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Home My WebLink About20132674.tiffRESOLUTION RE: APPROVE TWENTY-NINE (29) CHILD PROTECTION AGREEMENTS FOR SERVICES WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN 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 twenty-nine (29) Child Protection Agreements for Services 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 providers listed within Exhibit "A", commencing June 1, 2013, and ending May 31, 2014 with further terms and conditions being as stated in said agreements, and WHEREAS, after review, the Board deems it advisable to approve said agreements, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the twenty-nine (29) Child Protection Agreements for Services 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 providers listed within Exhibit "A", be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreements. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 23rd day of September, A.D., 2013, nunc pro tunc June 1, 2013. BOARD OF COUNTY COMMISSIONERS WELD S NT COLORADO ATTEST .er +A _ Weld County Clerk to the Board BY: Deputy Clerlo the Board APP AS T ounty orney Date of signature: OCT 0 1 2013 ara Kirkmeyer 2013-2674 HR0084 MEMORANDUM DATE: September 19, 2013 TO: William F. Garcia, Chair, Board of FROM: Judy A. Griego, Director, Human S' SUBJECT: �untyeppCom ;cassia ers o14; rtirC` v LLo Child Protection Agreements for Services between the Weld County Department of Human Services and Various Providers Enclosed for Board approval are Child Protection Agreements for Services between the Department and Various Providers. These Agreements were reviewed under the Board's Pass -Around Memorandum dated May 8, 2013, and approved for placement on the Board's Agenda. There are a total of 67 agreements with various providers; the first 11 agreements were approved by the Board on July 22, 2013, the next set of agreements were approve by the Board on August 14, 2013, the following represent 29 agreements received leaving 9 agreements needing to be signed by the Board Chair. The major provisions of these Agreements are as follows: No. Provider Program Area/ Funding Source PY13-14 Rate(s) 1 Arapahoe House 06/01/13 -05/31/14 Monitored Sobriety Services CW Admin $14.55/Episode(Breathalyzer) $41.58/Episode (Drug Patch) $64.88/Episode (Hair Follicle Test) $25.61/Episode (Urinalysis) 2 Devereux, Cleo Wallace 06/01/13 - 05/31/14 Day Treatment Core $90.00/Day 3 Devereux, Cleo Wallace 06/01/13 - 05/31/14 Home Based Intensive Services (Transition Services) Core $1,650.00/Month 4 Kerrigan, Ph.D., Laurence P. 06/01/13 - 05/31/14 Sexual Abuse Treatment (Safe -T Program Core $110.00/Hour $100.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) 5 Lutheran Family Services Rocky Mountains 06/01/13 - 05/31/14 Foster Parent Consultation Core $105.00/Hour (Greeley Metro Area - Greeley, La Salle, Eaton, and Windsor) $115.00/Hour (Outside Greeley Metro Area) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) 6 Lutheran Family Services Rocky Mountains 06/01/13 - 05/31/14 Home Based Intensive Services Core $105.00/Hour (Home Based Intensive Services) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) 7 Lutheran Family Services Rocky Mountains 06/01/13 - 05/31/14 Home Studies CW Admin $1,000.00/Episode (Home Study - English) $1,600.00/Episode (Home Study - Spanish) $100.00/Adult (Additional Adult) $250.00/Episode (Partial Home Study) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) 8 Lutheran Family Services Rocky Mountains 06/01/13 - 05/31/14 Life Skills Core $80.00/Hour (Supervised Visitation) $45.00/Hour (Monitored Visitation, Safe Exchange) $105.00/Hour (Therapeutic Visitation - Family Therapy Level) $95.00 (Therapeutic Visitation - Level 2 and 3, Parent Coach) $85.00 (Therapeutic Visitation - Level 1) $75.00/Hour (Court Staffing/Court Facilitation/Family Team Meeting/Team Decision Making Meeting) 9 Milestones Counseling Services 06/01/13 - 05/31/14 Foster Parent Consultation Core $90.00/Hour (Within 30 miles of Greeley) $115.00/Hour (Outside 30 miles radius of Greeley) 10 Milestones Counseling Services 06/01/13 - 05/31/14 Home Study and Relinquishment Counseling CW Admin $1,000.00/Episode (Full Study within 30 miles of Greeley) $1,150.00/Episode (Full Study outside 30 miles radius of Greeley) $250.00/Adult (Additional Adult) $600.00/Episode (Home Study Update within 30 miles of Greeley) $650.00/Episode (Home Study Update outside 30 mile radius of Greeley) $250.00/Episode (Cancellation Fee) $90.00/Hour (Relinquishment Counseling) 11 Mount St. Vincent Home, Inc. 06/01/13 - 05/31/14 Day Treatment Core $105.00/Day 12 Mount St. Vincent Home, Inc. 06/01/13 -05/31/14 Home Based Intensive Services Core $600.00/Month (Low, 1-3 Hours/Week) $1,400.00/Month (Moderate, 4-6 Hours/Week) $2,100.00/Month (High, 7-9 Hours/Week) $75.00/Hour (Hourly Rate) 13 Perklen Center for Psychotherapy 06/01/13 - 05/31/14 Anger Management/ Domestic Violence CW Admin $210.00/Episode (Anger Management/ Domestic Violence Evaluation) $70.00/Hour (Anger Management/Domestic Violence Evaluation - Hourly Rate not to exceed full evaluation) $575.00/Episode (Domestic Violence Assessment) $144.00/Hour (Domestic Violence Assessment Hourly Rate — Not to exceed cost of full assessment) $20.00/Hour (Domestic Violence Education Session/Caring Dads Group/Mothers Parenting Group) $37.50/Episode (Standard Group Session) $70.00/Hour (Domestic Violence Impact - 4 Hours Minimum/Individual Therapy Session -In Office) $85.00/Hour (Individual Therapy Session -Out of Office) $90.00/Hour (Family Therapy Session -In Office) 14 Perklen Center for Psychotherapy 06/01/13 - 05/31/14 Mental Health Services Core $575.00/Episode (Mental Health Evaluation with HARE, PCLR, VRAG) $144.00/Hour (Mental Health Evaluation - Hourly Rate for Partial Completed Evaluations) $50.00/Episode (Additional fee for evaluations conducted at the jail) $70.00/Episode (Individual Therapy Session -In Office) $85.00/Episode (Individual Therapy Session - Out of Office) $90.00/Episode (Family Therapy Session -In Office) 15 Perklen Center for Psychotherapy 06/01/13 - 05/31/14 Sex Abuse Treatment Core $70.00/Hour (Individual Therapy Session -In Office) $85.00/Hour (Individual Therapy Session -Out of Office) $90.00/Hour (Family Therapy Session -In Office) $70.00/Episode (Juvenile Sex Offender (JSO) - Intake) $37.50/Episode (JSO or SO Group Session/JSO or SO Education Group Session/Phase I, III or IV SO Treatment Group Session) $450.00/Episode (JSO Evaluation w/o testing, 13 years and younger) $600.00/Episode (JSO Evaluation w/ testing, no PPG/Abel, 14 years or older/SO Evaluation w/o testing or PPG/Abel, Adult/SO Updated Evaluation -Adult) $900.00/Episode (JSO Evaluation w/ testing and PPG and Abel/SO Evaluation with PPG/Abel, Adult) $800.00/Episode (SO Evaluation with no PPG/Abel-Adult) $150.00/Hour (Hourly Rate for Partial Adult/ JSO Evaluations. Not to exceed cost of full evaluation.) $50.00/Episode (Additional Charge per Evaluation for Evaluations Completed Off -Site) $95.00/Episode (SO Deniers Treatment Session) $42.00/Episode (SO Phase II Treatment Group Session) 16 Reflections for Youth, Inc. 06/01/13 — 05/31/14 Day Treatment Services Core $114.50/Day (Regular day Treatment — No Enhancements) $130.00/Day (Day Treatment -1 Enhancement) $159.00/Day (Day Treatment -2 Enhancements or 1 Enhancements Doubled) $175.00/Day (Day Treatment -3 Enhancements) 17 Reflections for Youth, Inc. 06/01/13 — 05/31/14 Home Based Intensive Services Core $316.00/Week (Permanency Services/Support Level — 10 Hours/Week YFA, No Therapy) $510.00/Week (Permanency Services/ Stabilization — 20 Hours/Week YFA, No Therapy) $413.00/Week (Permanency Services/Step- down Level -- 15 Hours/Week YFA and up to 4 Hours Therapy/Week) $560.00.Week (Permanency Services/Support Level — 10 Hours/Week YFA and Up to 4 Hours Therapy/Week) $785.00/Week (Permanency Services/ Stabilization Level — 20 Hours/Week YFA and Up to 6 Hours Therapy/Week) $1,040.00/Week (Permanency Services/Safety Level - 30 Hours/Week YFA and Up to 6 Hours Therapy/Week) $673.00/Week (Permanency Services/Step- down Level - 15 Hours/Week YFA and Up to 6 Hours Therapy/Week) 18 Shiloh Home, Inc. 06/01/13 — 05/31-14 Day Treatment Core $1,625.00/Month (Pro -Rated for any partial month of service) $75.00/Hour (Interpreter) 19 Shiloh Home, Inc. 06/01/13 — 05/31-14 Mental Health Services Core $75.00/Hour (Individual or Family Therapy Session. Interpreter) $45.00/Hour (Group Therapy Session) $95.00/Hour (Family Therapy — In -Home) $120.00/Hour (Psychological Evaluation) 20 Shiloh Home, Inc. 06/01/13 — 05/31-14 Sexual Abuse Treatment Core $75.00/Hour (Individual or Family Therapy Session. Interpreter) $45.00/Hour (Group Therapy Session) $95.00/Hour (Family Therapy —hi-Home) $120.00/Hour (Psychological Evaluation) 21 Stepping Stones, Inc. 06/01/13 — 05/31-14 Life Skills Core $55.00/Hour (Life Skills — within Weld County, Fort Collins, Loveland or Longmont) $85.00/Hour (Life Skills, outside Weld County, Fort Collins, Loveland or Longmont) $55.00/Hour (Court Facilitation/Court Staffing/ Family Team Meeting/Team Decision Making Meeting — within Weld County, Fort Collins Loveland or Longmont) $85.00/Hour (Court Facilitation/Court Staffing/ Family Team Meeting/Team Decision Making Meeting — outside Weld County, Fort Collins Loveland or Longmont) 22 Strong Foundations, LLC 06/01/13 — 05/31/14 Home Based Intensive Services Core $50.00/Hour (Home Based Intensive Services, Face -to -Face) 23 Strong Foundations, LLC 06/01/13 - 05/31/14 Foster Parent Consultation Core $100.00/Hour (Foster Parent Consultation, Face -to -Face) 24 Strong Foundations, LLC 06/01/13 - 05/31/14 Foster Parent Training CW Admin $150.00/Person (Foster Parent Training — 12 Hours/State Requirement) $200.00/Hour/Couple (Foster Parent Training/Topic Specific — 2 Hours) $100.00/Hour/Individual (Foster Parenting Training/Topic Specific — 2 Hours 25 Strong Foundations, LLC 06/01/13 - 05/31/14 Home Study and Relinquishment Counseling Services CW Admin $950.00/Episode (Full Home Study — Up to 2 Adults) $425.00/Episode (Home Study Update) $250.00/Person (Additional Adult — After 2 Adults) $225.00/Episode (Study Cancelled After 3.5 Hours Direct Service) $300.00/Episode (Flat Rate for Interpretive Services/Family Home Study) $150.00/Episode (Flat Rate for Interpretive Services/Individual Home Study) $110.00/Hour (Relinquishment Counseling) 26 Turning Point Center for Youth and Family Development, Inc. 06/01/13 - 05/31/14 Day Treatment Core $90.00/Day (Day Treatment w/ In -Home Family Therapy) $80.00/Day (Day Treatment w/o In -Home Family Therapy) $65.00/Day (Day Treatment — Transitional Service w/ In -Home Family Therapy) $55.00/Day (Day Treatment — Transitional Service w/o In -Home Family Therapy) 27 Turning Point Center for Youth and Family Development, Inc. 06/01/13 - 05/31/14 Home Based Intensive Services Core $25.00/Hour (Coaching. Enhanced Coaching. Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting - Coaches) $12.50/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting -Coaching Program Supervisor Only) $900.00/Month (Family Care Coordination. Pro -rated for any partial month of service) $600.00/Month (Family Care Coordination Light. Pro -rated for any partial month of service) 28 Turning Point Center for Youth and Family Development, Inc. 06/01/13 - 05/31/14 Mental Health Services Core $86.00/Hour (Individual/Family Therapy, In - Home. Greeley Metro Area — Greeley, Evans, LaSalle, Eaton and Windsor) $126.00/Hour (Individual/Family Therapy, In - Home. Outside Greeley Metro Area) $68.00/Hour (Individual/Family Therapy, In - Office) $34.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting — Service in Office) $43.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting -Service in Home, Greeley Metro Area) $63.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting — Service in Home, Outside Greeley Metro Area) 29 Turning Point Center for Youth and Family Development, Inc. 06/01/13 -.05/31/14 Substance Abuse Treatment CW Admin $68.00/Sesion (Individual/Family Therapy Session, In -Office) $26.00/Client/Session (Group Therapy Session) $90.00/Session (Intensive Outpatient Evening Session) $16.00/Episode (Urinalysis) $3.00/Episode (Breathalyzer) $34.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) If you have any questions, give me a call at extension 6510. PY-13-14- CPS -0134 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ARAPAHOE HOUSE 1O-9 Arthyl— Air 7' a This Agreement, made and entered into theo8 day of 2013, by and between the Board of Weld County Commissioners, hereinafter referred to as the "Department" and Arapahoe House, hereinafter referr to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Monitored Sobriety Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria 1 PV -13-14- CPS -0134 established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. sec. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14- CPS -0134 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.5.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14- CPS -0134 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14- CPS -0134 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14- CPS -0134 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14- CPS -0134 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Arthur J. Schut Name 17. Notice Administrator Title Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970)352-1551 18. Litigation For Contractor: Arthur J. Schut, Chief Executive Office 8801 Lipan Street Thornton, CO 80260 (303) 412-3678 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14- CPS -0134 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14- CPS -0134 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality 9 PY-13-14- CPS -0134 agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PV -13-14- CPS -0134 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: • Weld County Clerk to the Board By: APPRO 4241414091 na 1 Deputy Clerk t e Board ttorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNT(COMMISSIONERS WELD COUNCO ORADO ,.fin r// 1 NI 2Y illiam F. Garcia, Chair CONTRACTOR: By: Title SEP 2 3 2013 166 opois- 7V PY-13-14- CPS -0134 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide timely and quality monitored sobriety services to male and female clients referred by the Department as follows: 2. Services are available at the following locations: Aurora Outpatient Clinic 2600 South Parker Road, Building 5, 2"d Floor Aurora, CO 80014 (303) 412-3791 Monday -Friday (8 a.m.-8 p.m.) Saturday (7:30 a.m.-2:30 p.m.), Sunday (6:30 a.m.-2:30 p.m.) Denver Outpatient Clinic 55 West 5th Avenue Denver, CO 80204 (303) 412-3861 Monday -Friday (12 p.m.- 6 p.m.) Saturday (9 a.m.-2:30 p.m.) Sunday (Closed) Lakewood Outpatient Clinic 11495 West 8th Avenue, #102 Lakewood, CO 80215 (303) 412-3721 Monday -Friday (8 a.m.-8 p.m.) Saturday (8 a.m.-2:30 p.m.) Sunday (Closed) North Metro Outpatient Clinic 720 West 84th Avenue, #224 Thornton, CO 80260 (303) 412-3801 Monday -Friday (8 a.m.-8 p.m.) Saturday (8:30 a.m.-3:30 p.m.) Sunday (9:30 a.m.-3:30 p.m.) Washington House Outpatient Clinic 7373 Birch Street Commerce City, CO 80022 (303) 412-3970 Monday and Friday (8 a.m.-5:30 p.m.) Tuesday, Wednesday and Thursday (9:30 a.m.-6 p.m.) Saturday (6:30 a.m.-1:30 p.m.) Sunday (8:30 a.m.-2:30 p.m.) 3. CONTRACTOR will provide a qualified monitored sobriety collector for the times and locations noted above. 4. CONTRACTOR will confirm all positive and negative monitored sobriety results within 24 hours through a phone call, test result, e-mail and/or fax to the Department. 12 PY-13-14- CPS -0134 5. CONTRACTOR will submit a copy of the valid Authorization for Services form, result and client sign -in sheet (if applicable) with each monthly billing. 13 PY-13-14- CPS -0134 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $14.55/Episode (Breathalyzer) $25.61/Episode (Urinalysis) $41.58/Episode (Drug Patch) $64.88/Episode (Hair Follicle Test) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PV -13-14- CPS -0134 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14- CPS -0134 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14- CPS -0134 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14- CPS -0134 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14- CPS -0134 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7`h of the month may result in delay of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14- CPS -0134 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 20 PY-12-13-CPS-0132 ){ 0 co ]kf7_ 5.110 0 CO CO %y 3 3 ) \w ■c 0)22 00 LO 01 J k] o/ \ a 0 o 3§§ % 3 20 t aa c 15 co e) ; \ }/A] G o 0=— *)7 LO - co co )) " WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-12-13-CPS-0132 CONTRACTED SERVICES CUENT VERIFICATION FORM Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by dient) Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) co .m ro Attach all client verification. forms to the monthly billing when submitting your billing. All requests for payment must be received by the 7'" day of the month following PY-13-14-CORE-0218 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND DEVEREUX CLEO WALLACE a This Agreement, made and entered into the .°15_ day ofSe, 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Devereux Cleo Wallace, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 PY-13-14-CORE-0218 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PV -13 -14 -CORE -0218 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0218 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0218 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0218 11. Training CONTRACTOR may be required to attend training at the request of the Department specificto services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a, Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0218 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Perry May Name 17. Notice Administrator Title Assistant Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Perry May, Assistant Executive Director 8405 Church Ranch Boulevard Westminster, CO 80021 (303) 438-2202 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0218 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17, No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0218 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality 9 PY-13-14-CORE-0218 agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0218 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: CONTRACTOR: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO I' By: Contractor FKUar id, Chain SEP 2 32013 Arai Vainf)rf i ralk-Rt Contract MAMCt Title J ow.* h 2 51. PY-13-14-CORE-0218 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Day Treatment services to youth at 8405 Church Ranch Boulevard in Westminster, CO 80021, as referred by the Department. 2. Services are available to youth who in the Denver Metro area, as well as the neighboring towns along the Interstate 25/Highway 34 corridor up to Fort Collins and as far east as Greeley including the towns of Firestone, Evans, La Salle, Windsor, Johnstown, and Eaton. 3. Services are targeted at youth who exhibit behaviors which prevent them from attending public school. CONTRACTOR will accept both regular and special education youth. 4. CONTRACTOR will complete an evaluation of the referred youth's academic areas in order to earn specific credit from their home school district. For non -special education certified youth, CONTRACTOR will expedite the process for special education certification by completing special education assessments acceptable to the home school district within the first forty-five (45) days from admission. 5. Services within the Day Treatment Program include: a. Weekly individual, group, and family therapy or as determined by the Multi -Disciplinary Team. Therapy services may occur in -home or at the facility, as appropriate. b. Six (6) hours of academic instruction daily in a structured therapeutic environment. c. Educational evaluation, if needed, including assessment of special education services. d. Psychiatric evaluation and treatment including medication monitoring, if needed. e. Substance abuse evaluation and treatment if needed. f. Sexual offender treatment for adjudicated sexual offenders and youth who have been identified to have sexual perpetration and/or victim issues. Structured recreation therapy on and off site. g. h. Independent living instruction for youth ages sixteen (16) and older. i. Transition services for return to public school when youth when deemed appropriate. 6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12 PY-13-14-CORE-0218 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 11. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0218 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $90.00/Day (Day Treatment) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0218 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0218 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0218 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy) each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0218 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0218 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0218 0 ` O Q ▪ N O a)' a)) • u - (OTo E Z '' N w co Li - LL N u,< Q) N O 0,- M t CCO Y'5, Co) COLC CO O — = N CO MX CV CD cc) cm 0moo m (n-1>IQ_U� �� 0 F- O I- Z 0 O 0 h H Z W 0) W J J_ Z J W O X Z_ U) U) 2 a) CC (,-4 0 • IL � N aEI (1) .8 • O ,i O ai ▪ Z 7 o O Win. a 32 ro a) • •Z 0 • co ) a) a) Co U) N w J X W o N Q Eco- g .o o Q, Q- 0 For Use By Human ServiCa. __— Only Ip,nthly Total (calculates automatically) Comments . 0• o II ..1 I I ::1'' "' I III " I I I 1 0 ,o a) '3 :. coN O to,_c c 0.1 0 U) oa) (13 N a O <I O 4 N rn a) CO O OCO - - N O O oCO TOTALS (Calculate Automatically) Approved End Date (Per referral) rn 0 O N O C) O Approved Start Date (Per referral) a) 0 O N Household Number (Per referral) U) U) U) U) «) LO Trails Case ID (Per referral) CO CO CO V' u) W r' Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0218 CONTRACTED SERVICES CLIENT VERIFICATION FORM Z z Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) L w O U a C V V d U w U v W 0 z U a8 V H L T •O O il.. a) Y aJ W a) a) a) V N U O E as II c a d � J x Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) Y O es C 2 w .O RC 'CS L CJ C r°8 0 -• C a! Af z O V u d ~ N 0 2.t a) 0 u E z PY-13-14-CORE-0236 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND DEVEREUX CLEO WALLACE 1,02 This Agreement, made and entered into ther7t9 day of , 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Devereux Cleo Wallace, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services (Individual Transition Services); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 PY-13-14-CORE-0236 Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0236 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0236 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress overtime. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0236 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0236 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15, Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0236 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Perry May Name 17. Notice Administrator Title Assistant Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 1970)352-1551 18. Litigation For Contractor: Perry May, Assistant Executive Director 8405 Church Ranch Boulevard Westminster, CO 80021 (303) 438-2202 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0236 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17, No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0236 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality 9 PY-13-14-CORE-0236 agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0236 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS rye WELD COUNTY COLORADO OVAA-0. -NJ . -' 7 Weld County Clerk to the Board By: Deputy Clerk to the Board WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 By: CONTRACTOR: Garcia, Chair SEP 2 3 2013 ContXtfilwL— ra tc Gi JdA tI remit Y .44,\a Title PY-13-14-CORE-0236 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Individual Transition Services to youth, as referred by the Department. 2. Services are available to youth ages 14 to 21 and their families who are currently involved with Child Welfare, and require guidance and support connecting to resources and activities, or are in the process of transitioning back to their community. 3, The goal of services is to build skills, supports, activities and guidance to facilitate the youth functioning successfully within their community. 4. Referred youth will receive approximately five (5) hours face-to-face time per week for three (3) to five (5) months dependent upon whether or not the youth is transitioning from placement and the specific needs of the youth. 5. Individual services include: a. Resource Identification and Connection: Identification of specific resources that the referred youth and/or family may need. Resources may include, but are not limited to, the following: i. Mental health resources ii. Free/discounted healthcare Hi. Drug/alcohol groups iv. After school activities/sports v. Social groups/activities vi. Crisis support b. Urinalysis: Collection and processing of urinalysis samples on site by qualified staff. c. Independent Living Skills Development/Vocational Support: Completion of the Ansell Casey Assessment with the referred youth, as well as discussion with the treatment team, to determine vocational and independent living needs and goals to ensure the youth's success in the community. The vocation support and independent living skills curriculum is based on the Tri-County Youth Council "Get a Life" curriculum which includes the following categories: i. Housing: CONTRACTOR will assist you in finding appropriate housing within the community, including researching low-income housing, assisting with the completion of applications for financial assistance, filling out lease paperwork, assisting with the purchase of furniture and supplies, and teaching youth the necessary skills to be a reliable tenant. H. Employment: CONTRACTOR will assist the youth in finding employment by completing a career assessment to learn the youth's career interests, searching for potential job placements, assisting with the completion of applications, interview preparation, resume development, and teaching/coaching the youth about skills necessary to be successful in the workplace. Education/General School Support: CONTRACTOR will provide support and mentoring to ensure the youth's success in school. This will include facilitating meetings with teachers and school staff, checking with the youth and assisting with issue resolution. Check -ins will include going over current functioning at school, homework completion, checking online (Infinite Campus) if available, and checking in with teachers. If youth has graduated from high school or earned a GED, services will include assisting youth with enrollment in a post -secondary vocational program through identification of potential schools, completion of applications and coordinating transportation. 12 PY-13-14-CORE-0236 iv. Adult Life Functioning: CONTRACTOR will assist the youth with developing daily living skills, cooking and nutrition, banking, budgeting, credit/debit skills, leisure activities, communication skills, interpersonal relationship skills, transportation options. v. Health and Safety: CONTRACTOR will assist the youth in finding health insurance, locating healthcare providers, obtaining medications when necessary, enrolling in SSI and attending to medical needs as they arise. vi. Family Intervention: CONTRACTOR will assist the youth in navigating situations and crises that may arise. If therapy is indicated, the CONTRACTOR will work the Department to determine how best to facilitate services. vii. Mentoring: CONTRACTOR will identify appropriate adult role models and mentors for youth to assist in the development of skills necessary to be successful in their community. Adult role models will be paired with youth based upon youth's interest and preferred activities when possible. 