975. so that such provisions willbebindinguponeachsubcontractororvendor. The contractor will take such action with respect to any sub -contracting or purchase order as the contractingagencymaydirect. as a means of enforcing such provisions. including sanctions for non-compliance: provided. however. that in the event the contractorbecomesinvolvedin, or is threatened with, litigation. with the subcontractor or vendor as a result of such direction by the contracting agency. the contractormayrequesttheStateofColoradotoenterintosuchlitigationtoprotecttheinterestoftheStateofColorado. COLORADO LABOR PREFERENCE 6a. Provisions of CRS 8-17-101 & 102 for preference of Colorado labor arc applicable to this contract if public works within the State are undertaken hereunder and are financed in whole or in put by State funds. b. When a construction contract for a public project is to be awarded to a bidder. a resident bidder shall be allowed a preference against a non-resident bidder fromastatenrforeigncountryequaltothepreferencegivena: required by the state or foreign count/}• in which the non-resident bidder is a resident. If it is determined bytheofficerresponsiblefurawardingthebidthatcompliancewiththissuhscciiun .00 may c•aurc denial of fcdcrak funds which would otherwise be available or wouldotherwisebeinconsistentwithrequirementsofFederalIaw, this subsection shall be suspended. but only t0 the extent necessary to prevent denial of the moneys or to eliminate the inconsistency with Federal requirements (CRS 8-19-101 and 102) GENERAL 1. The laws of the State of Colorado and riles and regulations issued pursuant thereto shall be applied in the interpretation. execution. and enforcement of thiscoatrsct. Any provision of this contract whether or not incorporated herein by reference which provides for arbitration by any extra judicial body or person or whichisotherwiseisconflictwithsaidlaws. rules, and regulations shall be considered null and void. Nothing contained in any provision incorporated herein by referencewayofconiptaint, which purports to negate this oranyother special provisionandn is wholee oris f thisshall be valid or provisionforceable or available will not invalidate the in of this contract tany action at law whether o the extent that the defence. or otherwise. Any provision •rendered null and void by the operation contract is capable of execution. E. At all titres during the performance of this contract. the Contractor shalt strictly -adhere to all applicable federal and state laws, rules. and regulations that have been or may hereafter be established. 9. The signatories aver that they are familiar with CRS 18-8-301. et. seq.. (Bribery and Corrupt Influences) and CRS 184-441. et. seq.. (Abuse of Public Office). and that no violation of such provisions is present. 10. The signatories aver that to their knowledge, no state employee has any personal or beneficial interest whatsoever in the service or property described herein: WITNESS WHEREOF. the parties hereto have executed this Contract on the day first above written. Contracto Full Legal Name) Position (Title) If Corporation:) Attest tSeal) By Social Smoky Amber or Federal I.D. Mamba Corporate Secretary. or Equivalent.Too/Cref my Clerk ATTORNEY GEIvER By Fortis 6 -AC -02C Revised 1/93 3954341-1030 STATE OF COLORADO ROY ROMER, GOVERNOR By s EXEcusrvE CTOR DEPARTMENT OF APPROVALS CONTROLLER By Page 2 which is the Lott of pages COLO ' A ' O DEPARTMENT OF RANSPORTATION LEAF NTRACT ATTACHMENT A LEAF OBJECTIVE PLAN LEAF project # L-22-00 Responsible Agency Vail Police Department Contract Period 1-1-00 through 12-31-00 Project Coordinator Sergeant Mike Bulkeley r LEAF Objective: L-22-00: To increase and improve the enforcement of the laws pertaining to alcohol and drug related traffic offenses within the City of Vail by performing the activities described in the Approved Application and summarized below. Activity # Activity Description 1 2 3 4 Provide officers through out the term of this contract to perform DUUDRE enforcement duties and activities within the City of Vail as stated in the Approved Application. Conduct at least TWO sobriety checkpoints or saturation patrols during 2000. This can be in cooperation with a nearby agency, the State Patrol or solely by the Vail Police Department. The Vail Police Department will be actively involved in CDOT's DUI enforcement public awareness campaign by participating in the joint