6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8, CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 11. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0236 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,650.00/Month (Transition Services, Pro -rated for any partial month of service.) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0236 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0236 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0236 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy) each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0236 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0236 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0236 0 I — U I- Z 0 U 0 I- z W W J J O Z J W U X W Z_ 2 a) cc Q Cl) N E FLU V a• >- > z 3 O U U)a. -O 3� a) Q a L m a) L_ U_ • E O 2u) a) To a) 2 t/) Y y J w O U Q Em c�a c O O 00 For Use By Homan Services -_ Only Comments - 4. a ..+Q ., r: 1: z}F': . ..s:. r Monthly Total (Calculates automatically) 300.00 •t' 4'':. - sa'. CP O Q V). L a3 t O L E x n2 OD In N co a) f0 ` C '— O N Q r °.- a 12 'Pi .-. O N U a) 0 0woo N O O z s • ': TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) W O O N W Household Number (Per referral) 555555 Trails Case ID (Per referral) - I 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0236 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) N Ci Ol 0 d O C O a 3 • E t, u a • O N 61 6 r c � E T „Cj o_ Oro '111' e o `1 N o d O V t- 2 N N L O E y ro s E -a c01, E o y 0 C O O C 3 L � 4! •`.? J • U L N Y w 7/ C E E o m • a E E L o C O C C E o V u _ 0 'CD • J • C Le O C 7 N Section I: (To be completed by the CONTRACTOR) Total Hours Billed O I - Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) aa Q O c C cO E tc O A v L u E C d to V,cr ec c C1 Lc O u A °i SV a N O v L M • E O L z .. PY-13-14-CORE-0227 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LAURENCE P. KERRIGAN, PH.D. This Agreement, made and entered into the 4. day of j4 ' ., 2013, by and between the Board of Weld County Commissioners, hereinafter referred to as the "Department' and Laurence P. Kerrigan, Ph.D., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Sexual Abuse Treatment (Safe -T Program); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria 1. aei9-,2126 757 PY-13-14-CORE-0227 established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.• and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0227 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of theoffenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0227 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress overtime. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0227 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease, covering all employees at work site. General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0227 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0227 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Laurence P. Kerrigan, Ph.D. Name 17. Notice Administrator Title Psychologist Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Laurence P. Kerrigan, Psychologist 1750 25th Avenue, Ste. 101-B Greeley, CO 80634 {970) 353-7526 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0227 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0227 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PY-13-14-CORE-0227 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0227 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk o the Board WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COU TY9OLORADO William F. Garcia, Chair CONTRACTOR: By: SEP 2 3 2013 C�rrdr 1O:c �ssy �' Contractdr LL (1/;N;/-ef7 yr .rlTi� i.5 Title ,...4547.0,‘9 PY-13-14-CORE-0227 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide time -limited, outcome focused individual therapy for the treatment of the non -offending parent (adults) in sexual abuse cases referred by the Department. These services are formerly known as Part A of the Safe -T Program (Sexual Abuse Family Education and Treatment Program). 2. Services will be provided at 1750 25th Avenue, Suite 101-B, in Greeley. 3. All services will be provided by Laurence P. Kerrigan, Ph.D., also known as Larry Kerrigan, Ph.D. 4. Services will include the implementation of a plan with the non -offending adult parent to increase safety and avoid repetition of sexual abuse in the family unit. The referred client will explore and identify, through psychological and educational processes, the factors that contributed to the abuse and how to appropriately deal with those factors to eliminate these factors and avoid repetition of the abuse in the future. 5. Non -offending adult parents are considered appropriate for this program if the sexual abuse and its implications have resulted in: a. Imminent out -of -home placement of the child(ren); and/or b. A need for reunification; and/or c. The family facing imminent reunification failure; and/or d. The family has failed to implement the behaviors required of them. 6. Services will be provided over no more than fifteen (15) one -hour sessions, occurring over a maximum of four (4) months. 7. CONTRACTOR will utilize the "Connections Workbook" as a guide to structure the individual therapy of the non -offending adult parent. The workbook denotes clearly defined, achievable, structured behavioral changes that are needed to ensure future safety and develop a written safety plan. 8. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 PY-13-14-CORE-0227 12. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0227 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $110.00/Hour (Face-to-face Services) $100.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CORE-0227 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0227 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0227 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0227 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0227 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0237 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into the,-fi day ofSj'J/ , 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Lutheran Family Services Rocky Mountains, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Foster Parent Consultation (FPC); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. aQi3-d6?y PY-13-14-CORE-0237 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7ih day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-CORE-0237 All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative stepsbe taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. H. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0237 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this 4 PY-13-14-CORE-0237 Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0237 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0237 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: James Barclay Name 17. Notice Administrator Title President/Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: James Barclay, President/Chief Executive Officer 363 South Harlan Street, Suite 200 Lakewood, CO 80226 (303) 217-5830 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0237 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0237 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PY-13-14-CORE-0237 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0237 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: 14, Weld County Clerk to the Board By: APPR Cou,. y Attorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNyY,r COLORADO illiamX. Garcia, Chair SEP232013 CONTRACTOR Title a� - (24 71e PY-13-14-CORE-0237 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Foster Parent Consultation (FPC) services to foster children and families referred by the Department who are in need of in -home services to successfully parent specific children in the foster home. 2. The purpose of this service is to serve foster children and families who are struggling with issues and/or conflict that have the potential to disrupt the placement. 3. FPC services are designed to strengthen and preserve foster families by providing time -limited home -based services using flexible, individual service modalities as appropriate based on the child and family's strengths and specific needs. Skills taught and modeled in sessions are designed to educate foster parents on the effects trauma and/or neglect can have on children and how to cope with "survival" behaviors often exhibited by children who have experienced trauma and/or neglect. 4. Clinicians will work with referred child and family to create jointly defined goals and objectives as a guide to services, including implementation of behavior modification techniques known to successfully address challenging behaviors. 5. CONTRACTOR can provide bilingual services (Spanish). 6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 11. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 12 PY-13-14-CORE-0237 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $105.00/Hour (Greeley Metro Area - Greeley, La Salle, Eaton and Windsor) $115.00/Hour (Outside Greeley Metro Area/South County including Gilcrest, Frederick, Firestone, Dacono, Ft. Lupton, Lochbuie, and Hudson) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 13 PY-13-14-CORE-0237 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0237 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0237 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0237 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy) each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0237 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0237 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 y PY-13-14-CORE-0237 -CO To co /\ } \ a0 = D "C <o Ib@± CV \\ t CD O CV O Ja o 7JRf LO LO LO LO oo co IcE a) 0a O WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0237 L3_ O H U z O � 9. O2 o �- Hz W V • O LL ig W GI ▪ O O z O uJ J a_ c C a N -17 al `° 'O CU O 0 v — E In al N u al cu a • a O C ▪ ? CU r E � • N a o ro a C 6 O aJ N O Z ai o u o aJ ° N r O E • E ac E @ m E v O C O ra ra 3 V-. • aJ > n y k O w al Q, al o �. ✓ ra . a E E ✓ LL C C o o E ra V_ u a L a, VI aJ QJ ▪ al c u • v v c -° .ha a) 0J v ra 4.4 O. C O` ✓ n O. �, fa N O G-0 g ,a z Q o O 0.474 ▪ u V • N a O z Section I: (To be completed by the CONTRACTOR) Total Hours Billed CO F- Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) 12 C O V m 0 U a) U w 0 e) 12 N a) U F z O V C) a) O r Co a. v O m L ai C) V `a ro on CJ u H 0 u E V r a -o v C) .0 O a a, R C CO H . 7 • ea 1) V ' o C Y i U ro L • C L R z� Number of Hours of Service Provided Hours of Service m N 0 X w aJ a d by the 7"' day of th requests for pa ion forms to t c Attach all client v Qom. C g z Z O 0 r o y O 0 E o ar z PY-13-14-CORE-0187 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into the 0,; day o 2013, by and between the Board of° Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred' to as the "Department" and Lutheran Family Services Rocky Mountains, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 aaL3- a47/ PY-13-14-CORE-0187 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.• and 2 PY-13-14-CORE-0187 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0187 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this 4 PY-13-14-CORE-0187 Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0187 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows; a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0187 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: James Barclay Name 17. Notice Administrator Title President/Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: James Barclay, President/Chief Executive Officer 363 South Harlan Street, Suite 200 Lakewood, CO 80226 (303) 217-5830 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0187 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0187 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PY-13-14-CORE-0187 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0187 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: AP y Attorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COU TY COMMISSIONERS WELD COU.N IY COLORADO Garcia, air SEP 2 3 2013 Title 02©83- X67 PY-13-14-CORE-0187 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Therapy (HBT) Services to families referred by the Department. 2. Services are designed for families with children at risk of out -of -home placement or whose children have recently transitioned home. Services promote the safety and well being of children and their family members by reducing the risk of child maltreatment in the home. 3. CONTRACTOR will provide services utilizing flexible, individualized service modalities based upon the family's strengths and needs. The goal of services is to help parents improve their parenting abilities, identify parental and familial strengths, identify and link families to community resources and source of support, and support parents in appropriately caring for their children. 4. Services are: a. Short Term (Average of 10 weeks of service.) b. Intensive (Maximum of 20 hours of direct service, averaging two hours of direct service per week.) c. Home -Based (Service is provided in the clients natural environment.) d. Individualized (Treatment focuses on the family's strengths and needs.) e. Solution -Focused (Services focus on the areas of greatest need.) f. Strength -Oriented (Interventions build upon behavioral strengths in the family.) g. Approached as a partnership between the clinician and the family. 5. Families must be receptive to services; however, CONTRACTOR will accept referrals for non -receptive families when the courts have ordered participation. 6. CONTRACTOR can provide bilingual services (Spanish). 7. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 11. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12 PY-13-14-CORE-0187 12. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0187 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $105.00/Hour (Home Based Intensive Services) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0187 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0187 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0187 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy) each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0187 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0187 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0187 m �. N z X N LL o < N N L N 'r f� �z+'EM(Ot)(O o c o O9 7 F- oo x �n g, V c m t•7 Ch E •a) O O -OOT) O N N ti O F- U H Z 0 V 0 F- I — z LLI U) LU J 0 Z J LL] 0 X Li 0) • 2 a) Q o • N ID a) I — E) j Q >,d'Z c O = - LU a)FifQ Ta a) U) 42 N J X W (2 U < a) E cv c a) o O 0_ For Use By Human Services' -En- Only 'T Comments Monthly Total (Calculates automatically) O O O v.) II I I o i O p cf.) wN 5 :,-•' (0 o , c Q' QX o D N V N L _ '5. �1O L /y�J1 < I o _I a N U_ a) oOU) 06/01, 06/02 TOTALS (Calculate Automatically) Approved End Date i (Per referral) 8/30/2009 Approved Start Date (Per referral) rn O O N (O Household Number (Per referral) U) to LO lf) Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0187 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) a OJ 4) 4) O 4) 0 0 as .O c E w a n ai ❑ N 4) O 0 CI) fl E N Q o i 41 C a) O 1 N C N N u al O N t o E 4) E a E v N V E 01 O O_ `0 3 u _ N a 'C.) > Z 4/ N v w 4) aa, E E o m Q" 3 • E E L o 4- LL oC E O U ._ an > 4) Y L C N c v N 'O C 129 d N L � cu ry C v V )- 0. a ro 0.1 o . Q 2 fl• 0 E o o u V N 4J Z Total Flours Billed I- Phone Number Your Agency's Contact Person: Household Number: s 8 C C O I-� Q O U 0 U ti on >- u L N C U E v Q C L C Cl -, E E v A « 00 . a _ o O V } U .o C o a • URI C Z ,r C A V = V C C w z� v .n ca C C O .+ .O C L._ u v co u O LL C `^ v a) a! O L dD 4+ C Cu C on 04 -C C C C tI C C V7 v r4 m d C! 0.1 47 L v No 4J 4J C CU Q) C -• O C) d0 E C C) a ra 'C 47, v N m )o d 41 C QJ C v .7, 4- O Number of Hour Service Provided u Hours of Se O O w Y ca payment must be recei PY-13-14-HS-0114 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS 4O This Agreement, made and entered into theo2j day of 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departf Human Services, hereinafter referred to as the "Department" and Lutheran Family Services Rocky Mountains, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Home Studies; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 070 - 0247 PV -13 -14 -HS -0114 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.• and 2 PY-13-14-HS-0114 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-HS-0114 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this 4 PY-13-14-HS-0114 Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-HS-0114 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-HS-0114 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: James Barclay Name 17. Notice Administrator Title President/Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: James Barclay, President/Chief Executive Officer 363 South Harlan Street, Suite 200 Lakewood, CO 80226 (303) 217-5830 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-HS-O114 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PV -13 -14 -HS -0114 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PV -13 -14 -HS -0114 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-HS-0114 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk to the Board APP' e + % AS TO FORM: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: Cou y Attorne 11 BOARD OF COUNTY COMMISSIONERS WELD COUN-2, Garcia, Chair SEP 2 3 2013 otedc CONTRACTOR:5 " By: ontracto Title o&9/3'- 6767y PY-13-14-HS-0114 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide home study services for families referred by the Department. 2. CONTRACTOR utilizes the Structured Analysis Family Evaluation (SAFE) tool developed by the Consortium of Children. All staff completing studies under this contract are SAFE certified and appear on the State's approved home study vendor list. 3. CONTRACTOR will ensure that all staff conducting studies under this contract attend SAFE Refresher training during the term of the contract. 4. CONTRACTOR will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on www.consortforkids.org or www.SAFEhomestudy.org. 5. CONTRACTOR will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department, unless otherwise directed by the Department. 6. CONTRACTOR will notify the Department within three days of receipt of a referral if the referral will be accepted and acted upon. 7. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check information, SAFE questionnaires completed by the applicants, references and all other original documents submitted by the home study applicant. 8. CONTRACTOR can provide services in Spanish. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any specific Weld County home. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Child abuse must be reported immediately per law. 12 PY-13-14-HS-0114 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,000.00/Episode (Full Home Study - English) $1,600.00/Episode (Full Home Study -Spanish) $100.00/Person (Additional rate per person beyond primary client and four others.) $250.00/Episode (Partial Home Study - English or Spanish. Charge applies after three attempts to schedule or completion of one interview.) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 13 PY-13-14-HS-0114 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-HS-0114 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-HS-0114 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-HS-0114 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy) each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-HS-0114 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11`h Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-HS-0114 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-HS-0114 Ta _ To ? oc u_ 3co [/ & E< Cr4§ Co/ /\ j%a ;c _!§ § //\ o0 M IS om f;J2\ 4±:/± LO CV \t} CO CO CO CO 0-1 0 LO LO 0 Tr co ma CO CO LO CO § §z o <ai 0 Co O we dp WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-HS-0114 0 I- xQ 1— z z U o O z O� Qz LJ LL cc L! w i J ~ Z W In 2 O LL H W N Q 0 >- U J z 0 W J 11 2 to z CU 27 V O a T. 0 .C d .0 C 3 E vl Y 0 u a o N � V o M Y > a0i � E v f6 N Q '0 O L j H f0 d 7 C ,CU r/3 o z v c N t E OJ E 'C Y R c E . ra a, a, E a O C C y=, N _ ar V > Z v d ° C a o a 411 E z `o u - O E V 'L 0 N N .C d C U L d o C - c U .a 6! � 2 h R 'n O. C a V O_ C. fO Q d r z > a a g n O E V o O u Y cy V N O z 3 Section t: (To be completed by the CONTRACTOR) Total Hours Billed co r Phone Number Your Agency's Contact Person: 46 ij CU d :o.0 E c a.) z (.I -o O L ra d E •r. o a x SECTION II (To be completed by client) V w C O U W 0 O cl 0 a) U Cv .0 L_ 0 U Z C t d R C, an 4'. gD C V C d 0 C L 0 d L �-0 V c•= d V U Ts V C V R V h 7 Z v .Q Y O C O L C 3ro a ..c ,. u v cc - CO Q O u_ U1 N dl o V O Ol L Y C 4J en � N on }L E c T fO co ix) o Gl L -- (o t v ro a� .0 C N 0 a m an 01 C._ Ql 3 C o a C C I O an C N M an a. . .0 U' L N _ a v Y D C U 'w O Number of Hour Service Provided Hours of Servi N O O r -I W Y a s to the monthly bi PY-13-14-CORE-0202 a' -&-A5 oi CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into the e:Q.J day o 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Lutheran Family Services Rocky Mountains, hereinafter referred to as the "Contractor'.. WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Life Skills (Visitation, Parent Coach); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 PY-13-14-CORE-0202 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-CORE-0202 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0202 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5402 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this 4 PY-13-14-CORE-0202 Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0202 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0202 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: James Barclay Name 17. Notice Administrator Title President/Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: James Barclay, President/Chief Executive Officer 363 South Harlan Street Suite 200 Lakewood, CO 80226 (303) 217-5830 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0202 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0202 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PY-13-14-CORE-0202 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0202 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy CIer14£o the Board WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO L.7 am F. Garcia, Chair SEP 2 3 2013 CO CTOrr. to By: rac or t. �'5iivT (.ga Title &O/3- cola 751 PY-13-14-CORE-0202 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide the following Life Skills services to families referred by the Department: a. Home Based Parent Coach (HBPC): CONTRACTOR will serve families who are either at risk of having children placed out -of -home or whose children have transitioned home. Services are provided utilizing flexible, individualized service modalities based upon the family's strengths and needs. Services are designed to assist families in creating a safe, stable and nurturing family environment; promote the safety and well-being of children and families; maintain and build upon family connections and supportive resources; reduce isolation; assist parents in developing appropriate parenting techniques; improve household management skills; prevent, reduce or eliminate behaviors that may place a child or family at risk; and prevent unnecessary out -of -home placements. Families appropriate for this program demonstrate a fundamental lack of knowledge of parenting skills, basic life skills and community resources. This program is not intended to address marital issues outside the parenting context, domestic violence, or chronic mental health issues. b. Therapeutic Visitation: CONTRACTOR will actively monitor, assess and assist in the overall adult/child interaction between parent/relative/caregiver and child(ren). Services are intended to improve the quality of the relationship, to expedite and/or maintain the reunification, or if appropriate, provide an assessment which will move the child(ren) toward alternate permanency. Services levels are as follows: 1. Family Therapy: Intensive services that utilize various techniques from different therapy theories, including but not limited to, narrative and solution focused, to assist family members in increasing emotional regulation, improving family communication patterns and repairing parent/child relationships. Services will assist the referred family to identify dysfunctional family relationships, cross -generational patterns and trauma experiences that affect individual family members and the family unit. Level 4 will also include all Level 3 services. 2. Level 3: Assessment of future intervention needs for continuing visitation and providing protection, both emotionally and physically, for children and/or youth in out -of -home placement. 3. Level 2: Step down from Level 3 if deemed appropriate to assist in the maintaining stability and consistency within the family. 4. Level 1: Maintenance level that will be considered on a case -by -case basis if CONTRACTOR has available staff. Services will occur at the Lutheran Family Services CareHouse Visitation and Therapy Center in Greeley, CO, or at the Lutheran Family Services office in Fort Collins, CO. Services may also occur in appropriate community settings or in the family home if deemed appropriate, and approved by the Department. 12 PY-13-14-CORE-0202 All services will be provided by Master's, or higher, level therapists. CONTRACTOR has bilingual (Spanish/English) staff. c. Lower -level Visitation and Safe Exchange. Services levels are as follows: 1. Supervised Visitation: CONTRACTOR is physically present with the family at all times ensuring the safety and well being of the child(ren). This level allows for immediate intervention, coaching and role modeling. Parents are given the opportunity to practice new skills during visits. As appropriate, parental feedback may occur just prior to or immediately following the visit without the children present. 2. Monitored Visitation: CONTRACTOR is present in the facility and within earshot of the visit but not physically present with the family at all times. CONTRACTOR will intervene as necessary. 3. Safe Exchanges: CONTRACTOR is present during the exchange of children for the purpose of parenting time in situations that do not allow for face-to-face contact by the parents. Services will occur at the Lutheran Family Services CareHouse Visitation and Therapy Center in Greeley, CO, or at the Lutheran Family Services office in Fort Collins, CO. Services may also occur in appropriate community settings or in the family home if deemed appropriate, and approved by the Department. 2. CONTRACTOR can provide bilingual services (Spanish) in the areas of Parent Coach and Therapeutic Visitation. 3. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 7. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13 PY-13-14-CORE-D202 8. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 14 PY-13-14-CORE-0202 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $80.00/Hour (Supervised Visitation) $45.00/Hour (Monitored Visitation, Safe Exchange) $105.00/Hour (Therapeutic Visitation - Family Therapy Level) $95.00/Hour (Therapeutic Visitation - Level 2 or 3, Parent Coach) $85.00/Hour (Therapeutic Visitation - Level 1) $75.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 15 PY-13-14-CORE-0202 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 16 PY-13-14-CORE-0202 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 17 PY-13-14-CORE-0202 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 18 PY-13-14-CORE-0202 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy) each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 19 PV -13 -14 -CORE -0202 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11t" Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 20 PY-13-14-CORE-0202 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 21 PY-13-14-CORE-0202 ai Y O Q, N • C U a) '- to 0 X CD • COZ al LL O- < a) � O N _ ❑ O(ONN- NI U co CO (O (O O c a 0 H w 0(J® x -N (O _0a (O 7 Is a) a co ^ ^ U a) 0 0 O O 0 U F- H Z 0 U 0 H H z w 0) w CO -J J_ 0 CC z J w U X w z • CC U O Y (I) N J a ED O O U 0 O Q Y d • a } j z 4 0 =°w O U 'Da a mg a) m ¢ X O CU a) C • U_ o0 0 • 0) a) x To c a) U) Y U) w J X W N • m Em U3 c 0 0ao0 O 3 N N O c CC cat O = o" o ,w H 2 u T 6 U) r - E U n N'O 0 0 1.0 N _ Cu 12C 5 0 = O_ U O = O N ¢ I O c12 d N N O O O 0 rn O O 0 M CO rn O 0 N LO LO LO N U) 0 O m O as it CO N CO 00 Co CO CO } H H z W -c J o w < o co 0 U E 0 a) (U to U CO 0 N N WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0202 I.L O F- U NQ z z U O O 2I - O F — z w LL_ ozw C° I— J Z an 2 u z O LL w J Q W v H �H Q u z O w J a 2 co CU 2 N .O O °J. 0 C1 c 3 £ v G a W N aJ o C C C a CU E a > N n 0 0 N NO O O `J O a; ° _U N O O L O E c CU a II _ Y 3 4 N > N N a w v n c E > Y CL an E O C U. O C E O v R U U al a) al Y aJ C C..1 C c ai a c O •� a) C.1 �a N N Q C v a fl. CO a CU .C CC O a > u . o ae c O E v o O u •'. R U 4 Y 41 O a z Section I: (To be completed by the CONTRACTOR) Total Hours Billed O ea Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) CJ •L G C O CJ E Ca CC C .D O .O CJ E R CA 4C 0 Y R c d U o as ai R u N g zo O CL .O CO O _f O �+ t C CU L. v a C C U v O1 0 O LL CU yj N � fU C u O b0 CIO c m y O0 y C E LA a >, Y [Q In O U) o .C 0.1 Lel -C �+ al h � O OO N 7 0.1 C m a b4 E O C a) fU f,0 L CU Ln 0a m o_ CI C C a � V .7, Number of Hours Service Provided t_) Hours of Ser m N O W of the month following s to the monthly Notice to CONTRACTOR: A the month of service. PY-13-14-CORE-0229 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MILESTONES COUNSELING SERVICES This Agreement, made and entered into the(3 day of 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Milestones Counseling Services, hereinafter referred to as the "Contractor". WITNESSETH ESS ETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and ON11 WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Foster Parent Consultation (FPC); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria 1 PY-13-14-CORE-0229 established by the Department. CONTRACTOR shall submit alt itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b, Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OIV1B Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0229 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the US. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0229 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0229 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis, o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0229 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0229 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Adelaida Campbell Name 17. Notice Administrator Title Owner Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Adelaida Campbell, Owner 333 West Drake Road, #41 Fort Collins, CO 80526 (970) 403-7656 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0229 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0229 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PY-13-14-CORE-0229 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0229 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk o the Board APPR• D TO FORM: yA orney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: CONTRACTOR: 11 BOARD OF COUNTY COMMISSIONERS WELD COUC LORADO By: Garcia, hair SEP 2 3 2013 CAI 4„12Z1-,C,LI Contractor Title PY-13-14-CORE-0229 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Foster Parent Consultation (FPC) for children and youth residing in Weld County foster homes as referred by the Department. 2. CONTRACTOR will work collaboratively with children, foster parents, caseworkers, foster care coordinators and other service providers to identify and address issues, in a solution -focused manner, that could potentially disrupt placements. 3. CONTRACTOR will conduct services in the following manner: a. CONTRACTOR will meet with the foster home parent(s) to gather information regarding their specific concerns and prior attempts to meet the child's specific needs. b. CONTRACTOR will provide parents with the Parenting Relationship Questionnaire (PRQ). The PRQ takes 10-15 minutes to complete and is used to assess different parenting relationships, beliefs, and practices among parents and/or caregivers. It is appropriate for the assessment of parents or caregivers of children aged two (2) to 18. The PRQ measures caregivers' level of stress or distress in parenting, parenting confidence, Involvement, discipline practices and communication. c. CONTRACTOR will meet with the foster child, if age appropriate, to gather information about any concerns or barriers to maintaining the placement. d. CONTRACTOR will observe foster child and parents to gather additional information on parenting style, barriers to the formation of the parent/child relationship, possible "hot spots", and to develop an intervention plan. e. CONTRACTOR will meet with foster child and parents to provide feedback following implementation of the intervention plan to assess progress. f. CONTRACTOR will administer the PRQ again at the conclusion of services to measure the level of change. g. CONTRACTOR can conduct additional sessions/follow-up if approved by the Department. 4. CONTRACTOR can provide bilingual services (Spanish). 5. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children in their home and report this information on a monthly basis to the Department. 6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 8. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12 PY-13-14-CORE-0229 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TOM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other stuffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0229 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $90.00/Hour (Foster Parent Consultation - Within 30 miles of Greeley) $115.00/Hour (Foster Parent Consultation - In excess of 30 miles of Greeley) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7t1 day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0229 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas." The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. n Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0229 permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0229 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0229 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7"' of the month following the month of service in order to be processed for payment that month. Billing received after the 7`1 of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0229 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ 'Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer A A A AAAAAAAAA AAAAA AAAAM A AAAA AAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: CONTRACTOR Signature Date Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0229 0 F- E .Ocn ai to '-- z a) LL 4)lnNr'f— UrOIn(p .—C')cOLU(o o7t- LL p U) X L%1 (U >,U �m � air�i a)LY0 <DOo U a) �O -- 0 F- U F - z O U O F- F - z w w m J J O z J w O X w O 2: u U) aa)J ) E� (1) a) U • Q + .0 z C p O J U �Q • =� a)�Q co a) I c C) CD a) Jx N O N Q (1) E (0 O o _O n. a`. O For Use By Human Services OnIL Comments Monthly Total (Calculates automatically) 300.00 a a a a co (OO 6 N O ` E Q= O D in N W U O N a) < S p c d N N U N U ❑ O(0 r N O O OO TOTALS (Calculate Automatically) Approved End Date (Per referral) rn 0 O N O co Approved Start Date (Per referral) rn 0 0 N CO Household Number (Per referral) LU LU in If) Trails Case ID (Per referral) 1654888 , Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0229 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) z v 9 OI .D O S C) O C O a) C E u •� a m 8 N � O r C .Q v E a T N o d � T. T. o 51 z 6 o U N O o 'C E E • 10 E w CO y E x `o °i a+ C 2 0 f0 > a .2 = a a a m 0- -C C C O C E z m v m C m — Y y C 'i p a C m W Z v N IO N ` cQ O — 0. ea Q Y 2' C) v c c u o o u an v co 7 Section t: (To be completed by the CONTRACTOR) Total Hours Billed I - Primary Client bille Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 - 2:30) 0 CI PY-13-14-HS-0055 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MILESTONES COUNSELING SERVICES i This Agreement, made and entered into the day of6pt, 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Milestones Counseling Services, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration funding to the Department for Home Study and Relinquishment Counseling Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria 1 020/2 - aeb PY-13-14-H5-0055 established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 at seq. and its implementing regulation, 45 C.F.R. Part 80 et. s and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PV -13 -14 -HS -0055 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-HS-0055 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department wilt continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-HS-0055 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. O Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. o Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-HS-0055 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. Ail such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-HS-0055 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Adelaida Campbell Name 17. Notice Administrator Title Owner Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Adelaida Campbell Owner 333 West Drake Road, #41 Fort Collins, CO 80526 (970) 403-7656 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-HS-0055 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-HS-0055 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PV -13 -14 -HS -0055 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-HS-0055 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk t AP"OV ' AS TO F ty Attor WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY;ICOLORADO / "lliam F. Garcia, Chair SEP 2 3 2013 CONTRACTOR: By: Contractor .01it- — Vic, G Title i/3"-027 PY-13-14-HS-0055 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Study and Relinquishment Counseling services to families referred by the Department. 2. CONTRACTOR utilizes the Structured Analysis Family Evaluation (SAFE) tool developed by the Consortium of Children. All staff completing studies under this contract are SAFE certified and appear on the State's approved home study vendor list. 3. CONTRACTOR will ensure that all staff conducting studies under this contract attend SAFE Refresher training during the term of the contract. 4. CONTRACTOR will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on or 5. CONTRACTOR will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department, unless otherwise directed by the Department. 6. CONTRACTOR will notify the Department within three days of receipt of a referral if the referral will be accepted and acted upon. 7, CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check Information, SAFE questionnaires completed by the applicants, references and all other original documents submitted by the home study applicant. 8. Relinquishment counseling services will be provided to all adult individuals referred by the Department, as well as associated children 12 years of age and older, utilizing the required State format. CONTRACTOR will submit a written report and the appropriate affidavits and Interrogatories. 9. CONTRACTOR is bilingual (Spanish). 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any specific Weld County home. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Child abuse must be reported immediately per law. 12 PY-13-14-HS-0055 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,000.00/Episode (Full Home Study up to Two (2) Adults - Within 30 miles of Greeley) $1,150.00/Episode (Full Home Study up to Two (2) Adults - In excess of 30 miles of Greeley) $250.00/Adult (Additional fee per adult beyond two (2) adults) $600.00/Episode (Home Study Update - Within 30 miles of Greeley) $650.00/Episode (Home Study Update - In excess of 30 miles of Greeley) $250.00/Episode (Cancellation Fee - After four (4) hours of service) $90.00/Hour (Relinquishment Counseling) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7t° day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 13 PY-13-14-ITS-0055 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-HS-0055 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or Impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-HS-0055 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORS' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-HS-0055 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-HS-0055 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11t" Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-HS-0055 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date A AA AAAAAAAAAA AAAMAAAMM AAAAAAAAAAAA AAA AA AAA AAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 m 0 R 0 e 0 0 0 \ z $ w / 0 Z / 0 X 2 Q @ \ 0 2 ± / \/ a) H \[\ o >I z 2\O G©\ \ a_< J(D For Use By Human Services Only Comments Monthly Total (Calculates automatically) o / ci o m O \ \ f%}_7 I o O k amf�\ D§g§.C <$>@I 12 � 0oWoo // TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 I Approved Start Date (Per referral) 0 N \ Household Number (Per referral) \ \ Trails Case ID (Per referral) % CO % Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-HS-0055 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) Z O 2 appropriate signed ss accompanied Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client bi Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) U C , U O ✓ O O U V O. 0 U aa 0b •L E 2 5 ,O C7 gb 8 U U � E c � 2 (• 7, Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) QJ 0 E d M O m ro w O } V a- .0 E a' 71 T o▪ . w NN yd 71. c .a on N E .O N C 4O C a C O O d 'C+ 2 O C O a+ K 4) a+ C N V Ii • m 2 PY-13-14-CORE-0224 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MOUNT ST. VINCENT HOME, INC. This Agreement, made and entered into the0/,2 day of 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Mount St. Vincent Home, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 ow/3 - &&77 PY-13-14-CORE-0224 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0224 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services fur;ds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0224 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0224 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0224 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0224 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Sr. Amy Willcott Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Sr. Amy Willcott, Executive Director 4159 Lowell Blvd. Denver, CO 80211 (303) 458-7220, x226 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0224 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0224 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0224 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0224 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLOhADO F. Garcia, Chair CONTRACTOR: By: SEP 2 3 2013 PXecutfre— Title cX -0767r PY-13-14-CORE-0224 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide comprehensive, highly structured day treatment services, as proposed, to female and male children, ages 5-13, as referred by the Department. 2. CONTRACTOR will provide day treatment services, as proposed, at 4159 Lowell Blvd., Denver, CO 80211, 7:30 a.m.-3:30 p.m., Monday through Friday, year round. 3. CONTRACTOR is accredited by North Central and licensed by the Colorado Department of Human Services State Child Care Licensing (license number45174). Program supervision is provided by a Master's level clinician. 4. CONTRACTOR is Medicaid approved provider. 5. Services are geared toward to children who have significant trauma, neglect and/or mental health needs. 6. The primary goals of service are to provide the following for each referred client: a. A comprehensive Neurosequential Model of Therapeutics (NMT) assessment along with practical and clinical recommendations. b. Therapeutic services for children with psychiatric, behavioral and emotional difficulties which make it difficult to maintain in their community. c. Collaboration with outside agencies such as the Department, school districts and Medicaid. d. Involvement of families/guardians in all aspects of the child's treatment by in close conjunction with the child's therapist and program staff. e. Scheduling and facilitation of psychiatric medication assessment and ongoing medication monitoring as appropriate. f. Partnership with the Sr. Daniel Stefan' School at Mount St. Vincent and the child's therapist to provide a therapeutic milieu, and understanding of the child's therapeutic needs and a context within which to under their symptoms. g. Participation in monthly staffings and in transition planning if appropriate. h. Facilitation and/or provision of transportation to and from the program as appropriate. 7. Teacher/Student ratio is 1 to 6. 8. CONTRACTOR will provide individual, group and family therapy, unless otherwise directed by the Department. Family therapy can be provided in -home if clinically appropriate. Additionally, CONTRACTOR will provide psychiatric services, case management, assessment and treatment planning at no additional cost. 9, CONTRACTOR will assign each referred client a Master's level clinician. 10. All classes are taught by Master's level special education teachers. 11. CONTRACTOR is able to provide bilingual services. 12. Referred youth will receive services for approximately (6) months (average length of stay). Length of services is dependent upon the referred youth's daily/weekly progress, individual/family needs and availability of funding. Services will include, but are not limited to, the following as appropriate: a. 30 hours per week of education approved by the Colorado Department of Education. b. Weekly individual therapy. c. Weekly family therapy (in -home if clinically appropriate). d. Bi-weekly group therapy. e. Daily recreation activities. 12 PY-13-14-CORE-0224 f. Psychiatric services. g. Consultation. h. Creative arts therapy. i. Specialty therapies as appropriate (Eye Movement Desensitization Reprocessing, Animal Assisted Therapy). j. Case management. 13. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 14. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 15. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 16. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 17. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 18. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0224 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $105.00/Day (Day Treatment Services) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0224 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress overtime. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0224 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORS' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0224 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0224 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0224 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0224 ai ▪ o Q O aa)) — M CO Z to LL Q Q o N U. —cocoa) 2 •L"McoU)co o— 0 co II LLp X "= >U m000 NcoM -Dor)) �0 �• tiN. W—) 2CL0T224 0 F- U CC Z 0 U 0 z w to w m -J -J a z -J w U X w Z_ to a) w •2 0 to co J a E� i- t U L � Q ;, m z O c • w O U 0_ -O 3� a) 8Q w 7 i C •� O U O? a) Q Z �a)C_ U) N N t-- d O O O • w O (0 f6 0 ` O. -a N Qc LUa 2 rn O O N co co rn O O N U) U) U) U) U) U, a cn L - N V) cv ) Ha 00 co ao U) co WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0224 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) V 4l 4) al a U 4) O O a, C E O u (a v N L Y C O N N O. O O L 4 T O C. O o v N Z O V .> 7 4.° O O E E E 'X Y r4 E r0 v E 0 c c u w N V > 2 L W O fl. N O a E O Y LL C O C E O V N O N 7 c ar C U •C -O C 01) O)0) N d 0 N_ C O al a a Q O 0 v a CL C Z a o E V o w u m (0 U z0 CJ Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: z al O Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) 4) 0 m O C N O Y L C 3 tl u al CO Yvs tai N N t0 O U C 4. .00 Y 410 C 40 >- '7, .O 4 C -O E C V1 al too m v to • to .C j U L i Y N 0 to w O v 60 •N Number of Hours of Service Provided 0 month folio all dient verifi Notice to CONTRACTOR: A the month of service. PY-13-14-CORE-0230 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND MOUNT ST. VINCENT HOME, INC. 4) This Agreement, made and entered into they[ day of+mod' / 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Mount St. Vincent Home, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B'Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 07©/3-- O767 y PY-13-14-CORE-0230 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0230 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0230 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0230 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0230 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0230 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Sr. Amy Willcott Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 j970) 352-1551 18. Litigation For Contractor: Sr. Amy Willcott, Executive Director 4159 Lowell Blvd. Denver, CO 80211 (303) 458-7220, x226 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0230 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0230 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0230 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0230 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk to he Board AP WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTI,rCOtiORADO William F. Garcia, Chair-- - SEP 2 3 2013 CONTRACTOR: By: Contrac� Title 6V/S-- ala757 PY-13-14-CORE-0230 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Intensive Services, as proposed, to female and male children, ages 5- 13, and their families, as referred by the Department. 2. CONTRACTOR utilizes a strengths -based, solution focused approach, integrating the Neurosequential Model of Therapeutics (NMT). 3. Available services levels: a. Low (1-3 hours per week) b. Moderate (4-6 hours per week) c. High (7-9 hours per week) 4. Services include: a. Assessment b. Treatment planning c. Individual and family therapy which includes parenting approaches, family communication, conflict resolution, household functioning, and behavior regulation d. 24/7 crisis intervention e. Attendance at staffings and meetings as appropriate, including but not limited to, Family Team Meetings (FTM) and Team Decision Making Meetings (TDM) f. Monthly reports g. Weekly communication with the referral source or other professionals as appropriate h. Connection to appropriate community resources i. After care planning and connection to long-term resources to ensure stabilization and continued success, including follow-up one (1) month post -discharge 5. The primary goals of service are to provide the following for each referred client: a. A comprehensive Neurosequential Model of Therapeutics (NMT) assessment along with practical and clinical recommendations. b. Therapeutic services that address the individual and family needs, as well as the environmental setting to build a foundation of emotional and physical safety. c. Services that are developmentally relevant with the goal of regulation for the both the child and the caregiver(s). d. Promotion of long term success for the family, measured by self-sufficency, utilization of appropriate community resources, the decreased need for higher level services and/or entry or re-entry in to the child welfare system, and higher functioning of the individual family members and family as a whole. e. Involvement of families/guardians in all aspects of the child's treatment by in close conjunction with the child's therapist and program staff. 6. All services will be provided by Masters Level and/or Licensed therapists in the home environment. 7. Services will be provided for approximately three (3) to (6) months (average length of stay). Length of stay is dependent upon the referred individual and family needs and availability of funding. 8. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12 PY-13-14-CORE-0230 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form, This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0230 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $600.00/Month (Low, 1-3 Hours/Week) $1,400.00/Month (Moderate, 4-6 Hours/Week) $2,100.00/Month (High, 7-9 Hours/Week) $75.00/Hour (Hourly Rate) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CORE-0230 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0230 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0230 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORS' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0230 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0230 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0230 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0230 CNI co ){ N0rRQE !a§\\{e - c o co co'tr E E•°EE w IoO \\ / 0 0 0 CO -J \ j a) j §�U- 0 (\ \j\ ow - 3 -k\ \/\ 0 {, o 2 c \4o) ro m\ 0} }\\f #f:9± (N \%) CO CO 0 co oo co co / LLJ <0 0 WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0230 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) N cu .O o O L ci a c 3 E t u n 2 w w c o c 9 E ›- a. Lo Lo c .ti j V UJ N 7 G 0 0 7n o z al V N g O O h L E E E •x Y @ E '-- ro E � 49c O 0 —r. 3 V J CL, L W w-2 4- 7.3. o V N °- E t 0 ••-• LL C ii v C ou G! N .? 1O• Cl ry CC 0 N Q u CO .C T 0'0 O OC H fu Z O - o E O u V N U in r N O Z Section I: (To be completed by the CONTRACTOR) 0 0 Primary Client billed: Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) >: 0 co 0 d O N U 0 O I- F 0 V 6) N s >, .0 V !ea C) U .C in w ID A N O V O v CO v C .0 .0 0 d d C7 d9 7 � O �y w d10 VCO t N O 7 Z L 0 0) .O CO c N O 3 C v O. i CO ID O LL 41 U 0 0 s m 0.0 N C v E c �n •I••• CO fa N o N Y = CIJ CO L > u . L 6fa 4- N � v c n. OD %dl N C a- O f do CCO CO L ns ti o. v 4-1 d C OD V 'N Number of Hours of Service Provided Hours of Service the month of service. PY-13-14-CPS-0093 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN, INC., DBA PERKLEN CENTER FOR PSYCHOTHERAPY IrgiirlEpskg e 013 This Agreement, made and entered into the Cs✓ day of t 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Perklen, Inc., dba Perkien Center for Psychotherapy, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Anger Management/Domestic Violence Evaluation and Treatment; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 0?V/3- a; 7/ PY-13-14-CPS-0093 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et seq.; and 2 PY-13-14-CPS-0093 All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CPS-0093 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CPS-0093 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CPS-0093 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CPS-0093 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Kim Ruybal Name 17. Notice Administrator Title President Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Kim Ruybal, President 1020 8th Street Greeley, CO 80631 (970) 353-8171 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CPS-0093 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CPS-0093 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-13-14-CPS-0093 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CPS-0093 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS WELD COUN CO1ORADO 61u x P �i �.k,� n 4; Weld County Clerk to the Board By: Deputy Clerk t AP Countorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 F. Garcia, Chair CONTRACTOR: By: SEP 2 3 2013 te_de •CcuS2 Contractor - rles-i d� Title a�� a677 PY-13-14-CPS-0093 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Anger Management and Domestic Violence evaluation and treatment services to male and female, adults and juveniles, including developmentally disabled individuals and same sex, in Weld County, who are 10 years of age or older. 2. If referred for evaluation or assessment, two (2) to three (3) sessions will be needed to complete the requirements of the evaluation or assessment. 