efforts. This includes, but not limited to, obtaining media interviews and media outreach, hosting media ride alongs and similar activities. The Vail Police Department will report back the requested data to CDOT by the specified times. Make all reasonable efforts to increase the DUI alcohol and drug related arrests within the Vail Police Department by 8% from the 1999 level. COLOFDO DEPARTMENT OFRANSPORTATION LEAF CONTRACT ATTACHMENT B LEAF REPORTING CRITERIA LEAF Project # L-22-00 - Vail Police Department 1). Each quarter the Contractor shall submit a report to the Office of Transportation Safety in accordance with the LEAF Contract Management Manual. The Quarterly Reports will state all activity accomplishments as required by Contract Number L-22-00 during the reporting period. The Vail Police Department will use the provided LEAF Grant Manager software package when compiling data and submitting the required reports. All recipients are required to use the software so the Colorado Department of Transportation can better manage the statewide LEAF program. 2). No payment for cost incurred during the reporting period will be reimbursed by the Office of Transportation Safety if such Quarterly Reports are not current or are not compiled using the LEAF Grant Manager software program. 3). Upon completion of all LEAF activity the Vail Police Department will submit a Final Report in accordance with the LEAF Contract Management Manual. COLOO DEPARTMENT OFNSPORTATION LEAF CONTRACT ATTACHMEAT C LEAF Project # L-22-00 - Vail Police Department REVENUES TOTAL LEAF Funds 21,000 Category LEAF Funds Personal Services 20,000 Operating expenses 1,000 Capital equipment 0 Travel expenses 0 TOTAL 21,000 SEP -01-1999 WED 01:38 PM PA/C. LEAF PERSONAL SERVICES LEAF Salaries Position Base pay Benefits FAX NO, P. 06 Total wonting the grant VA No, 0 t L.Z•O Nuruber of units (Months, LEAF COST weeks. dove)... 550 FIE 64-3 , LEAF Overtime Pnsikion Total LEAF salaries TIMM- Overtime rote Number Of hours LEAF COST LEAF Contractual Services Contractor Colorado Department of Health Total LEAF overtime Miretg1 Services LEAF COST Blood alcohol analysis ($15 for each ' J OLJ analysis, $15x$0) Total LEAF contractual services WNW Total LEAF personal services (total of all three sec:lons on thls page) 0 od SEP -01-1999 WED 01:38 PM FAX NO. P..07 Pale- LEAF OPERATING EXPENSES (ter unit under $3,000) • Number Description of units Cost per unit LEAF COST Blood alcohol test kit 90 Postage to mail blood atcahol test kits for analysis 90 Mouthpiece for breath test Silica gel tube for breath test 0,00 $324 3.67 $330,30 135 $.23 $31.05 135 $2.05 $276.75 Total LEAF operating expense ) OC Part E - LEAF CAPITAL EQUIPMENT (Cost per unit $3,000 or more) Number Description of un#ts Cost per unit LEAF COST Teter car. r Total LEAF capital equipment Part F. LEAF TRAVEL AND SUBSISTENCE Purpose LEAF COST Total LEAF travel and subsistence SEP -01-1999 WED 0139 P[1 FAX NO. P G - LEAF BUDGET SUMMARY ice totals tram previous pages) Cost Category LEAF COST • P. 08 PART H - EVALUATION: Evaluation and reporting requirements will be incorporated in the contract. PART 1 - LEAF PROJECT CONTACTS 1. Project Responsibility Name Chief Greg Morrison or his designee. Address 75 South Frorlage Road Vail, CO 81667 Personal Services Mae 2 O, 000 _____, OO 0 2. Accounting records responsibility Name Linda Wolx Address 75 South Frontage Road Vali, CO 81657 Operating Expenses Telephone 970.479.2210 Fax 970.479.2216 E-mail address Capital Equipment liefidalior O' Travel and Subsistence 0 D/6) Total LEAF Funds Requested 2/ 'o PART H - EVALUATION: Evaluation and reporting requirements will be incorporated in the contract. PART 1 - LEAF PROJECT CONTACTS 1. Project Responsibility Name Chief Greg Morrison or his designee. Address 75 South Frorlage Road Vail, CO 81667 3. Project payments mailed to Name Linda Wolx Address 75 South Frontage Road veil. CO 81357 Telephone 970,479.2200 Fax 970,470.2218 E-mail address Telephone 570.479.2210 Fax 970.478,2216 E-mail address 2. Accounting records responsibility Name Linda Wolx Address 75 South Frontage Road Vali, CO 81657 4. Correspondence malted to Name Officer Michael 6ulkeley Address 75 South Frontage Road Vali, CO 91657 Telephone 970.479.2210 Fax 970.479.2216 E-mail address Telephone 970.479.2200 Fax 970.479.2216 E -malt address APPROVED AS WRITTEN APPROVED WITH MODIFICATIONS DISAPPROVED State LEAF Administrator Date