3. Following evaluation sessions, CONTRACTOR will pose questions designed to gather basic identifying information, examine the client's mental status/mental health issues, and various history (mental health, family/medical, substance abuse, inpatient/outpatient, current social, and criminal). 4. CONTRACTOR will utilize a variety of psychometric assessment tools that may include the following: Hare Psychopathy Checklist -Revised Minnesota Multiphasic Personality Inventory -II (MMPI-II) - Jesness Inventory Multiphasic Sex Inventory Wilson Sex Fantasy Questionnaire SASSI-Ill Drug and Alcohol Inventory Milton Clinical Multiaxial Inventory (MCMI) Shipley Institute of Living Scale State Trait Angry Inventory -II Violence Risk Assessment Guide Milton Clinical Adolescent Inventory Domestic Violence Risk Needs Assessment - Domestic Violence Screening Instrument Spousal Assault Risk and Assessment 5. CONTRACTOR will submit a written document outlining client's amenability for treatment, recommendations for treatment, further assessment, and risk to repeat similar behavior. The evaluation will determine the best placement for the client in regards to treatment. CONTRACTOR will provide a copy of the evaluation to the caseworker. 6. Anger Management services will include a minimum of twenty (20) weeks of treatment. 7. CONTRACTOR will follow the minimum expected requirement for the treatment of male, female, and Gay/Lesbian/Bisexual/Transgendered individuals who have been domestically violent as mandated by the Colorado Domestic Violence Offender Management Board (DVOMB). Level A (Low Risk): Level B (Moderate Risk): - Psycho -educational Treatment — One (1) 90 -minute session per week 36 week educational curriculum First treatment plan review within two (2) to three (3) months - Second treatment plan review within two (2) to three (3) months of the first review Open ended psycho -educational treatment — One (1) 90 minutes session per week 46 week educational curriculum One a month adjunct therapy required; (a) Substance Abuse Treatment, (b) Individual Session, (c) Skills Group, (d) Healthy 12 PY-13-14-CPS-0093 Relationship Group, (e) DV Education, (f) Caring Dads Group/Mothers Parenting Group, (g) Victim Speaker, (h) Sex Education, (i) HIV/AIDS Education, or (j) Sexual Abuse and Boundaries - First treatment plan review within two (2) to three (3) months - Second treatment plan review within two (2) to three (3) months of the first review Level C (High Risk): Open ended psycho -educational treatment — One(1)90 minutes session per week - 46 week educational curriculum - One weekly skills group; (a) Healthy Relationship Group, (b) Caring Dads/Mothers Parenting Group, (c) Victim Speaker, (d) Sex Education, (e) HIV/AIDS Education, (f) Sexual Abuse and Boundaries, or (g) DV Education First treatment plan review within two (2) to three (3) months Second treatment plan review within two (2) to three (3) months of the first review 8. CONTRACTOR offers Caring Dads Parent Education Group. The 17 -week group aims to engage fathers, to help them develop more child -centered fathering, and to take responsibility for ending their abusive behavior towards their children and children' mother. 9. CONTRACTOR offers Mothers Parenting Group, which is similar to the Caring Dads Parent Education Group. The emphasis around the mother as a victim and the impact of that on parenting. 10. CONTRACTOR offers Domestic Violence Education, Caring Dads and Mothers Parenting Group to meet the Domestic Violence Offender Management Board (DVOMB) Standards and Guidelines requirement for a second clinical contact. 11. CONTRACTOR offers The Impact of Domestic Violence on Children and Victims program. Clients referred to this program will complete a total of four (4) hours of education. The program includes education related to the cycle of abuse, types of abuse, and the impact on the family, as well as a short social history, and a collateral review. 12. Individual sessions will only be utilized under one or more of the following circumstances: - The referred client's individual treatment needs cannot be adequately addressed in a group setting. - The client is not currently appropriate for a group setting and requires a limited number of individual sessions to prepare for a group setting. - The client's job requirements make it impossible to attend regularly scheduled group sessions and individual sessions are the only option for the client to comply with their treatment plan. - When assessed for a DV track in which an additional contact is required. 13. CONTRACTOR will submit a discharge summary at the conclusion of services. A standard discharge summary will include the reason the client is being discharged (successful, administrative or negative discharge), treatment history with CONTRACTOR, progress or lack of progress, risk to community and any recommendations for future care and/or treatment. 13 PY-13-14-CPS-0093 14. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 15. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 16. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 17. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 18. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 14 PY-13-14-CPS-0093 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $210.00/Episode (Anger Management/Domestic Violence Evaluation) $70.00/Hour (Anger Management/Domestic Violence Evaluation Hourly Rate - Not to exceed cost of full evaluation.) $575.00/Episode (Domestic Violence Assessment) $144.00/Hour (Domestic Violence Assessment Hourly Rate - Not to exceed cost of full assessment.) $20.00/Hour (Domestic Violence Education) $20.00/Hour (Caring Dads Group) $20.00/Hour (Mothers Parting Group) $37.50/Episode (Standard Group Session) $70.00/Hour (Domestic Violence Impact - 4 Hours Minimum) $70.00/Hour (Individual Session - In -Office) $85.00/Hour (Individual Session - Off -Site) $90.00/Hour (Family Session) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. 15 PY-13-14-CPS-0093 a. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. c. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 16 PY-13-14-CPS-0093 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 17 PY-13-14-CPS-0093 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 18 PY-13-14-CPS-0093 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 19 PY-13-14-CPS-0093 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 20 FY -13 -14 -CPS -0093 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 21 PY-13-14-CPS-0093 7 ai 5 a CNI \k .- co to < } </\/\7co \.c/\/I H®0 d% �G00 co)Dr.)� co co =osEolcD /\sfo_oa)a) k \\< 22/ �k< o >2 z 0 O j \9$ =E< cif co ORM IS IN EXCEL AND WILL BE SENT TO CONTRACTOR.) For Use By Human Services Only'' Comments / ? 2 §\ » < , Monthly Total (Calculates automatically) 0 � I I I I I 2• \• i KJ' }� . ' \ » \ §5k - W Q. I » _ ( a �U)-�_ O = n .S /$G@a 2 S e X07 ot\S/ �& TOTALS (Calculate Automatically) Approved End Date (Per referral) q 8 CO Approved Start Date (Per referral) \ e } Household Number (Per referral) 555555 Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CPS-0093 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) a 0 0 12 .O OJ y N O C E f0 a O C N C 61 Q) O YJ E 0J (o E Q C O u H G) C V E L C E V C) V Co ., Z 0 C 01 ce 0 0 0 z., Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION I1 (To be completed by client) Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00— 2:30) 4-4 CO All requests for payment must be received by the 7"' day of the month following C a C E .O h C yW C a t cO E d Y E O .2 W C } C v R L co z C2 O . ✓ V r a 0 0 o V s " e V E o Z as PY-13-14-CORE-0140 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN, INC., DBA PERKLEN CENTER FOR PSYCHOTHERAPY �} J� This Agreement, made and entered into theO(3 day o 2013, by and between the Board of Weld County Commissioners, sitting as the Board of Human Services, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Perklen, Inc., dba Perklen Center for Psychotherapy, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 02e9i. - X671 PY-13-14-CORE-0140 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-CORE-0140 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0140 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CORE-0140 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0140 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0140 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Kim Ruvbal Name 17. Notice Administrator Title President Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Kim Ruybal President 1020 8th Street Greeley CO 80631 (970) 353-8171 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0140 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0140 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0140 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0140 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTOR: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY; 3COLORADO By: F. Garcia, Chair SEP 2 3 2013 Contractor F vue/26 a-nd- Title &w -aZ271/ PY-13-14-CORE-0140 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Mental Health evaluation and treatment services to male and female adults and juveniles, including developmentally disabled individuals and same sex, in Weld County, who are 10 years of age or older. 2. If referred for evaluation, two (2) to three (3) sessions will be needed to complete the requirements of the evaluation or assessment. 3. Following evaluation sessions, CONTRACTOR will pose questions designed to gather basic identifying information, examine the client's mental status/mental health issues, and various history (mental health, family/medical, substance abuse, inpatient/outpatient, current social, and criminal). 4. CONTRACTOR will utilize a variety of psychometric assessment tools that may include any of the following: Shipley Institute of Living Scale Millon Clinical Multiaxial Inventory (MCMI) Minnesota Multiphasic Personality Inventory-ll (MMPI-II) SASSI-Ill Drug and Alcohol Inventory Jesness Inventory State Trait Angry Inventory -II Violence risk Assessment Guide, Domestic Violence Risk Needs Assessment Domestic Violence Screening Instrument Spousal Assault Risk and Assessment Hare Psychopathy Checklist -Revised Wilson Sex Fantasy Questionnaire Multiphasic Sex Inventory Millon Clinical Adolescent Inventory 5. For evaluation services, CONTRACTOR will submit a written document outlining recommendations for treatment, further assessment, and risk to repeat similar behavior. CONTRACTOR will provide a copy of the evaluation to the caseworker. 6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 PY-13-14-CORE-0140 10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 11. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0140 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $575.00/Episode (Mental Health Evaluation with HARE, PCLR, VRAG) $144.00/Hour (Mental Health Evaluation - Hourly rate for partial completed evaluations. Not to exceed cost of full evaluation.) $50.00/Episode (Additional charge for jail evaluations.) $70.00/Hour (Individual Session - In -Office) $85.00/Hour (Individual Session - Off -Site) $90.00/Hour (Family Session - In -office) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. a. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 14 PY-13-14-CORE-0140 b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. c. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0140 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0140 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0140 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0140 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11`h Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0140 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0140 O I- U I- Z O U O H Z w w m J a Z J w U X w Z_ •U O Y U) 0 -0 E j a) a)1 — L =U p EZi. >,Z %-O Ua. a) a) g< Co a) 2 Co G N N w X w Co < ED- T o o" a _ a For Use By Human Services Only Comments. :', . , ;fry CC ,. Monthly Total '(Calculates •' ;. automatically) O O cb Cac w: w, O O M L Co L Q : CCQI0C N y U -U TO 7 L E. O t; OO L TT y ' N ie 0 O C/) 06/01, 06/02 ?, . • . Y, . TOTALS (Calculate Automatically) Approved End Date (Per referral) rn O O N O Cr) CO Approved Start Date (Per referral) rn O O N CO Household Number (Per referral) 555555 Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0140 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) 61 V •y 01 O a a 0 0 L 4! 9 C 3 E t+ W G W N W o Y C > •Q E0. .o N o` L N � W N Cr d N N W O N O D j E E x - m r E a -, a; cu E O u � .a u N w •N E E u - a C O E N 11:71 .O on 4.7 a a w 4. C a a 0 0 u w V O Z unless accompanied by the appropriate signed Client Verification Form. Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Per Household Number: SECTION II (To be completed by client) L C O U 0 V u O u did E b 0 O U 0 0) •0 V a 0 O CL v 0) V 0) N s 0J C) V C nC 8D 0 u C C E .0 CC C C D O u a C 7 i t0 . C O V (0 c d d U� 2� m � V VI •O O Gs 0 Y N co 0 C 0 y+ t C v v a U U ro H 0 LL V N f0 V O GJ L c v tid > •N a Y c T o to N o ai ._ Y t Q1 V N t Y N4_ W a m v � z c O C m O C j C fl t a N 1.0 R a N Y C C G1 U 'N Number of Hours of Service Provided Hours of Service Y OD (Ex. 1:00 — 2:30) PY-13-14-CORE-0160 IAJ CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND PERKLEN, INC., DBA PERKLEN CENTER FOR PSYCHOTHERAPY This Agreement, made and entered into the 2i/ day o !:I flat• i 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Perklen, Inc., dba Perklen Center for Psychotherapy, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Sexual Abuse Treatment (Offense Specific); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 c2&3- =&6 7y PY-13-14-CORE-0160 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.' and 2 PY-13-14-CORE-0160 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0160 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CORE-0160 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0160 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0160 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Kim Ruybal Name 17. Notice Administrator Title President Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Kim Ruybal, President 1020 8th Street Greeley, CO 80631 (970) 353-8171 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0160 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0160 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-13-14-CORE-0160 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights,or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0160 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Garcia, Chair CONTRACTOR: By: SEP 2 3 2013 iCc tz 2 c);;&,0 Contractor Title ob/3 - X2677 PY-13-14-CORE-0160 EXHIBIT A SCOPE OF SERVICES 1) CONTRACTOR will provide offense specific evaluation and treatment services to male and female juveniles, ages 12 to 18, and adults, including developmentally disabled individuals and same sex, in Weld County, as referred by the Department. 2) CONTRACTOR utilizes a non -medical, cognitive behavioral model, which focuses primarily on the treatment of juveniles and adults with sexually abuse behaviors. 3) The goal of this program is to reduce recidivism rates by: a) Providing a structured environment for the safety of the client, family and community. b) Increasing awareness and empathy for the victim and the impact of the offense on the victims and family members. c) Fostering a family environment to effect positive change. d) Developing the use of appropriate social/sexual skills and expressions through recognition of situations and stimuli that trigger sexually aggressive behavior. e) Assisting family members to develop the skills necessary to recognize and understand the sexual behavior their family member for the purpose of providing support while the client progresses through treatment. 4) The target populations eligible for services under this agreement include: a) Male and female youth 12 to 18 years of age, and male and female adults 18 years of age or older. b) Youth with current sexual offense adjudications or youth who have admitted guilt and will provide a written letter from a parent or attorney stating they plan to plead guilty. c) Adults who have been found guilty of a sexual offense or have a written letter form an attorney stating they plan to plead guilty. d) Adults and youth of average intelligence and those who are developmentally delayed. 5) Services available under this agreement include: a) Psychosexual testing and evaluation. b) Offense -specific group therapy. c) Individual or family therapy. d) Relationship and interpersonal social skills. e) Sex education. f) Interdisciplinary team meetings (monthly as needed) g) Victim empathy and awareness. h) Anger management/impulse control skills. i) Cognitive behavioral modification. j) Self-esteem building. k) Values clarification and examination. I) Relapse prevention plan. m) Aftercare services. 6) CONTRACTOR has three (3) staff approved by the Sex Offender Management Board (BOMB) to provide treatment and evaluation for adolescent and adult, male and female, offenders. Two (2) of the three (3) are also approved to provide evaluation and treatment for developmentally delayed offenders. Therapists who are not fully approved have submitted an Intent to Apply application to the SOMB and are supervised by a licensed Masters level psychotherapist (Kim R. Ruybal, MA, LPC, LPC, NCACII). 7) All evaluations will be conducted under the supervision of by Kim Ruybal, MA, LPC, NCAC II. Ms. Ruybal will also review and sign all evaluations. 12 PY-13-14-CORE-0160 8) Evaluations will examine six key areas: Potential to reoffend Amenability for treatment - Recommended treatment setting Type of treatment needed Risk factors/monitoring/potential new victims - Psychiatric/substance abuse/individual/family needs Mental health concerns. 9) Evaluations will include the following: Structured clinical interview - Collateral information from schools, caseworkers, probation/parole officers, case managers, therapists, doctors, courts, police reports and/or other relevant sources. Other assessment tools (depending on the age of the offender and circumstances of the case). Assessment tools many include any of the following: Shipley Institute of Living Scale Millon Clinical Multiaxial Inventory -III Minnesota Multiphasic Personality Inventory -II (MMPI-II) SASSI-Ill Drug and Alcohol Inventory Jesness Inventory State Trait Angry Inventory -II Violence risk Assessment Guide Hare Psychopathy Checklist -Revised Wilson Sex Fantasy Questionnaire Multiphasic Sex Inventory Sex Offender Needs Assessment Guide Penile Plethysmograph Abel Assessment for Sexual Interests Juvenile Sex Offender Assessment Protocol -II 10) For evaluation services, CONTRACTOR will submit a written document outlining recommendations for treatment, further assessment, and risk to repeat similar behavior. CONTRACTOR will provide a copy of the evaluation to the caseworker. 11) All services will comply with the Colorado Sex Offender Management Board (SOME) Standards and Guidelines for for juveniles, adults and developmentally delayed offenders. 12) CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 13) CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 14) CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 15) CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 13 PY-13-14-CORE-0160 16) CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 17) CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 14 PY-13-14-CORE-0160 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $70.00/Hour (Individual Session - In -Office) $85.00/Hour (Individual Session - Off -Site) $90.00/Hour (Family Session - In -Office) $70.00/Episode (Juvenile Sex Offender Intake) $37.50/Episode (Juvenile Sex Offender Group) $37.50/Episode (Juvenile Sex Offender Education Group) $37.50/Session (Phase I, Ill or IV Sex Offender Treatment Group) $42.00/Session (Sex Offender Phase II Treatment Group) $95.00/Session (Sex Offender Deniers Treatment Session) $450.00/Episode (Juvenile Sex Offender Evaluation without Testing - 13 years or Younger) $150.00/Hour (Adult or Juvenile Sex Offender Evaluations - Hourly rate for partial evaluations. Not to exceed the cost of full evaluation.) $600.00/Episode (Juvenile Sex Offender Evaluation with Testing and without PPG/Abel - 14 years or older) $900.00/Episode (Juvenile Sex Offender Evaluation with Testing and PPG/Abel) $600.00/Episode (Adult Sex Offender Evaluation without Testing or PPG/Abel) $900.00/Episode (Adult Sex Offender Evaluation with Testing and PPG/Abel) $800.00/Episode (Adult Sex Offender Evaluation with Testing and without PPG/Abel) $600.00/Episode (Adult Sex Offender Evaluation Update) $50.00/Episode (Additional charge per evaluation for evaluations completed off -site.) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 15 PY-13-14-CORE-0160 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. a. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7"h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. c. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 16 PY-13-14-CORE-0160 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 17 PY-13-14-CORE-0160 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 18 PY-13-14-CORE-0160 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 19 PY-13-14-CORE-0160 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 20 PY-13-14-CORE-0160 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 21 PY-13-14-CORE-0160 0 U I- H z 0 U 0 I- I-, z W U) W c0 J J C z J W xU z (,) 2 U Q �0 co a n E a; a) I-- tLa Q 0. >- j� ci z c OL 0 `4- W Urna a) a z For Use By Human Services Only;, Comments Monthly Total '(Calculates automatically) o O p o M 1 1 1+ rG 1 = 1 1('..5;1 ('. 1 1 h> '1 "'1 1 „ G i O O -6 O M N L -- C6 O O L c cc d.= O D N N a) Y U -Cy 's,- � L .O O0C) a) <IO_a 12 N wr w a) X 0 0(/)00 TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) O) 0 0 N zz Household Number (Per referral) U) IC) U) Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John • WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0160 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) v `o a) m 0 0 L N 0 3 G1 V 0) O C E 0 0 VI Ul O u N D E L N O C O V 0) L y w E V a E L 0 E V v a) L m C 0.1 0 V z Z 0 0 u 0 z CC 0. 0 m 0 v 0 m C O �N O 0 L E a E C0 E d V O C V N 0 C E N a. E 0 LL 0 ra 0 C v U d C m CU 0 4 10 L Ol C m a E 0 w a Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) v C C VI o 17; L c o = a I- U y a- w 0u - 'U U C d O L ao C 00 C 00 .C .N 00 L C +' E c ro a U O a1 t .70. ro j V L L N „ N °u N C +�+ C co O N o E N C > C fD a s f0 in_ a) ate+ Q to U 'N by the 7th day oft 0 O Number of Hour Service Provided Hours of Servi N 0 w s to the mo PY-13-14-CORE-0112 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND REFLECTIONS FOR YOUTH, INC. 7 This Agreement, made and entered into the O2 day o 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departm nt of Human Services, hereinafter referred to as the "Department" and Reflections for Youth, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit E "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 cox-d6i'/ PY-13-14-CORE-0112 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.• and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0112 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0112 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit D which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0112 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0112 11. Trainin CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0112 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: John Kinnaird Name 17. Notice Administrator Title Interim Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: John Kinnaird P.O. Box 1860 Berthoud, CO 80513 (970) 344-1380, x205 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such documents) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0112 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0112 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0112 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0112 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk t: the Board AP WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY—. ORADO arcia, Chair SEP 2 3 2013 CONTRACTOR: By: Cou - Att.rney ctor 04;3 EyeCAA. ,✓e- ls2\ O( Title a02_5-6 �y PY-13-14-CORE-0112 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide comprehensive, highly structured Day Treatment services to female and male youth, ages 11-18, as referred by the Department. Youth, age 18-21, which are considered special education and eligible for educational services, any youth with an extensive history of aggression to self and/or others, adjudicated sexual offenders, youth will a full-scale IQ below 70 and youth requiring routine medical assistance (diabetes, seizure disorders, etc.) will be assessed on a case -by -case basis for admittance into the program. 2. CONTRACTOR will provide services in Loveland, CO, at 1000 South Lincoln Avenue, #190, or in Brighton, CO, at 60 South 27th Avenue. CONTRACTOR is licensed by the Colorado Department of Human Services State Child Care Licensing (Loveland: 1545846, Brighton: 1609468). 3. Services include: a. Regular Day Treatment: Comprehensive, highly structured educational program that incorporates therapeutic components. Inclusive of transportation. b. Enhanced Day Treatment: Comprehensive, highly structured educational program that incorporates therapeutic components and optional enhancements (up to three [3] enhancements at one time.) Optional enhancements include Drug and Alcohol Therapy and Support, In -Home Family Therapy, or five (5) hours per week of community -based involvement (behavioral coaching) for the youth. Enhancements can be combined to meet the needs of the client and any one enhancement may be doubled. i. Drug and Alcohol Therapy and Support Enhancement: Consists of a weekly substance abuse group and individual check -ins with a CACII, LPC clinician. The curriculum utilization is evidenced -based ADAD/DBH approved. The goal of this enhancement is to assess precursors to abuse/dependence, decreasing sobriety -interfering behaviors, increasing internal motivation towards sobriety, and increasing the youth's ability to make decisions that promote a healthy lifestyle. ii. Five (5) Hours/Week with a Youth Family Advocate: Consists of 1:1 support from a Youth Family Advocate (YFA) to support the youth in developing positive community connections in the areas of social, recreational, job development/employment, and treatment -based resources. The goal of this enhancement is to provide the lowest level of community intervention and support to meet the identified needs of the youth, and to increase the family and youth's abilities to access and engage in supportive community resources. iii. In -Home Family Therapy: Consists of family therapy in the family home to address issues with transportation, sickness, disabilities, and assists families who struggle with the therapeutic process outside of the home. The goal of this enhancement is to ensure the family is consistently participating in the therapeutic process, and that the home is a safe and supportive environment. Services further include, but are not limited to, assessment and evaluation, development and implementation of a treatment plan, therapy, daily information to parent and/or caretaker regarding homework and treatment goal progress, staffings as needed (at least monthly), a discharge plan and aftercare. Parents and/or caretakers are expected to participate in the above progression of services and will be provided detailed information at the time of discharge. 4. CONTRACTOR will provide individual, group and family therapy to all referred youth unless otherwise directed by the Department. 5. CONTRACTOR will provide bilingual services and transportation on a case -by -case basis as needed at no additional cost to the Department. 12 PY-13-14-CORE-0112 6. Testing and psychiatric medication evaluations and appointments will be conducted as needed to aid in case planning and ensure the appropriate treatment is utilized for the referred youth's maximum growth and benefit. 7. Services will be provided by Masters' level therapists who have specific training in one or more of the following areas: Eye Movement Desensitization and Reprocessing (EMDR), Dialectic Behavioral therapy, Cognitive Behavioral Therapy and/or Reactive Attachment Disorder. 8. Referred youth will receive services for approximately four (4) to six (6) months. Length of services is dependent upon the referred youth's daily/weekly progress, individual/family needs and availability of funding. 9. CONTRACTOR is a Medicaid approved provider through ValueOptions, Inc., and can bill Medicaid for Regular Day Treatment only. Eligible clients referred for Regular Day Treatment will be identified at the time of referral. 10. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 11. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 13. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 14. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 15. Proposed services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0112 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $114.50/Day (Regular Day Treatment - No Enhancements) $139.00/Day (Day Treatment - One (1) Enhancement) $159.00/Day (Day Treatment - Two (2) Enhancements or One (1) Enhancement Doubled) $175.00/Day (Day Treatment - Three (3) Enhancements) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit E. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CORE-0112 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0112 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0112 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORS: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that maybe required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0112 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0112 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0112 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0112 Y O Q N U 0 uni E Z • m cn it n Q W zE 0 01 O U)f)(CO zco c 2 CO O in h Ci, O N a coN th X H O O TN a „co C m y M M W E -y O N a O CO -05 to. U' • °.i °) O H U H z O U 0 H H z w CO w J J 0 Z Q J w U X W Z_ CO o cc 2 "E.0 (O J N N U �2 t"Q c• a )- CoO • -w + o ai J -C o 2 • g 0 m t L L) 02 2m t C) m 2 It C N OC J x 0 O ° Em m c 0 0 a0 For Use By Human Services Only Comments Monthly Total (Calculates automatically) O O O O co 1 1 1 1 1 1 1 1 1 1 1 1 1 1 O O O M °) j .. f0 N O C K o.2 `o D Le O N Ur j j N ? _ O N ti aa 12 in U N ooino0 N O o co TOTALS (Calculate Automatically) Approved End Date (Per referral) rn O O N 0 CD CO Approved Start Date (Per referral) rn O O N 0 Household Number (Per referral) 555555 Trails Case ID (Per referral) to co co et in O (O Client Name (Per Referral) SAMPLE ENTRY: Doe. John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0112 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) Section I: (To be completed by the CONTRACTOR) Total Hours Billed 12 Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) Your sienature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the 110 3 O O a 0 E ar .y of E 0 S a a. ao E • ar aci O • O V L M `g ▪ E w m PY-13-14-CORE-0206 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND REFLECTIONS FOR YOUTH, INC. f� This Agreement, made and entered into th day of 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Reflections for Youth, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services (Youth and Family Advocate Permanency Services); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit E "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 &o/s-i67>' PY-13-14-CORE-0206 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0206 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.5.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0206 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5401, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5401, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit D which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0206 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, itsemployees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0206 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0206 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: John Kinnaird Name 17. Notice Administrator Title Interim Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: John Kinnaird P.O. Box 1860 Berthoud, CO 80513 (970) 344-1380, x205 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0206 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0206 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0206 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0206 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: ee � 6reu-ex- t �+J'C� Weld County Clerk to the Board By: APP Co Deputy Clerk to the Board rney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: CONTRACTOR: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY; 6pLORADO 6r By: arcia, air SEP 2 3 2013 actor eye c,ivre_ 1)ivrecf Title igejlei 3 a®/, - a67y PY-13-14-CORE-0206 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Youth and Family Advocate (YFA) Permanency Services to youth 10 years of age or older, and their caregiver(s), as referred by the Department, except when any of the following exist: a. The referred youth has an IQ below 55. b. There is active sexual abuse is occurring in the home. c. There is recent or current domestic violence. d. A high lethality suicide attempt has occurred within the last 30 days (will accept/assess on a case -by - case basis). e. There are felony assault charges by youth or family member within the last 30 days. f. The youth or another participating family member is actively psychotic. g. There are any legal or behavioral patterns that present significant issues of danger to staff providing services. h. The youth identified for services is age three (3) or younger. 2. Goals of service include: a. To provide the lowest level of in -home intervention to meet the need. b. Being flexible with family situations in order to help families and youth access services. c. Providing therapeutic and behavioral skills and assistance in the environment in which the youth resides and spends their time. d. Providing support to families who are struggling with difficult behavioral problems without out -of - home placement. e. Assisting with transition from residential level of care back to the community. f. Completing therapeutic work that would have been interrupted with a transition out of residential or day treatment services (if utilizing the in -home intervention with ongoing therapy). g. Working collaboratively with youth, families, client manager, mental health centers and other Multi - Disciplinary Team (MDT) members to establish individualized goals and a treatment/reintegration plan. h. Setting individual goals for youth that are tailored to the youth's needs (emotional regulation, relationship skills, substance abuse treatment, and other behavioral areas/concerns). i. Increasing family and youth's abilities to access other community resources (mental health centers, support groups, etc.). 3. Services will include treatment and support to the youth and their caregiver(s) to prevent out -of -home placement or an increase in placement level. Family therapy can also be included. Services are available as follows: a. With therapy: i. Support Level = 10 hours/week YFA and up to four (4) hours therapy/week ii. Stabilization Level = 20 hours/week YFA and up to six (6) hours therapy/week Hi. Safety Level = 30 hours/week YFA and up to six (6) hours therapy/week iv. Step-down Level = 15 hours/week YFA and up to four (4) hours therapy/week 12 PY-13-14-CORE-0206 b. Without therapy: i. Support Level = 10 hours/week YFA ii. Stabilization Level = 20 hours/week YFA Hi. Step-down Level = 15 hours/week YFA 4. The program is designed to be offered in three (3) phases over the course of 12-20 weeks based upon the needs of the referred youth. The phases are identified as: a. Assessment and Treatment Planning: This phase encompasses the first two (2) weeks of programming. The purpose of this phase is to set up behavioral and support plans for the family that outline the treatment process and recommendations. This phase includes up to six (6) hours of clinical involvement and in -home support time. All assessments are scientifically validated and include the GAIN, CANS and SASSI-A2 for clients with drug and alcohol concerns. b. Ongoing Treatment: Implementation of treatment plans. c. Discharge Phase: Treatment hours are reduced to prepare family and youth for end of services. Discharge assessments and Aftercare Agreement will be completed during this phase, which will include an agreed upon plan for reduction of hours and phase out of services. 5. The goal of services is primarily to prevent out -of -home placement or transition the child(ren) home. Additional goals include the following: - a. Providing the lowest level of in -home intervention to meet the need. b. Maintain flexibility with family situations in order to help families and youth access service. c. Provide therapeutic and behavioral skills and assistance in the environment in which the youth resides and spends their time. d. Provide support to the family in addressing their struggles with the youth's behavioral problems. e. Assist with transition from residential level of care to the community (if applicable). f. Complete therapeutic work that would have been interrupted with a transition out of residential or day treatment services (if utilizing the in -home intervention with ongoing therapy). g. Work collaboratively with youth, families, client managers, mental health centers and other Multi Disciplinary Team (MDT) members to establish individualized goals and treatment/reintegration plans. h. Set individualized goals for referred youth that can be tailored around emotional regulation, relationship skills, substance abuse treatment, and other behavioral areas/concerns. i. Increase family and youth's ability to access other community resources (e.g., mental health' centers, support groups). 6. All services will be provided in the referred youth's home and/or community unless otherwise directed by the Department. 7. CONTRACTOR will develop a case management plan within 30 days of receiving a referral and provide that to the referred family, with a copy to the caseworker. The plan will include, at a minimum; goals, goal timelines and a measurement of success. 8. CONTRACTOR will update the caseworker at least twice (2) per month with updated progress information and concerns. 9. CONTRACTOR will provide bilingual/interpretive services, transportation and on -call support on a case -by - case basis as needed at no additional charge to the Department. 13 PY-13-14-CORE-0206 10. Therapeutic services will be provided by therapists with a Master's degree or higher. Non -therapeutic therapeutic services and support will be provided by a trained Youth Family Advocate (YFA) who is supervised weekly by a Master's level therapist. 11. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 12. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 13. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 14. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 15. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TOM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 16. Proposed services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 14 PY-13-14-CORE-0206 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $316.00/Week (Permanency Services/Support Level - 10 Hours/Week YFA, No Therapy) $510.00/Week (Permanency Services/Stabilization Level - 20 Hours/Week YFA, No Therapy) $413.00/Week (Permanency Services/Step-down Level - 15 Hours/Week YFA, No Therapy) $560.00/Week (Permanency Services/Support Level - 10 Hours/Week YFA and up to 4 Hours Therapy/Week) $785.00/Week (Permanency Services/Stabilization Level - 20 Hours/Week YFA and up to 6 Hours Therapy/Week) $1,040.00/Week (Permanency Services/Safety Level - 30 Hours/Week YFA and up to 6 Hours Therapy/Week) $673.00/Week (Permanency Services/Step-down Level - 15 Hours/Week YFA and up to 4 Hours Therapy/Week) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit E. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the 15 PY-13-14-CORE-0206 month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 16 PY-13-14-CORE-0206 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 17 PY-13-14-CORE-0206 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 18 PY-13-14-CORE-0206 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 19 PY-13-14-CORE-0206 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 20 PY-13-14-CORE-0206 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 21 PY-13 14 -CORE -0206 0 H 0 Z 0 U 0 F - H Z W U7 W m J 7J 0 2 Q J W U X UJ 2 U O a u - CJ CU J E1- r a) f - N ��a C Z oLU O + J 0 a CD < .6 ca a) Z C a) N J W ) .0 Q a) E C a o o0 For Use By Human Services Only Comments Monthly Total (Calculates automatically) o O 0 O c+s O O 0 O c ) L a) r, ca a) O L C Q a= o: U N, ci'71 e U_ 'C7 a) < I O V.2 Q N 12 N U z d O (i) 06/01, 06/02 TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) O O O N CD Household Number (Per referral) 555555 Trails Case ID (Per referral) CO CO CO T1.r CO Client Name (Per Referral) SAMPLE ENTRY: Doe. John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0206 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WELL BE SENT TO CONTRACTOR) U N N :c C v 0 c O C) c E a m 17 N N 0 C L . N t ro a, i! O Z 0 u i 2 C L E E g E Y a m a E C O 8 c 3 4" 'C > LC la m ,o a m o u A N a E• L u0 C O E a Q Z 'C d Cl > i c u D C 'O m d N NO. u � 7c- 0 1 Q C Z v 0u a aan C C Total Hours Billed Phone Number Your Agency's Contact Person: Household Nu SECTION It (To be completed by client) co O C N O c a u v co 0 O W vi f° c u L C I`^^ V (0 •? C CC c E ra v O Ql V U R W L No L N a m 61 �+ C m o m co E 0. m • t N a d a U 'N Number of Hours of Service Provided Hours of Servic m N O P v 0 0 E d 0 'O .O .0 d A a .O A C 3 c C E N N 4 O V y the month of s PY-13-14-CORE-0193 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SHILOH HOME, INC. This Agreement, made and entered into them , Pday of 5LYi2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Shiloh Home, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria 1 J - C cry/3- �i9 PY-13-14-CORE-0193 established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0193 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.5.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0193 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0193 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other 5 PY-13-14-CORE-0193 associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements 6 PY-13-14-CORE-0193 between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Steven Ramirez Name 17. Notice Administrator Title Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Steven Ramirez, Chief Executive Officer 6400 West Coal Mine Avenue Littleton, CO 80123 (303) 932-9599 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the 7 PY-13-14-CORE-0193 services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an 8 PY-13-14-CORE-0193 agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which maybe pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third 9 • PY-13-14-CORE-0193 parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0193 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: APP Deputy Clerk the Board y Atto e WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: (La yA. Grie;o, Director 11 BOARD OF COUNTY COMMISSIONERS WELD COUNttOOkORADO cia, Chair SEP 2 3 2013 Title PY-13-14-CORE-0193 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Day Treatment services to male and female youth, ages 5-18 years of age, who speak English, as referred by the Department. In situations in which a family member does not speak English, CONTRACTOR will provide an interpreter for the primary language of the family member. 2. Services are primarily intended for youth with mental health treatment needs as well as social, emotional and academic challenges. Services are appropriate for youth with sexual offense -specific issues, both those adjudicated delinquent and those who may have offending issues but are not involved in the juvenile justice system. 3. Services are available at the following locations, 8 a.m. to 3 p.m., year round, with session breaks: a. 6884 S. Marshall Street, Littleton (Males and Females, Ages 7-18) b. 2700 E. Ken Pratt Boulevard, Longmont (Males, Ages 12-18) c. 7400 Kearney Street, Commerce City (Males and Females, Ages 5-12) d. 8461 Delaware Street, Thornton (Males and Females, Ages 5-18) 4. Services include: a. Educational, psychological and clinical assessment services b. Offense specific treatment services (when identified) c. Individual, family, group and milieu therapies (weekly) d. Case management e. Research -based academic curriculum (credits transferable to public school) f. Special education services g. Transportation to and from school (within designated catchment area) h. In -home services (case -by -case basis) i. Community activities j. Monthly progress review facilitated at Shiloh k. 24/7 on -call assistance I. Random urinalysis m. Ongoing assessment of family, transitional services/staffing to public school 5. Services are specifically designed for the behavior -disordered youth with a primary goal of teaching referred youth behavioral self control and pride in being a responsible citizen. 6. The program focuses on skills development where the youth recognizes their problems and how thinking errors contribute to irresponsible behaviors, develops adaptive social skills, and develops new, healthy coping skills. Newly acquired skills are practiced in the program, in group therapy with their family and in the community at large. 7. Group therapy occurs weekly by a master's level clinician. Groups address a variety of issues, including negative thinking and behavior, healthy alternative activities and thinking patterns, and self control. The focus of the group is to instill a belief that talking out feelings rather than blindly acting out is helpful, mature and appreciated by others. 8. Individual therapy is offered weekly and facilitated by a master's level clinician with the focus being on the youth's individual treatment plan for how to maintain behavioral self-control and positive self-esteem. 9. Recreational activities are scheduled regularly based upon the client's interests and needs, as well as available community resources. 12 PY-13-14-CORE-0193 10. Progression through the program is assisted through a feedback system in which the youth's behavior and quality of work on phase projects in the program and at home is tied to program privileges. Additionally, positive progression is measured by successful completion of written and behavioral assignments, and the development of a relapse prevention plan. 11. Referred youth and adolescents with severely limited cognitive abilities (IQ below 65), ongoing medical issues that cannot be supervised/managed by staff, an inability or significantly impaired ability to understand and/or communicate in English, and those who are actively psychotic are generally not considered appropriate for this program. 12. CONTRACTOR administers program year round, minimum of six (6) hours per day, five days per week (excluding holidays and teacher in-service days). 13. CONTRACTOR has identified the following performance outcomes: a. Successful transition to public school upon completion of program. b. Successful graduation from program or completion of GED when indicated. c. Client will remain in the caregiver home or less restrictive setting after discharge. d. Academic improvement as evidenced by Wide Range Achievement Test (WRAT), which will be administered at intake and discharge. e. Client and caregivers will be linked to identified community resources (mental health, medical, dental, community support, etc.) prior to discharge. f. Caregivers will increase parenting competency as evidenced by parents ensuring a safe environment that is free of present dangers or impeding threats. g. Caregivers will demonstrate compliance with Informed Supervision Criteria (if applicable). 14. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 15. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 16. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 17. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 18. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 19. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0193 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $1,625.00/Month (Pro -rated for any partial month of service.) $75.00/Hour (Interpreter - when indicated) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0193 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0193 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0193 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0193 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0193 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0193 ai Y o < a) C _c U a) E m Z it a N o U O•c a LL pU) X U O E q,D �m .0 Ed 52 CL a) U ORM IS IN EXCEL AND WILL BE SENT TO CONTRACTOR.) Ca) -a E CD a) 1— i2 � � Q Z c O a o W Og a) -a n 2 TD L l6 a) (U a) In X tea) J X W (a < a) E00 (o _.O a a..O for Use By Human Services Only Monthly Total (Calculates automatically Comments 300.00 1 1 1 I f • I 1 [ I I I 1 I O O O M a) 7 (6 N O E Qa1o0 N (r) U U O W (1) <Z O 112 d N 12 I - a) '1)U 0 O(n r N O O 00 TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) 0) 0 O N x - CD Household Number (Per referral} 555555 Trails Case ID Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: li Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0193 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) a) U a) C, a) .D a 0 c 0 s a) E R v 0 v o G > v � E > a R • o '- 3 a) R O C 6 O ✓ N Z ai O U � H O • E • } E E ▪ C s E • v a E a1 • O � • C R U a N a) N E E O u ▪ a E L O Y W • C O O E a) _ a, al a) L C f a) • V 7 -OC C a, 0) N N 0 O d 2 <• a L j r V Q .2 1' C z O E o 8 •' R V O Z Section I: (To be completed by the CONTRACTOR) Total Hours Billed 0 Phone Number Your Agency's Contact Person: SECTION 11 (To be completed by client) Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the 0 O▪ J Ia O C N o t C 3 � m Q. r O a/ CO w 0 0 0- 0 CU C = 1.9 OA >- _0 DO L C !" c c vi W (0 N N O w (0 a r al O) `0 a) _C Y al � • O CO 41 a cn '01 a- C @ o a) bn E I. O 4-0 C > Ll L yU a0 o_ al CC W m U 71 the 7th day of the month following ent must be received by Number of Hours of Service Provided Hours of Service (Ex. 1:00 —2:30) w 0 PY-13-14-CORE-0213 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SHILOH HOME, INC. This Agreement, made and entered into the Et day of 013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Shiloh Home, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire Mav 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B'Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 Qv/3 e:72y-• 'I PY-13-14-CORE-O213 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0213 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0213 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0213 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other 5 PY-13-14-CORE-0213 associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements 6 PY-13-14-CORE-0213 between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Steven Ramirez Name 17. Notice Administrator Title Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Steven Ramirez, Chief Executive Officer 6400 West Coal Mine Avenue Littleton, CO 80123 (303) 932-9599 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the 7 PY-13-14-CORE-0213 services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an 8 PY-13-14-CORE-0213 agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third 9 PY-13-14-CORE-0213 parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0213 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: o the Board AP Co "tyAttorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: . Griego, Erector 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO G ".)._-� arcia, Chair SEP 2 3 2013 CONTRACTOR: By: Contractor % c Title aos 2- PY-13-14-CORE-0213 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Mental Health Services to youth, and their families, who speak English. In situations in which a family member does not speak English, CONTRACTOR will provide an interpreter for the primary language of the family member. 2. Services will be available at the following locations: a. 2700 E. Ken Pratt Boulevard, Longmont b. 8461 Delaware Street, Thornton c. 6350 West Coal Mine Avenue, Littleton d. 7400 Kearney Street, Commerce City 3. Services will utilize the following evidence -based treatments: a. Cognitive Behavioral Therapy (Correcting thinking errors, linking thoughts, feelings and behaviors; and teaching new, healthy empathic and reality -based ways for thinking) b. Behavioral Therapy (Teaching and rehearsing healthy ways to behave when overwhelmed by feelings and perceived needs) c. Psycho -education and Family System Theory (Teaching families to work together and provide them with coping skills to promote the well-being of the family) 4. Available services include: a. Individual Therapy: Addresses the impact of mental health disorders, works to lessen the effect of disorders and restores the client to the best possible level of functioning, and facilitates recovery. b. Family Therapy: Focuses on improving communication, increasing family member's level of differentiation and creating a better functioning home environment. c. Group Therapy: Addresses a variety of issues, symptom management, family issues, anger management, self-esteem, social skill, independent living, coping skills and cognitive restructuring. Sessions offered throughout the day, including late afternoon and early evening for working families. d. Crisis Intervention: Available as needed to assist individuals in dealing with unexpected situations that may arise between therapy sessions. e. Community Resources: Links referred youth and family with community services that may be beneficial or that are not provided by CONTRACTOR. An aftercare plan will be provided that outlines ongoing services to ensure youth is maintained successfully in the family home. 5. Services will be provided by either a licensed clinician or a Master's level clinician supervised by a licensed clinician. The frequency of therapy will be determined at the time of referral and assessment, and sessions will be offered throughout the day and evening to accommodate working family members. 6. CONTRACTOR will develop a comprehensive service plan during the intake process. The plan will identify the goals for successful completion of treatment and a plan for a system of care following completion of treatment. 7. Performance Outcomes: a. Youth will improve and manage their presenting problems areas. b. Family participation as measured by caregiver's attendance in sessions and level of participation. c. Caregivers will maintain a safe and stable home environment for youth and other family members. d. Youth will be maintained safely in their home when possible and appropriate. e. Continuity of family relationships and connections will be preserved by identifying barriers and providing appropriate interventions. f. Caregiver will gain the capacity to provide their children's education and mental health needs on an on -going basis. 12 PY-13-14-CORE-0213 8. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0213 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $75.00/Hour (Individual or Family Therapy Session) $45.00/Hour (Group Therapy Session) $95.00/Hour (Family Therapy - In -Home) $120.00/Hour (Psychological Evaluation) $75.00/Hour (Interpreter) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CORE-0213 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0213 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0213 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 • PY-13-14-CORE-0213 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0213 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0213 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0213 N- (O - x a) IL c ti 1.0 CD CD1OCD co ca CO M M a)oo ornrn 0 I- U H Z 0 U 0 h I- z W (/) W J J 0 J w U X w z_ co (,) 2 a) cc U 0 CL � ( a E� a.. .) a) . -. U 10 .� .O Q } > Z � 00 4--w 0 `ld N a n2 5 re; •::c a) a> m a) N a) J X w Q Ecc' ca c m.o o 0 For Use By Human Services Only Monthly Total (Calculates automatically) Comments O O d O co IIIIIIIIIIIIII 300.00 0 - C6 O E c' CiI o If) N w a) U 8 (132 - m QI `ova 12 12 - a) U CD Iii a) 0 OU) _ 'N O O Zii O0 TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) O) CD CD CV s- CD Household Number (Per referral) 1654888 555555 Trails Case ID (Per referral) Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0213 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) N V vs v d L O W io V O O d A _ - G 3 E YI Y ILO m V - n d d Q N d O t. .I-• >. d • A E N T N O t w 3 Udm h 7 G c 0 d Va a an o al z k ✓ ti i p N O • 7 E E X ✓ • E r-0 ✓ d CO d E z o d `' 0 C • c CS V N d a, u> L > • d L N YW d L a d V N Y 0. E E L O Y tL C o 0 • M d N U V a ai m a • 7 d Y al c v • ID 7 d v c Jtco Q .C ii Q a C a r • n u S M V IO d VI V VI W O 2 7 Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) V CO C 0 w Y Cd E d s D A b 1.- s .o C s C .0 .0 C D E d t ✓ E 0 C O d PY-13-14-CORE-0212 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND SHILOH HOME, INC. This Agreement, made and entered into thed3 y o MEE 2 c3 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Shiloh Home, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Sexual Abuse Treatment (Offense -specific Evlauation and Treatment); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D'Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 aoi3- 52495/ PY-13-14-CORE-O212 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 t PY-13-14-CORE-0212' • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and. • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. H. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0212 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0212 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other 5 PY-13-14-CORE-0212 associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements 6 PY-13-14-CORE-0212 between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Steven Ramirez Name 17. Notice Administrator Title Chief Executive Officer Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Steven Ramirez, Chief Executive Officer 6400 West Coal Mine Avenue Littleton, CO 80123 (303) 932-9599 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the 7 PY-13-14-CORE-0212 services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §524-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an 8 PY-13-14-CORE-0212 agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third 9 PY-13-14-CORE-0212 parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0212 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: APP Co tyAtt.rney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, 010RADO / ;i/'fir Willie`riS F. Garcia, CI air CONTRACTOR By: Ced Title SEP 2 3 2013 &O/3 -0767 PY-13-14-CORE-0212 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Sexual Abuse Treatment (Offense Specific Services) to youth, ages 7 to 18, and their families, who speak English. In situations in which a family member does not speak English, CONTRACTOR will provide an interpreter for the primary language of the family member. 2. Services will be available at the following locations: a. 2700 E. Ken Pratt Boulevard, Longmont b. 6350 West Coal Mine Avenue, Littleton 3. Services will utilize the following evidence -based treatments: a. Cognitive Behavioral Therapy (Correcting thinking errors, linking thoughts, feelings and behaviors; and teaching new, healthy empathic and reality -based ways for thinking) b. Behavioral Therapy (Teaching and rehearsing healthy ways to behave when overwhelmed by feelings and perceived needs) c. Psycho -education and Family System Theory (Stabilization of the client's mental health diagnoses) 4. Services will be provided by either a licensed SOMB clinician or a Master's level clinician supervised by a licensed SOMB clinician. All therapy adheres to the Colorado Sex Offender Management Board (SOMB) Standards and Guidelines for the Evaluation, Assessment, Treatment and Supervision of Juveniles. 5. The frequency of therapy will be determined at the time of referral and assessment and will be offered throughout the day and evening to accommodate family schedules. 6. Offense Specific Treatment Objectives: a. Completion of a comprehensive intake assessment to include identifying relationship concerns and/or barriers to achieving treatment goals. b. Ongoing assessment of functioning evident in client, family and therapist feedback. c. An initial treatment plan developed with family, caseworker and CONTRACTOR. d. Ongoing review and modification of treatment plan monthly to include ongoing assessment of risk and safety concerns, and the interventions to address any identified concerns, recommendations for service and/or safety measures to ensure safety of the client. e. Consistent participation in scheduled individual, family and group sessions. f. Functional change in family that does tolerate abusive behavior. g. Evidence of abuse -free functioning by displaying appropriate and pro -social behavior in sessions and in the home. h. Recognition of harm done to victim(s). i. Implementation of relapse prevention plan. j. Acceptance of responsibility for abusive behavior without blame or externalizing. k. Overview of interventions/progress/ongoing needs. I. Recommendations of completion of treatment. 7. Offense Specific Treatment Goals: a. Full disclosure of abusive behavior. b. Full disclosure of own victimization. c. Ability to understand personal cycle of abuse, as well as ways to avoid maladaptive thoughts, feeling and behavior. d. Behavioral stability evident in consistent display of safety toward self and others and respect toward property. e. Development of parent -child relationship and home environment that supports abuse -free functioning and does not tolerate abuse behavior. f. Development of a relapse prevention plan that matches abusive behavior. 12 PY-13-14-CORE-0212 g. Recommendations upon completion of treatment to include ongoing needs and supports to increase likelihood of success to ensure youth maintain in the home. 8. Performance Outcomes: a. No sexual recidivism. b. Completion of Sex Offender Management Board (BOMB) standards. c. Increased parenting competency as evidenced by parents ensuring a safe environment that is free of present dangers and impending threats. d. Parental compliance with Informed Supervision criteria. e. Successful completion of victim clarification if appropriate measured in conjunction with the victim's therapist. f. Maintenance in the community (home, job, public school). 9. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 13. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 14. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0212 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $75.00/Hour (Individual Therapy Session) $75.00/Session (Family Therapy Session) $45.00/Hour (Group Therapy Session) $95.00/Hour (Family Therapy - In -Home) $120.00/Hour (Psychological Evaluation) $75.00/Hour (Interpreter) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CORE-0212 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0212 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0212 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0212 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0212 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0212 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 20 N �-i N cal w 0 U ai > X 0 < N U m t --- u-) To • (D x Z m co ii a Q a)u- m (Din N N -N N Ux— MLt)cD 92 >,'> c) co Ln (D O- LL s O (1i X a)a cON (D 3 � Ua)L-O• ,_N -N - CC O H U F- h z O U O F- F- z W W 00 J J 0 z J U X W z a) U 0 u- • J -a E I • a) F. CO .r L >, z 3 `O uJ uj U a) a. a2 a)oQ a- ) I Cu a) X U J X m Q a) E ca- m 2 ti 6.2 �O For Use By Human Services Only Comments Monthly Total (Calculates automatically) 0 0 O O co I I I I 1 I I I I I I I: 1 1 300.00 a) — �_ m O C C QI oD in (N N a) :*-m=(U -U U O a) a) <IOV2a 12 N x-- c- a) V as C) ou1)oo _ N O O TOTALS (Calculate Automatically) Approved End Date (Per referral) rn O O N 0 CO CO Approved Start Date (Per referral) O) O O N Household Number (Per referral) U) U) LO U) It) Trails Case ID (Per referral) CO CO CO In (.D x- Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0212 CONTRACTED SERVICES CLIENT VERIFICATION FORM O 1- U I- z O U O I- 1- z Li co W J J_ 2 O U - J Q U J z O LU J O_ Section I: (To be completed by the CONTRACTOR) Total Hours Billed 0 a) Primary Client billed: Phone Number Your Agency's Contact Person: C T O 411 a) a c V E O Z a Z c O o s° Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 - 2:30) a) 0 O w L C O E Ol N O m cu n T a d i a) a. E a O a) v ea C d O e7 121 E s 3 c A. L_ C E L O E O C O .(0 V a) fa cc 01 u O f- al f- w Z O o u o c 0) u E ZO w PY-13-14-CORE-0233 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STEPPING STONES, INC. !L�t ffi This Agreement, made and entered into the day o 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Stepping Stones, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Life Skills; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B'Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria 1 PY-13-14-CORE-0233 established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0233 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0233 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0233 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. a As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 c State of Colorado to be named as additional insured on each comprehensive general liability policy. c Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0233 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if 6 PY-13-14-CORE-0233 performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Marsha Jones Name 17. Notice Administrator Title Owner/Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Marsha Jones, Owner/Director 2032 35th Avenue, Suite A-152 Greeley, CO 80634 (970) 518-2977 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0233 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0233 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR'S written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. 9 PY-13-14-CORE-0233 CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0233 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: AP tto ey By: WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTOR: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY,) COLORADO illiam F. Garcia, air By: SEP 2 3 2013 Title aw3_a67y PY-13-14-CORE-0233 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide the following Life Skills services to children, youth and families referred by the Department. 2. The goal of services is to enhance self-sufficiency and increase an individual's and/or family's level of independence that better assures an ability to maintain a level of wellbeing. 3. CONTRACTOR will conduct an assessment of current skills, strengths, resources and barriers. Utilizing the assessment results, CONTRACTOR will work with referred client(s) to establish individual goals and objectives that insure the focus and interventions are understood and appropriately addressed. The majority of interventions will be: a. Interactive b. Real Life Application c. Providing Information and Exploring Options d. Providing Opportunities e. Practice f. Identifying Resources g. Homework h. Assessing Results and Outcomes 4. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 8. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 9. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 12 PY-13-14-CORE-0233 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $55.00/Hour (Life Skills -within Weld County, Fort Collins, Loveland or Longmont) $85.00/Hour (Life Skills - outside Weld County, Fort Collins, Loveland or Longmont) $55.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting - within Weld County, Fort Collins, Loveland or Longmont) $85.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting - outside Weld County, Fort Collins, Loveland or Longmont) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 13 PY-13-14-CORE-0233 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0233 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORS. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0233 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0233 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PV -13 -14 -CORE -0233 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0233 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAMAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0233 ai Q r Z x >01 li gu, a a) LL ND U�M lfl va 2 A,'� M CO u Co H O (!) X er �.0 mm MM -"O „T, a) O o moo c 3Icf. O 0 h U cr — Z 0 U 0 I--' I — z w w m J —J O Z J w U >< cn U ix o U aI J m o� 12 a U5_I >, f2 Z LO °w 0 ai 0 - TD < a) z �a C a) a) w J X w N CJ co L Q) a E c` c 6 O a`O o a I— L IX O.i N Lo D 8 wa)To N _ O -: C' O .C am Oda N N - CV Zo- o ocoaa rn N N — O g0> - Q C N w M a w °o '2 co O) O O N O o a) .O cLa cn E a) m = z a 2 U) U) U) u) U) co OD CO U r a) Z E w c Zm-wao L a •°)a<o Uav)C WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0233 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) a 2 a .O w a 0 a) .O E N .. 0. Nal O N O ... C � QI E >- r0 Q O IA aJ y N • C O O CI H O N Z a O E r .r E ai E a a) ✓ E CO44 m aJ Q • c � • 3 w N u_ > a, al ai a m E • ? u to . ' a E L O C ▪ LL C C O 2 ai @ u_ Z al a) N C ▪ C 4.. N c C a • a) a O a ao N N y • aa v V Q 0 0. aJ Section I: (To be completed by the CONTRACTOR) Total Hours Billed O N Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: J1.5 C O U a1 v 0 cv u w 0 O • aJ 44 a) a/ T .O 'OU y O 0. 4) 8 U a N a 4 04 O V a a) .O O a) .n C 7 v_ E u .a a gaN CD •N Eo • .8 o o- ):) _ `a Z 8d O ae` 0 a) .0 O C VI O i. 3 c a u a) U V �a 0 O - O U- 0.1 a, N a7 f O C C 6 - ion T '73 L m C 6 E ra ra ▪ N N O.0 07 r ti a � L U O N z Y ai N vim. a�i C d 013 N d � C A O W a0 E V1 O cu a7.3 L a m ▪ Q. • C al to U Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) 4) O PY-13-14-CORE-0238 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS, LLC This Agreement, made and entered into the t-23 day of f/aL 12013, by and between the Board of Weld County Commissioners, sitting as the Board of Human Services, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Strong Foundations, LLC, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 a0/,3 c4 7F PY-1344-CORE-0238 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et seq.; and 2 PY-13-14-CORE-0238 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome{AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C,R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds, c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0238 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17,5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CORE-0238 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site, General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0238 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0238 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Julie Box Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. litigation For Contractor: Julie Box, Executive Director 1702 68th Avenue Greeley, CO 80634 1970) 302-1471 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0238 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0238 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0238 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0238 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATf EST: Weld County Clerk to the Board By: Deputy Clerk t AP"O D AS TO o rty Attorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COU , c LORADO F. Garcia, Chair SEP 2 3 2013 CONTRACTOR: By: ` A,GP G SLV.-L Yt Ayr - Title Lowl CPI PY-13-14-CORE-O238 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Intensive Services for children and youth residing in Weld County foster homes within a 100 -mile radius of Greeley, CO., as referred by the Department. 2. The goal of services is to stabilize placements therefore ensuring safety and permanency for Weld County's children and youth. 3. Services will include the following: a. Baseline assessment through identification of specific issues and goals related to the needs of the child/youth and foster family. b. Individual intervention with foster children and youth that can include appropriate therapeutic and community activities in the community such as addressing socialization needs. c. Therapeutic interventions to address common childhood diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD), mood disorders, attachment issues, trauma, Post Traumatic Stress Disorder (PTSD) and behavior issues. d. Directive Play Therapy, Grief/Anger Therapy, and Cognitive Behavioral Therapy as appropriate. e. A minimum of one (1) hour per week of services. More than one (1) hour can be provided as needed. f. Reassessment after three (3) months to determine progress. 4. CONTRACTOR will work collaboratively with children/youth, foster parents, caseworkers, foster care coordinators and other service providers to identify and address issues, in a solution -focused manner to address issues that could potentially disrupt placements. 5. CONTRACTOR will make recommendations following assessment of the child/youth and foster family. CONTRACTOR will document recommendations and follow through of foster family with regard to recommendations. 6. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children/youth in their home and report this information on a monthly basis to the Department. 7. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12 PY-13-14-CORE-0238 10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 11. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 12. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CORE-0238 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $50.00/Hour (Home Based Intensive Services, Face -to -Face) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-CORE-0238 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress overtime, Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-CORE-0238 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-CORE-0238 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-CORE-0238 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-CORE-0238 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-CORE-0238 ai Y O a' N O ac) r L) E CO x U C Z co Il am< c) I.,1-_, am a)u,N N- N� U_m LT) co `c L'>'Or N Ali �(/j X� NCO r TO cap° m VV) OD �oiE00oo 0 F O F- Z 0 0 0 F - Z W (/) W 07 J 0 Z Q -J W 0 x w to 2 a) X .(-2 0 • Y CL co a) < -0ED a) a) h l6 Q g E } j Z) J Z Co 3 w W O a) a a J Q) aQ O a) a> a) ->±: U_ C a O 20 m a) 2 To c Co U) L2? J W N U E°5 m c 00 a a0 for Use By Human Services Only o a) E E o Monthly Total (Calculates automatically) 0 0 0 O m 0 0 0 ,.. 0 Co 0 O .. K 0_2 0 2 N N U O J L . U O N a) Q2 `o C2 o_ N N a) y U O Z 0 O (n .- N O O 0 co 0 TOTALS (Calculate Automatically) Approved End Date (Per referral) rn O O N 0 CO co Approved Start Date (Per referral) CO 0 0 N CO O N 9 a) 3 E N a) 2za 2 555555 Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe. John 0 N WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0238 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) N .O r 0 0 .O • C 3 E N i U N a y D O G E @ N O. o O L � N p7 C W v L N z ru Ol O u 2 o N L O E 01 E Cu a E E x o m > ▪ 72 Y• H O C a5 u m • O. E E L C C O C E m u_ u a7 • > c C Y a) m U J OJ0) C O▪ J N p� O) A � a C E O. 1.1 C aL-i O 2; c 'd c z ▪ a- c) E u o o OJ N u � O c Z 7 Section 1: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) O Y a) u O O s+ 3 C TJ 1.1 L N- U a) CO t O LI- Cu v u C 61 O L 0 C ibD C a) C CD T ▪ .O C C In � T • N d O a) Y To > u L H CO .to r a 7 ▪ C + ' O m E Y C • > C U t a a a c • c U N Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) V Cu 01 O c N E .O 01 .c 3 C. Aft L C O E 1 r a) ti la at Q ce Q , V 0 o U 5 • C a E O d! Z PY-13-14-CORE-0199 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS, LLC Ate This Agreement, made and entered into they o t; ,,r'�E p;EI,cp • 4o 724,7 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Strong Foundations, LLC, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Foster Parent Consultation; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit 0 of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 &D/$-dl779 PY-13-14-CORE-0199 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CORE-0199 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. sect, and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PY-13-14-CORE-0199 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CORE-0199 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0199 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0199 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Julie Box Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Julie Box, Executive Director 1702 68th Avenue Greeley, CO 80634 (970) 302-1471 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0199 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0199 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, ail such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested, 9 PY-13-14-CORE-0199 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0199 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk to AS TO FOR my Attorney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY,.GOLORADO f J/1 / _ ..z./ William F. Garcia, Chair CONTRACTOR: By: <` SEP 2 3 2013 r Title 02045- &625/ PY-13-14-CORE-0199 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide time -limited Foster Parent Consultation (FPC) services to children and youth residing in Weld County foster homes within a 50 -mile radius of Greeley, CO., as referred by the Department. 2. The goal of FPC services is to enhance and improve the quality of care being provided to Weld County's children and youth. 3. CONTRACTOR will work collaboratively with children, foster parents, caseworkers, foster care coordinators and other service providers to identify and address issues, in a solution -focused manner, which could potentially disrupt placements. 4. CONTRACTOR will make recommendations to foster family following assessment of the child. CONTRACTOR will document recommendations and follow through of foster family with regard to recommendations. 5. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children in their home and report this information on a monthly basis to the Department. 6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 11. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 12 PY-13-14-CORE-0199 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $100.00/Hour (Foster Parent Consultation, Face -to -Face) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 13 PY-13-14-CORE-0199 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 PY-13-14-CORE-0199 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORS: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-13-14-CORE-0199 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 16 PY-13-14-CORE-0199 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 PY-13-14-CORE-0199 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 18 PY-13-14-CORE-0199 Boa' g6 r - O H - U I- z O U O H- H - z w U) w J J a J w U X W z_ O a) C J a) a a) a H — N (0 O UQ >. z • 00 � 4--w O J U ai 0 Ti) PQ O ≥ •U_ L O crn r (a a) 2 i- C a) to U) a) J X w N a°' E M c CS) .o d0 For Use By Human Services Only Comments Monthly Total (Calculates automatically) 300.00 • ...... 0 o M a) '5 ( `,:r) O C (2C o_i O D L N co (9 a U O ` a) <Z oo- r u) a) U IC ❑ OU) - N O TOTALS (Calculate Automatically)._ Approved End Date (Per referral) rn O O N d CO CO Approved Start Date (Per referral) rn O O N C_U Household Number (Per I referraj) U) LO Lc) Client Name (Per l Trails Case ID Referral) (Per referral) 1654888 SAMPLE ENTRY: Doe, John F WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0199 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL SE SENT TO CONTRACTOR) N U d d a `0 a) 0 QJ O al ai 0 0 C QJ E >- 0. 0 in v a a) 0 z a; u al 0 E r to 4. 0 0 V C.= a V. v Q V E L C O E .2 a) as a▪ ss C S a, C u a G O 0 fZ C C E to a 0 as v N O S ro 0 a) 0 0 O t E S E x E a ar ai u x a) 0 C N N 0 a) . O C O C C V N C Vl Y (43 O O. m L .O y. al co 4.3 u a C 7 Section I: (To be completed by the CONTRACTOR) Total Hours Billed 0 L I- Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the .0 O V .O E v a) Eo 0 ▪ d O ti . a u � r 40 V N 0 O z Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 - 2:30) 4-. MI O 3C C 0 C 0 E m a CO } A a s s a as 0) a as 3 E C a) E T 0. 4) 3 d to C C 0 c �N E .0 to C al C a C Q E d M aaa E w C O a C ai To A u A 4 0 a ? k d 0 0 u -c M O L.• E O 4J z PY-13-14-CPS-0096 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS, LLC Ace This Agreement, made and entered into the day o e -al ill i_ 1.) �� 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Departmdnt of Human Services, hereinafter referred to as the "Department" and Strong Foundations, LLC, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Foster Parent Training; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit 0 "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the 1 as/�-alU7, PY-13-14-CPS-0096 Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. S. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seg and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. 2 PY-13-14-CPS-0096 • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with ail other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 3 PV -13 -14 -CPS -0096 d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with ail reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers and agents. 4 PY-13-14-CPS-0096 Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CPS-0096 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this. Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CPS-0096 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Julie Box Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Julie Box, Executive Director 1702 68`h Avenue Greeley, CO 80634 1970)302-1471 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CPS-0096 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CPS-0096 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 9 PY-13-14-CPS-0096 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PI -13 -14 -CPS -0096 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUN ,COLORADO LK/frit/ — William F. Garcia, Chair CONTRACTOR: By: SEP 2 3 2013 �C�VV gxeubt- v:2-i,treci-6`c-- Title (Q®/s c?(o 25/ PY-13-14-CPS-0096 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide the 12 -Hour State -required Core Certification Training for foster care applicants, as well as individuals or couples training as needed and referred by the Department. The goal of the program is to enhance and improve the quality of care being provided to the Department's children and youth. 2. All trainings will satisfy the requirements set forth in the State of Colorado Volume VII and as set forth by the Department. 3. CONTRACTOR will provide the 12 -Hour State -required Core Certification Training as needed. This training will include, at a minimum, the following ten primary topic area, as outline in Volume 7.500.311: 1. General overview of foster care 2. Administrative and legal issues 3. Why children get placed in out -of -home care 4. Parenting and family dynamics 5. Key concepts of child growth and development 6. Importance of the team approach 7. Individual differences, such as ethnicity and culture 8. Discipline 9. Effects of fostering on the foster family 10. Working with the biological family 4. Individual or couples training will be referred as a specific topic/need. 5. At a minimum, CONTRACTOR will instruct on attachment and bonding issues, grief, loss and separation issues, adoption issues, child growth and development, boundary setting and discipline, providing for children of differing races, cultures and ethnicities, confidentiality, understanding adoption laws and procedures, including termination of parental rights, relinquishment and expedited permanency plans, contact and communication with the child's biological family members, safety and permanency for foster children, the well-being of families and the use of community resources. 6. CONTRACTOR will provide individual or couple training on specific topics as referred by the Department. 7. CONTRACTOR will provide a completion certificate to each applicant who completes training. 8. CONTRACTOR will provide the 12 -Hour State -required Core Certification at 1702 68th Avenue, in Greeley, CO, unless otherwise determined by the Department. 9. CONTRACTOR will work collaboratively with foster parents, caseworkers, foster care coordinators and other service providers to identify and address issues, in a solution -focused manner. 10. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children in their home and report this information to the Department. 11. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12 PY-13-14-CPS-0096 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $150.00/Person (Foster Parent Training -12 Hours/State Requirement) $200.00/Hour/Couple (Foster Parent Training/Topic Specific - 2 Hours) $100.00/Hour/Individual (Foster Parenting Training/Topic Specific - 2 Hours) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit O of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 13 PY-13-14-CPS-0096 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress overtime. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 PY-13-14-CP5-0096 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children, Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-13-14-CPS-0096 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. if contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 16 PY-13-14-CPS-0096 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 PY-13-14-CPS-0096 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 18 Lifeskills, Mental Health, PY-13-14-CPS-0096 ca 0cIo LO co ); 7 \$ 4«;@/ CV O O C.O CD O) $ 2 5o ]f{ LO LO LO U §k 2 CO 03 CO tO WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CPS-0096 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) U 2 0 a a) V N 0 0 a) a U Z a, O C a) E to a 0 aJ E' 0 2 a, U a a1 O E L 8 O U a) J Y Y ai c E O E L C O E a) a, .c 00 C v Q7 N C U a et a v O C E to d aJ .0 N 0 -C IC 0 .y an O N 0 t E 3 E E .fl V N 0 3 an U j an MO - 41 C E m o. E O LL C U 4, al aa▪ i U b a Do 01 la O o. to L 0 CO 0. E U al Section I: (To be completed by the CONTRACTOR) Total Hours Billed a3 F Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) L W T 0 O a) U a) U W 0 v U a, c W GG 0 0 L_ 5 O V • C. H Do u d M C Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; I.e., Sally Smith by Gregg Jones, Foster Parent} Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) v a SC O r C a! s 0 O a d U R PY-13-14-HS-0043 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS, LLC Thee This Agreement, made and entered into the day of 2013, by and between the Board of Weld County Commissioners, sitting as the Board of Human Services, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Strong Foundations, LLC, hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration to the Department for Home Study and Relinquishment Counseling Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013, upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 0011- X71/ PY-13-14-HS-0043 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seg; and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-HS-0043 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. if necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-HS-0043 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PV -13 -14 -HS -0043 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-HS-0043 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-HS-0043 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Julie Box Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Julie Box, Executive Director 1702 68th Avenue Greeley, CO 80634 (970) 302-1471 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-HS-0043 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-HS-0043 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-HS-0043 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-HS-0043 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld Co Clerk to the Board By: WELD COUNTY DEPARTMENT OF HUMAN SERVICES 11 BOARD OF COUNTY COMMISSIONERS WELD COUN OLORADO iam F. Garcia, Chair CONTRACTOR: By: SEP 2 3 2013 a '.ycec.0 h;P i terst9s— Title PY-13-14-HS-0043 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Study and Relinquishment Counseling services to families referred by the Department. 2. CONTRACTOR utilizes the Structured Analysis Family Evaluation (SAFE) tool developed by the Consortium of Children. CONTRACTOR is SAFE certified and appears on the State's approved home study vendor list. 3. CONTRACTOR will attend SAFE Refresher training during the term of the contract. 4. CONTRACTOR has completed SAFE Supervisor Training and is certified to supervise others' using the SAFE format. 5. CONTRACTOR will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on www.consortforkids.org or www.SAFEhomestudv.org. 6. CONTRACTOR will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department, unless otherwise directed by the Department. 7. CONTRACTOR will notify the Department within three days of receipt of a referral if the referral will be accepted and acted upon. 8. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check information, SAFE questionnaires completed by the applicants, references and all other original documents submitted by the home study applicant. 9. Relinquishment counseling services will be provided to all adult individuals referred by the Department, as well as associated children 12 years of age and older, utilizing the required State format. CONTRACTOR will submit a written report and the appropriate affidavits and interrogatories. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any specific Weld County home. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Child abuse must be reported immediately per law. 12 PV -13 -14 -HS -0043 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $950.00/Episode (Full Home Study - Up to two (2) adults) $425.00/Episode (Home Study Update) $250.00/Person (Additional Adult - After two (2) adults) $225.00/Episode (Study cancelled after 3.5 hours direct service.) $300.00/Episode (Flat rate for interpretive services/family home study.) $150.00/Episode (Flat rate for interpretive services/individual home study.) $110.00/Hour (Relinquishment Counseling) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 13 PY-13-14-HS-0043 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 14 PY-13-14-HS-0043 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 15 PY-13-14-HS-0043 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 16 PY-13-14-HS-0043 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 17 PY-13-14-HS-0043 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-13-14-HS-0043 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY_ ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Address: Billing Contact: Phone Number: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 19 PY-13-14-HS-0043 is a) 2 is a) 2 N U, a) sts W U Q 4) E co- t? o o .° For Use By -Human Services Only ";Comments Monthly Total (Calculates automatically) 300.00 II till II I II III 0.. o: 0 0. a) _ (3 a) O C k LT O a to N — vN. U_ O O O - �a L.` ti 0 Q) <IOV?0_ cNc-•r U a) 16 o 0 O U) Z0/90 l•0/90 _ _ TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) O) O O N CO Household Number (Per referral) 555555 Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-HS-0043 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) z H -o v .0 a a▪ l 0 O 0 CU C • E Ut u a 4 0 d N O CU O aL C N E -o m Qo w L a • ca 01 7 C C 0 o s- o • N 0 V i 7 Ol O ▪ L E CU E £ ▪ ro .0 E Y ▪ W CO U E w • 0 O C H 01 y� •C CL o ≥. r0 • CZ • • • E L E • Y Cu rd 0) In J U a -I L C Y 4J C d '0 -a °D m N a 0 O. C o o. U a 10 W C o ? a CC q C Z ✓ • u r CU CU V col an 7. N 0 • J Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client billed: Phone Number Your Agency's Contact P Household Number: SECTION II (To be completed by client) 8 W C 0 C V tot -' b 8 • c b taa er- E t- ea O a an 4.• C 0 • -0 0 cal L Z.0 Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent) Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) l0 no 3 0 7 .0 0 E U W 0 A .0 V 0) N C� E C C E 10 0. N a d m C a 0 C E .0 N C 3 C a .0 C C E Qr O k C O A C 0) V R 0 d C $ z N u 0 $ 0 E PY-13-14-CORE-0175 u CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT, INC. firjr 11 11tt _7'�' C' This Agreement, made and entered into the 3 day of ' 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Turning Point Center for Youth and Family Development, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Day Treatment Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 Bois... a&29 PY-13-14-CORE-0175 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-CORE-0175 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. sea. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. H. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0175 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CORE-0175 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0175 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0175 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Stephanie Brown Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 1970)352-1551 18. Litigation For Contractor: Stephanie Brown, Executive Director 1644 South College Avenue Fort Collins, CO 80525 1970)567-6461 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0175 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0175 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0175 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0175 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: APP C./ ty A•.rney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: J 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY„CSLORADO i F. Garcia, Chair SEP 2 3 2013 CONTRACTO'(t'— JJ 4 ,ciq y�r� Title t7�Jrtve'—I-Dtex- _ et Tery,L. PY-13-14-CORE-0175 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide comprehensive, highly structured day treatment services, as proposed, to female and male youth, ages 10-18, as referred by the Department. 2. CONTRACTOR will provide day treatment services, as proposed, at 913 11th Avenue, Greeley, CO 80631, 8:30 a.m. to 4:30 p.m., Monday through Friday. 3. CONTRACTOR is licensed by the Colorado Department of Human Services State Child Care Licensing. License number 1553624. 4. Admission criteria include: a. Adolescents between the age of 10-18, male or female. b. Youth's needs cannot be met in a less restrictive environment due to emotional, family, behavioral, mental health, gang, legal and/or substance abuse issues. c. Youth is motivated and willing to participate in the program. d. Low to normal range of cognitive functioning. e. History of school failure and/or truancy. f. Family is willing to participate in treatment. 5. Teacher/Student ratio is 1 to 10. 6. Testing and psychiatric medication evaluations and appointments will be conducted as needed to aid in case planning and ensure the appropriate treatment is utilized for the referred youth's maximum growth and benefit. 7. Services will be provided by Masters' level therapists. 8. CONTRACTOR will utilize a bilingual Spanish interpreter when needed. 9. Referred youth will receive services for approximately four (4) to six (6) months. Length of services is dependent upon the referred youth's daily/weekly progress, individual/family needs and availability of funding. Services will include the following as appropriate: a. 30 hours per week of education approved by the Colorado Department of Education b. Milieu therapy c. Weekly individual therapy d. Bi-weekly group therapy (two hours per week/per referred youth) i. One hour of Dialectical Behavioral Therapy skills ii. One hour either substance abuse or social skills (based upon assessment upon acceptance into the program) 1. Substance Abuse Group (Pathways curriculum) e. Weekly in -home family therapy (if approved) f. Recreation Therapy g. Psychiatric services provided by a licensed psychiatrist (weekly as needed) h. Weekly community NA groups i. Daily recreation activities j. Vocational programming k. Affective education I. Transition services (Connections Program) i. Provided through a Department of Education grant H. Utilized for students transitioning back into a public school setting 12 PY-13-14-CORE-0175 m. Door to door transportation to and from program 10. CONTRACTOR agrees that each referred client will be given the initial 10 days after intake to settle in without an attendance requirement. Following the initial 10 days, any five (5) unexcused absences in a 30 -day time frame would necessitate discharge. 11. CONTRACTOR will provide individual, group and/or family therapy to all referred youth unless otherwise directed by the Department. 12. CONTRACTOR is a Medicaid -approved provider. Clients eligible for Medicaid will be referred with Core funding authorized for a short period of time to allow for the Medicaid approval process. Once approved, Medicaid will be billed for services. CONTRACTOR will work with the appropriate behavioral health organization to obtain the necessary approval for Medicaid funding and will community with the Department regarding the approval status. 13. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 14. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 15. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 16. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 17. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 18. Services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PV -13 -14 -CORE -0175 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $90.00/Day (Day Treatment with In -home Family Therapy) $80.00/Day (Day Treatment without In -home Family Therapy) $65.00/Day (Day Treatment - Transitional Service with In -home Family Therapy. Only used for clients transitioning to public school.) $55.00/Day (Day Treatment - Transitional Service without In -home Family Therapy. Only used for clients transitioning to public school.) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CORE-0175 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0175 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0175 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0175 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0175 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7`h of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11`h Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0175 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAMMAAAMMMMMAAAMMAAAAAAAMMMMAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0175 i o O C Ua) U Q Ll O O N0 8 ES(?) .O ca ETD -o E J U N C a) r 2 LO N ti CO CO 1f) CD co o 03 CO M • O O 0 2 D-Oa>a) ce 0 0 I- z 0 0 0 I- J - z LLJ w lb —J J_ z —J w 0 X w 0) U) 2 co CC .9 0 a Y 0) N a) CU F-.. CA a s 0 al >, z 0 f. °w O Q a) aa2 c`if) a 0 0 C) .C U_ E O (i) U a) 2 f0 c a) N Y y w X w O Nom, aa) E �) o 20 For Use By Human Services Only Comments Monthly Total (Calculates automatically) 300.00 a a 3 a a M 0 O L C cC a. I O N I0. .�+ U 'o (a i_ C •> O 7 O L U O ? N o a2 0�0- N ,.� U a O U) 06/01, 06/02 TOTALS (Calculate Automatically) Approved End Date (Per referral) rn co O N O CI) co Approved Start Date (Per referral) O O O N Zo Household Number (Per referral) LO lO U) LO V) Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0175 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) CC CC a m O -O O O L - C 3 E N it u v CC '^ v o C a s E T N )o n O 'C O C 6 O d N � N O Z al O a) L o E x Y s E -O C a) a! EGI O C c O .l t C u > Na Y O al y„ m C O. y V N a+ LL E E C O C C O O E W u V W Y aJ c V c C) O C c .0 a) 00 Z a, N N O. C O a! Q. m Q w CC G� < al as c 2 . v 8 3 CI an N o G Z Section I: (To be completed by the CONTRACTOR) Total Hours Billed 0 C) Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION It (To be completed by client) 2-2 O U O U U w w U 0 cC O Z O U V y d p C) O a •v u L v C) 0 bL a) U v C) E a) CC C c O 0 E v C 00 } V a) a) Ua 8 d U N o Z .c O CC)) .n to 0 c h o - L C 3 , U aJ N y O Il a/ r d u c m O s g m c � an 7, CO -a L C Cc v) O T ro 1.0 cn O a) .— Y O io � u .C .C C Y N o cu C O +' O CO 4, to E a > •V L a) a- CC d a) c Number of Hours of Service Provided Hours of Service 44 0 (Ex. 1:00 - 2:30) OC/ of /5d PY-13-14-CORE-0208 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT, INC. itte This Agreement, made and entered into the day o 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Turning Point Center for Youth and Family Development, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Home Based Intensive Services (Coaching, Family Care Coordination); and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1 2013 upon proper execution of this Agreement and shall expire May 31, 2014, unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 PY-13-14-CORE-0208 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq. and 2 PY-13-14-CORE-0208 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.5.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0208 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CORE-0208 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit -$500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0208 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0208 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Stephanie Brown Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 (970) 352-1551 18. Litigation For Contractor: Stephanie Brown, Executive Director 1644 South College Avenue Fort Collins, CO 80525 1970)567-6461 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PY-13-14-CORE-0208 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0208 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0208 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0208 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD CO,4.N ccOLORADO K4 1 r! m b. Garcia Chair SEP232013 CONTRACTOR fj ctor L /\ itJT i\t Title o?,046,- 621/ PY-13-14-CORE-0208 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Intensive Services to individuals and families in Weld County referred by the Department. Services include: a. Coaching. Services can include, but are not limited to, the following: i. In -home parenting support and education ii. Assistance with appointments iii. Engaging child or youth in recreational and leisure activities in the community iv. Supervision of child or youth while parents or caregiver is unavailable v. Assisting youth with job searches vi. Mentoring and positive role modeling vii. Connect child and/or youth and family with community resources viii. Assist with housing issues ix. Homework assistance and tutoring x. Life skills coaching and education b. Enhanced Coaching. Services include all of the services of Coaching with the addition of the following supportive services as needed: i. Emotional and social support for families ii. Parenting skills to improve family functioning iii. Behavioral interventions for children iv. Assistance with establishing services within the community and development of community connections v. Skill development for housekeeping with the focus on child safety vi. Family advocacy vii. Assistance with establishing household routine and structure viii. Development of positive social activities c. Family Care Coordination (FCC). FCC combines intensive family therapy, case management and overarching family support, and is designed to address risk of out -of -home placement with the goal of providing short-term intervention to stabilize and keep families intact. Services include: i. Assessment of all family members ii. Services in -home or in the community iii. Average of two (2) sessions per week; up to five (5) hours per session iv. 24/7 on -call support v. Collaboration with the Department, other providers and community members working with the family d. Family Care Coordination Light (FCC LIGHT). FCC Light provides identical services to FCC, including 24/7 on -call support, at a lower frequency of sessions. Referred clients will receive an average of one (1) session per week for up to five (5) hours. FCC Light is primarily utilized as a step-down from FCC for continuity of care. 2. CONTRACTOR will work with the Department to appropriately modify services as needed to meet client(s) needs. 3. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 12 PY-13-14-CORE-0208 4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 7. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 8. For Coaching and Enhanced Coaching only, CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. FCC and FCC Light are inclusive of meetings and staffings. 13 PY-13-14-CORE-0208 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $25.00/Hour (Coaching) $25.00/Hour (Enhanced Coaching) $25.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting - Coaches Only) $12.50/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting - Coaching Program Supervisor Only) $900.00/Month (Family Care Coordination. Pro -rated for any partial month of service.) $600.00/Month (Family Care Coordination Light. Pro -rated for any partial month of service.) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of ExhibitA and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 14 PY-13-14-CORE-0208 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0208 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0208 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0208 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0208 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES, Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0208 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: _ Phone Number: Address: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / _ Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0208 ai Y O Q N-.. w N 0 N r LX ' co X U i z n3 LEa a (1) '-'-= 0.1 LO p1. � 15 o Cl) a)�XOONCfl Lc) Tr TU Cm (DMM E N — 4) 0 O ▪ U a) 0 N Lt O F- () Q CC F- 2? O U O H f - z W uJ W m - J - J CD -J LLI 0 X 111 U) U U Q 0 m N .O- • U a a z C O c Ili o J U aid 32 a) co a) 2 a a) N N a) J X W Co U E (0 o o" O n For Use By Human Services Only Comments Monthly Total (Calculates automatically) 300.00 1 1 l f f 1 1 1 1 1 1 1 t 1 300.00 m 5 .r f6 a) O L C CCa1o❑ LO co — -0 03 E2 M = D `'O L U O L m U O <2 o 12 Na) r' U) N U al v- 000CO CI oU)oo - ,-- N O o TOTALS (Calculate Automatically) Approved End Date (Per referral) Cr) 0 0 N O Cr) CO Approved Start Date (Per referral) rn 0 O N x— Household Number (Per referral) in U) U) u7 Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0208 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) Section I: (To be completed by the CONTRACTOR) Total Hours Billed Primary Client bille Phone Number Your Agency's Contact Person: Household Number: SECTION lI (To be completed by client) C U Cy C U C) C) ti CJ Cl CE u CJ. O F- O .0 CC) C) 0 ti O D. N L 0 U O Cr C } ai Y u W E CU 'O • C CU D O C) E U CC C bfl 4. 4. b ii O 0 4-c 0 a, CD 0 C N O •N .0 0 3 d ro - 0- :E Q) N v- 0 • U- 4.1 ,,; N N ea"' c u o d L Y C CL L C 6 pp L• C E a N L T m �a w O odl 4l - 0 ro .O N N 41 L L H, M O - G • dD L1 41 7 C 0 ro E• ar V7 C 4l O. Cu CU CU a v Q. CC Q. • 41 ha U 'N Number of Hours of Service Provided Hours of Service (Ex. 1:00 — 2:30) CU PY-13-14-CORE-0234 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT, INC. G� / a - I Iii This Agreement, made and entered into the �S day of c 2fI .2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of of Human Services, hereinafter referred to as the "Department" and Turning Point Center for Youth and Family Development, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for Mental Health Services; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 1 ate/ Y c"))7,27 PY-13-14-CORE-0234 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-CORE-0234 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. H. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PY-13-14-CORE-0234 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CORE-0234 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CORE-0234 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CORE-0234 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Stephanie Brown Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 1970) 352-1551 18. Litigation For Contractor: Stephanie Brown, Executive Director 1644 South College Avenue Fort Collins, CO 80525 1970)567-6461 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. PY-13-14-CORE-0234 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PY-13-14-CORE-0234 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PY-13-14-CORE-0234 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CORE-0234 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: Deputy Clerk APP ROV AS TO F y Att.rney WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO 7 fly/ WilliaL≤F. Gtidia, Chair 11 SEP232013 CONTRACT u"eyfr r Title aO/3--&&29 PY-13-14-CORE-0234 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide client -center, family -focused Mental Health Services to individuals and families referred by the Department. Services include: a. Individual Therapy (either in -office or in -home) b. Family Therapy (either in -office or in -home) 2. All Mental Health Services are provided by a Master's Level Therapist who is supervised by a Licensed Clinical Director. 3. CONTRACTOR will work with the Department to appropriately modify services as needed to meet client(s) needs. 4. CONTRACTOR has implemented the following tenets related to Mental Health Services: a. Treat clients and their families with respect b. Openly communicate with referred individual and/or family c. Build on strengths of the youth and families as well as foster a partnership d. Collaborate with youth and families in making treatment, policy and programming decisions including involving families in designing, monitoring, and evaluating services e. View youth and families as individuals and as members of a family and a community f. Regard families as a key source of information about the youths' and their own needs g. Design services to fit family's needs and preferences including ensuring that services are appropriate for a family's culture and traditions and recognizing that conceptualizations of illness and substance use may vary within and across families. 5. CONTRACTOR has adopted Stress Process Theory when addressing the impact of mental illness within a family system. This theory assumes that chronic stress has predictable negative consequences that must be mitigated to promote the well being of families. In Family Therapy, CONTRACTOR will focus on the following primary areas: a. Reduction in the amount and intensity of demands b. Connection to additional resources c. Stress management strategies and behaviors d. Making situations more constructive, manageable and acceptable for the entire family 6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 PY-13-14-CORE-0234 10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 11. For Coaching and Enhanced Coaching only, CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. FCC and FCC Light are inclusive of meetings and staffings. 13 PY-13-14-CORE-0234 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $86.00/Hour (Individual or Family Therapy, In -Home. Greeley Metro Area -Greeley, Evans, La Salle, Eaton and Windsor.) $126.00/Hour (Individual or Family Therapy, In -Home. Outside Greeley Metro Area.) $68.00/Hour (Individual or Family Therpay, In -Office) $34.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting -Service in Office) $43.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting - Service in Home, Greeley Metro Area) $63.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting -Service in Home, Outside Greeley Metro Area) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. 14 PY-13-14-CORE-0234 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CORE-0234 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CORE-0234 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CORE-0234 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PY-13-14-CORE-0234 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Forms) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11th Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CORE-0234 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month /Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAMMAAAAAAAAAAMMMAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 20 PY-13-14-CORE-0234 ai w > 0 r. X N i0 Z X Il Q y v N � (8 A' 7)) C0 '� COLO CO CnR O O O O� V? —lc h o X TV cm 0M� co Jo -o o00 • o a) 30• 2r -r` tY 0 r U H Z 0 O O H F - z CO !U J - J 0 z J W O X W Z_ CO a) re U 0 2 LL (!) a)• J a�7 a) H 11 120 m3Q O .E >- >, Z • L 0 • Lu O -.0 __I o n. p 3 2 g< 0 Cu a) O C O 2U) t io a) To a) 2 N N X W c Q E mi- ca c O O 0 a For Use By Human Services Only Comments Monthly Total (Calculates automatically) O 0 0 0 M 1 1 1 1 1 1 1 1 1 { 1 1 1 1 300.00 _ .66 N O C 0.1 O J U) N _ ..�+ U -O N N E 5 o .2 3 D I. '- a) Qz o'a. N N ". n � U O OU)Co 01) - � N 0 O c)c) TOTALS (Calculate Automatically) Approved End Date (Per referral) rn O O N 0 C'V) CO Approved Start Date (Per referral) O) O 0 N CO Household Number (Per referral) 555555 Trails Case ID referraj) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John 4 y WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CORE-0234 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) d a a O 0 O p .+ a 3 E m n N N N O r C p E rc 0. 0 O w 7 a+ ry C 6 d N O N Zo 41 N u Li 0 II O v E w O O C 3 N N V > Z Ol t an k. °1 c m O T V O E4.4 t O C O E U CU v > N L C a+ N c7 CU 0 c 0 c to a Z a f° N n c O a. V Q N r 0 0 O p U -0 c to a E o N .47 U N d Z Section I: (To be completed by the CONTRACTOR) Total Hours Billed 0 N Primary Client billed: Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the u ti C 44, u a C c .0 0 to C 0 V >.. d :i C C " U0 o d V N O � 0 cu co 0 0 C C 3 a - a O w 0 0 O a - a) N cu L pp C Op T 'y .0 C 0 c vi Y CO CO N O Y . a CO L > U c>0 U .0 C ii V n Number of Hours of Service Provided Hours of Service (Ex. 1:00 - 2:30) CO equests for pa b9j94n e PY-13-14-CPS-0137 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TURNING POINT CENTER FOR YOUTH AND FAMILY DEVELOPMENT, INC. 4[? This Agreement, made and entered into the day of 24 , 2013, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred to as the "Department" and Turning Point Center for Youth and Family Development, Inc., hereinafter referred to as the "Contractor". WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration funding to the Department for Substance Abuse Treatment; and NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and shall expire May 31, 2014 unless sooner terminated as provided herein. 2. Scope of Services Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by reference 3. Referrals/Billing/Tracking CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto and incorporated herein by reference. 4. Payment Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and incorporated herein by reference. "Payment Schedule" shall establish the maximum reimbursement which will be paid from Child Welfare Administration funding during the duration of this Agreement. 1 PY-13-14-CPS-0137 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. c. The Department shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit A and authorized by the Department. Work performed prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed or considered part of this Agreement. 5. Financial Management At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall comply with the administrative requirements, cost principles and other requirements set forth in the Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133. 6. Payment Method Unless otherwise provided in Exhibit A and Exhibit B: a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs incurred in the performance of this Agreement. b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 7. Compliance with Applicable Laws CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following: a. Compliance with Applicable Laws At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or guidelines issued pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records, papers, documents, tapes and any other materials have been or may hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the following laws are included: • Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing regulation, 45 C.F.R. Part 80 et. seq.; and 2 PY-13-14-CPS-0137 • All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed, color, se, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under the is approved Agreement. • Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing regulations, 45 C.F.R. Part 84; and • the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation regulations, 45 C.F.R. Part 91; and • Title VII of the Civil Rights Act of 1964; and • the Age Discrimination in Employment Act of 1967; and • the Equal Pay Act of 1963; and • the Education Amendments of 1972; and • Immigration Reform and Control Act of 1986, P.L. 99-603 • 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in judicial proceedings any efforts to obtain access to client records except as permitted by 42 C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to assure that small and minority businesses are utilized, when possible, as sources of supplies, equipment, construction and services. This assurance is given in consideration of and for the purpose of obtaining any and all Federal and/or State financial assistance. • Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, CONTRACTORS, and sub -contractors. CONTRACTOR is further charged with the knowledge that any person who feels that s/he has been discriminated against has the right to file a complaint either with the Colorado Department of Human Services or with the U.S. Department of Health and Human Services, Office for Civil Rights. b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which may govern the ability of the Department to comply with the relevant funding requirements. CONTRACTOR understands that the source of funds to be used under this Agreement is Child Welfare Adminstration funds. c. CONTRACTOR assures and certifies that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department or agency. ii. Have not, within a three-year period preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; violation of federal or state antitrust statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Hi. Are not presently indicted for other otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 12 of this certification; and 3 PV -13 -14 -CPS -0137 iv. Have not, within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter in to a contract with a subcontractor that fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants, and agrees that is (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and CONTRACTOR shall be liable for actual and consequential damages to the Department. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement. 8. Compliance with Child and Family Services Review The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitor progress over time. Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance services to families. Any CONTRACTOR providing services under this Agreement to families and children referred by the Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is required to comply with the standard assessment and reporting system set forth in Exhibit C which will address the aforementioned three areas, unless otherwise determined by the Department. 9. Insurance Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its subcontractor, or their employees, volunteers, or agents while performing duties described in this Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County 4 PY-13-14-CPS-0137 Commissioners of Weld County, its employees, volunteers and agents. Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the acceptable evidence that such coverage is in effect. At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld County, its employees and agents, shall be named as additional named insured on the insurance, where permissible by the insurance CONTRACTOR. • Standard Workman's Compensation and Employer's Liability. o As required by State statute including occupational disease, covering all employees at work site. • General Liability (PL and PD) (Minimum). o Combined single limit - $500,000.00 written on an occurrence basis. o Any aggregate limit will not be less than $1 million ($1,000,000.00). o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate below $500,000.00 o State of Colorado to be named as additional insured on each comprehensive general liability policy. o Certificate of Insurance to be provided to Weld County. o Insurance shall include provision preventing cancellation without 60 days prior notice by certified mail to Weld County. • Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to whom Department services are being provided. • Additional coverage may be required in specific program areas. For any insurances that are required by this Agreement, a completed Standard Certificate of Insurance shall be provided to the Department by the Contractor prior to the start of any Agreement. 10. Certification CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the Contractor prior to the start of any Agreement. 5 PY-13-14-CPS-0137 11. Training CONTRACTOR may be required to attend training at the request of the Department specific to services provided under this Agreement. The Department will not compensate CONTRACTOR for said training in the form of registration fees, time spent traveling to and from training, attending the training or any other associated costs unless otherwise agreed to by the Department. 12. Subpoenas CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the subpoena must be personally served. 13. Monitoring and Evaluation CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and evaluation shall be provided to the Board of Weld County Commissioners, the Department and the Contractor. CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency, to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such monitoring shall be performed in a manner that will not unduly interfere with work conducted under this Agreement. 14. Modification of Agreement All modifications to this Agreement shall be in writing and signed by both parties. 15. Remedies The Director of Human Services or designee may exercise the following remedial actions should s/he find Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Contractor. These remedial actions are as follows: a. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 6 PY-13-14-CPS-0137 b. Deny payment or recover reimbursement for those services or deliverables, which have not been performed and which due to circumstances caused by the Contractor cannot be performed or if performed would be of no value to the Department. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to the Department. c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered from Contractor by deduction from subsequent payments under this Agreement or other agreements between the Department and Contractor, or by the Department as a debt due to the Department or otherwise as provided by law. 16. Representatives For the purpose of this Agreement, the individuals identified below are hereby designated representatives of the respective parties. Either party may from time to time designate in writing a new or substitute representative(s): For the Department: Heather Walker Name For Contractor: Stephanie Brown Name 17. Notice Administrator Title Executive Director Title All notices required to be given by the parties hereunder shall be given by certified or registered mail to the individuals at the addresses set forth below. Either party may from time to time designate in writing a substitute person(s) or address to whom such notices shall be sent. For Department: Judy A. Griego, Director P.O. Box A Greeley, CO 80632 1970) 352-1551 18. Litigation For Contractor: Stephanie Brown, Executive Director 1644 South College Avenue Fort Collins, CO 80525 (970) 567-6461 CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual litigation in which it is a party defendant in a case that involves services provided under this Agreement. Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any Federal or State court or administrative agency, shall deliver copies of such document(s) to the Director of Human Services. The term "litigation" includes an assignment for the benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure. 7 PV -13 -14 -CPS -0137 19. Termination This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year, as this Agreement is subject to the availability of funding. Therefore, the Department may terminate this Agreement at any time if the source of funding for the services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR reserves the right to suspend services to clients if funding is no longer available. 20. No Third Party Beneficiary Enforcement It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under this Agreement shall be an incidental beneficiary only. 21. Governmental Immunity No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. 22. Partial Invalidity of Agreement If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Agreement and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 23. Improprieties No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement, CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall 8 PV -13 -14 -CPS -0137 submit to the Department, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR. CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 24. Storage, Availability and Retention of Records CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect and copy records, and shall be allowed to monitor and review through on -site visits, all activities related to this Agreement, supported with funds under this Agreement to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. All such records, documents, communications, and other materials created pursuant or related to this Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to Human Services upon its request, for a period of seven (7) years from the date of final payment under this Agreement, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the seven (7) year period, or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the resolution of the audit finding. 25. Confidentiality of Records CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Agreement except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to, duplication and dissemination of, all such information, in any form, including social networks. CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 9 PV -13 -14 -CPS -0137 CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall provide a copy of such agreement to the Department, if requested. 26. Proprietary Information Proprietary information for the purposes of this Agreement is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Agreement. Any proprietary information removed from the Department's site by CONTRACTOR in the course of providing services under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR for similar information in the course of its own business. 27. Independence of CONTRACTOR: Not Employee of Weld County CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 28. Entire Agreement This Agreement, together with all attachments hereto, constitutes the entire understanding between the parties with respect to the subject matter hereof, and may not be changed or modified except as stated in Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder without the prior consent of both parties. 10 PY-13-14-CPS-0137 IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board By: the Board APBR WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: 11 BOARD OF COUNTY COMMISSIONERS WELD COUNTY RADO F. arcia, Chair CONTRACTOR: By: SEP232013 l V+en�tn-n� 2„ Title ao/g-a7,27- PY-13-14-CPS-0137 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide substance abuse education, intervention and/or treatment to adolescents referred by the Department. 2. The goal of services is to educate youth to prevent substance abuse and, when problems already exist, to provide treatment and relapse prevention. 3. CONTRACTOR will work with referred clients to: a. Utilize community services to provide a continuum of treatment and ensure successful recovery. b. Transition clients successfully into their home communities. c. Support clients in developing a recovery plan. d. Allow clients to experience recovery. 4. CONTRACTOR will assess each client to determine the appropriate level of care and a treatment plan. The treatment plan may include any of the following services: a. Individual Therapy b. Group Therapy c. Intensive Outpatient Program (meets ASAM criteria) d. 12 -step Facilitation and Support e. Relapse Prevention Planning 5. Assessed clients will be assigned to one (1) of four (4) tracks as follows: a. Education and Prevention: Youth attend one (1) drug and alcohol educationgroup per week led by a Certified Addictions Counselor (Level II or III). This group focuses primarily on education, biological effects of drug and alcohol use on the body, peer pressure and other pertinent information. Youth in this track also are provided exposure to recovery groups and educated on the use of such groups. b. Intervention: The goal of intervention is to reduce the risk of harm and decrease problem behaviors that result from continued use of substances. The intent of the intervention is to take action that decreases risk factors related to substance use, abuse or dependency; enhance protective factors; and provide ongoing services, as appropriate. Youth attend one (1) 60 -minute treatment -focused drug and alcohol group per week led by a Certified Addictions Counselor (Level II or III). This group focuses on treatment interventions and recovery using the DBH developed and approved curriculum Pathways to Self Discovery and Change. Youth in this track also choose a recovery program and assisted individually with work on that program. c. Treatment: The goal of treatment is to improve social functioning through complete abstinence from alcohol and drugs for individual diagnosed with chemical dependency. Youth in this level of care participate in the Intensive Outpatient Program and are provided additional services that allow for the implementation of individual treatment plans targeted at the unique needs and the combination of impairments that may hinder the youth's recovery. These youth will attend services nine (9) hours per week along with their family supports. Services are as follows: i. Monday, Wednesday and Friday ii. Monday (Client Only): Education Group (5-6 p.m.), Motivation & Change (6-7 p.m.) and Process Group (7-8 p.m.) iii. Wednesday (Client and Family Support): Education Group (5-6 p.m.), Dialectical Behavioral Therapy (6-7 p.m.), Process Group (7-8 p.m.) iv. Friday (Client Only): Experiential Recovery (5-8 p.m.) 12 PY-13-14-CPS-0137 d. Relapse Prevention: The goal of relapse prevention is to increase awareness and range of choices concerning behavior, to develop specific coping skills and self -management abilities, and to create a general sense of manageability. To achieve these goals, youth are asked to take a thorough look at their substance abuse and problematic behavior, explore personal characteristics, and develop specific plans for alternative behavior and choices. All youth must complete an individual relapse prevention plan before completion of the program. 6. CONTRACTOR incorporates a Contingency Management Program, which applies the following principles: a. An undesirable activity or behavior is more likely to reoccur if it is followed by some kind of positive reinforcement or reward each time it occurs. b. Positive reinforcement or rewards are more effective than punishment in changing behaviors. c. Contingency management can be sued even when an individual's behavior is out of control because it teaches self control. d. Contingency management can be used in a variety of settings, including home or school. 7. CONTRACTOR will work with the Department to appropriately modify services as needed to meet client(s) needs. 8. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Child Welfare Contract and Services Coordinator immediately. 9. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 10. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 11. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented service on the initial authorized referral form. This may include an increase or decrease in services hours, change in frequency, change in location of services, transportation needs, or any change to the initial referral or subsequent authorizations. 13. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring, and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or meetings with Department staff are not considered billable hours unless otherwise approved by the Child Welfare Contract and Services Coordinator. 13 PY-13-14-CPS-0137 EXHIBIT B PAYMENT SCHEDULE 1. Funding and Method of Payment The Department agrees to reimburse Contractor in consideration for the work and services performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be paid to Contractor during the term of this Agreement shall be reported by the Department in Trails after May 31, 2014. Expenses incurred by Contractor prior to the term of this agreement are not eligible Department expenditures and shall not be reimbursed by the Department. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon the continuing availability of said funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by the Department, the Department may immediately terminate the Agreement or amend it accordingly. 2. Fees for Services $68.00/Session (Individual or Family Therapy Session, In -Office.) $26.00/Client/Session (Group Therapy Session) $90.00/Session (Intensive Outpatient Evening Session) $16.00/Episode (Urinalysis) $3.00/Episode (Breathalyzer) $34.00/Hour (Court Facilitation/Court Staffing/Family Team Meeting/Team Decision Making Meeting) CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department client is responsible, but which a particular client refuses or fails to pay. CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any payment received on the monthly billing. 3. Submittal of Vouchers CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services authorized were provide on the date(s) indicated and the charges made were pursuant to the terms and conditions of Exhibit A and Exhibit D. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the month following the month the cost was incurred. Failure to submit by the aforementioned deadline may result in forfeiture of payment. a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria established by the Department. 14 PY-13-14-CPS-0137 b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client signatures or the test result. 15 PY-13-14-CPS-0137 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS (CFSR) The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety, Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review, a Performance Improvement Program (PIP) will be implemented for the state to enhance services to families. Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are, first and foremost, protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats, or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and destructive to a child's cognitive, social, emotional and/or physical development, and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 16 PY-13-14-CPS-0137 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out -of -home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made, in the CONTRACTORs' opinion. • CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended family/child, etc.) and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well -Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 17 PY-13-14-CPS-0137 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all contractors regardless of the service being provided, unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to contractors via e-mail. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Child Welfare Contract and Services Coordinator for a referral. 3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the Department periodically. Contractors are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. Contractors may attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Child Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or Family Team Meeting (FTM), or by court order. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact the Child Welfare Contract and Services Coordinator for a referral. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together (ex. Family therapy), each member should sign the same form at the time of service. 3) If the client receives services over multiple dates, then the client must sign at the time of service for each date (appointment). 18 PV -13 -14 -CPS -0137 4) If a child is receiving services and is unable to sign, then an appropriate person should sign for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only, should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7`h of the month following the month of service in order to be processed for payment that month. Billing received after the 7`h of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online (if applicable to the service provided), 2) the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures, and 4) a monthly progress report if applicable submitted per the online format required by the Department unless otherwise directed by the Department. A contractor also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Joceyln Florez, Fiscal Clerk WCDHS/Service Utilization Unit Mailing Address: P.O. Box A, Greeley, CO 80632 Physical Address: 315 A North 11t° Avenue, Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-13-14-CPS-0137 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month / Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core & Service Contract Coordinator Date 20 PY-13-14-CPS-0137 ai • O Q N O N ant) (O SZ n• i z fa X u..2-0‹ N o >• • M L G o > CD O LL O a) 09NCO h p C!) X =' �,O C m (1,-, M M E a)a _E 000 a) j0 g), SO- - COg 2a:0cr)co 0 h 0 cc h z 0 O O h h z W m J J z a J W O x W Z_ U) 2 a) 2 U O U- 01 N E� • O C) w p }• a� z � LO 3 ow O N J O a) d ▪ p • Q re co For Use By Human Services Only Comments Monthly Total (Calculates automatically) .,: O O - O. oo O L _ N N O .:_.-mot_c R' a I O : N w tom) p N 3 C O a) <I o2a N N U_ o O co 06/01, 06/02 TOTALS (Calculate Automatically) Approved End Date (Per referral) 8/30/2009 Approved Start Date (Per referral) O) O O N 7. co Household Number (Per referral) 555555 Trails Case ID (Per referral) 1654888 Client Name (Per Referral) SAMPLE ENTRY: Doe, John WELD COUNTY DEPARTMENT OF HUMAN SERVICES PY-13-14-CPS-0137 CONTRACTED SERVICES CLIENT VERIFICATION FORM (SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR) Section I: (To be completed by the CONTRACTOR) al -lours Billed P I- Primary Client b Phone Number Your Agency's Contact Person: Household Number: SECTION II (To be completed by client) C� •o C a O U) LC 4) B ld C 44 C 7 V g O .5 V V u U� r C d '04 zs ture (Please ha 4) 4-0 O C N O +• L C m O. u y y O LL '0, "'' V C 0) O .O on Y C C - � no 4 00 wC O C N ✓ T m N N L • ..1 ▪ . U O L V W 00 d C O d no O V) C cu N o ra .O 47 i N a 4) U - 'N Number of Hours of Service Provided Hours of Set -vi Y O nth following day of the mo All requests for payment must be received by Hello