HomeMy WebLinkAbout20132289.tiffSubmitted by: Tobi Vegter 9/26/2013 8:27:43 AM
September 25, 2013
DEPARTMENT OF HUMAN SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:-ww.co.wcId.co.us
Administration and Public Assistance (970) 352-1551
Child Support (970) 352-6933
Johnson Drug Testing, LLC
Shane T. Johnson, Operations Manager
605 South College Avenue
Fort Collins, CO 80524
Dear Mr. Johnson:
After reviewing our contracted services for substance abuse monitoring, the Weld County
Department of Human Services has decided to terminate our contractual agreement with Johnson
Drug Testing, LLC effective October 24, 2013. We are no longer in need of in-house drug
testing due to having another substance abuse monitoring vendor who is located within two
blocks and is available 24/7 for monitoring purposes.
At this time, we are officially giving our 30 -day written notice to terminate Agreement Number
PY-13-14-CPS-0132 for Monitored Sobriety Services. The agreement will terminate 30 days
from the date noted above. All current referrals that you are handling will continue as usual,
however, there will be no new referrals made during this 30 day period. We thank you for your
service to Weld County clients and if you have any questions or concerns regarding this decision
you may contact Veronica Cavazos at Ext. 6282 or Heather Walker at Ext. 6218.
Sincerely,
y A. iego, ctor
eld County Department of Human Services
cc: Bruce Barker, Weld County Attorney
Heather Walker, Child Welfare Division Director/Administrator
Veronica Cavazos, Resource Manager
Lesley Cobb, Financial Supervisor
9-30 -020/3
a?0/3- as 89
RESOLUTION
RE: APPROVE EIGHTEEN (18) 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 eighteen (18) 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 the memorandum marked 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 eighteen (18) 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 the
memorandum marked 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 14th day of August, A.D., 2013, nunc pro tunc June 1, 2013.
BOARD OF OUNTY COMMISSIONERS
WELD C TY, COLORADO
Weld County Clerk to the Board
BY:
AP
Deputy Clerk
ounty Attorney
Date of signature:
\
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$II%
illiam F. Garcia, Chair
EXCUSED
Douglas Rademacher, Pro-Tem
an P. Conway
TA-
ike Freeman
rbara Kirkmeyer
2013-2289
HR0084
MEMORANDUM
DATE: August 6, 2013
TO:
William F. Garcia, Chair, Board of County Commissioners
FROM: Judy A. Griego, Director, Human ervices Derma
SUBJECT: Child Protection Agreements for 1 tip" s eiwee
Weld County Department of H a Servi.es 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 following represent 18 agreements received
leaving 39 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
Alternatives Homes for
Youth
06/01/13 - 05/31/14
Home Based
Intensive Services
(Transition
Services)
Core
$600.00/Month (Low, 4-8 Hours/Month, No
Therapy)
$900.00/Month (Medium, 8-15 Hours/Month,
No Therapy)
$1,200.00/Month (High, 15+ Hours/Month, No
Therapy, Includes On -call Crisis Management)
$900.00/Month (Low, 4-8 Hours/Month, with
In -home Therapy up to 3 Hours/Week)
$1,200.00/Month (Medium, 8-15 Hours/Month,
with In -Home Therapy up to 3 Hours/Week)
$1,500.00/Month (High, 15+ Hours/Month, with
In -home Therapy up to 3 Hours/Week and Crisis
Management)
2
Creative Test Creations
06/01/13 - 05/31/14
Monitored
Sobriety
CW Admin
$15.00/Episode (Urinalysis -7 Panel plus EtG)
$14.50/Episode (Urinalysis — 7 Panel)
$37.00/Episode (Urinalysis — Spice)
$16.00/Episode (Urinalysis — Oxycodone and
Suboxone)
$2.00/Episode (Breathalyzer)
$5.00/Episode (Antabuse Monitoring)\
3
Crossroads Counseling,
LLC
06/01/13 -05/31/14
Sexual Abuse
Treatment
Core
$1,000.00/Month (Individual Solution Directed
Therapy, Low Intensity)
$1,400.00/Month (Individual Solution Directed
Therapy, Medium Intensity)
$1,800.00/Month (Individual Solution Directed
2013-2289
Therapy, High Intensity)
$1,000.00/Episode (Family Solution Directed
Therapy, Low Intensity)
$1,600.00/Episode (Family Solution Directed
Therapy, Medium Intensity)
$2,400.00/Episode (Family Solution Directed
Therapy, High Intensity)
$80.00?Hour (Tapering off services at the end of
treatment or standalone clarification)
4
Griffith Centers for
Children
06/01/13 - 05/31/14
Life Skills
(Parenting Skills,
Visitation)
Core
$38.00/Hour (Parenting Skills)
$36.00/Hour (Therapeutic Visitation)
$25.00/Hour (Court Staffing/Court
Facilitation/Family Team Meeting/Team
Decision Making Meeting)
5
Griffith Centers for
Children
06/01/13 - 05/31/14
Mental Health
Services
Core
$52.00/Hour (Individual Therapy)
$56.00/Hour (Family Therapy)
$150.00/Episode (Mental Health Pre -Treatment
Assessment)
$25.00/Hour (Court Staffing/Court
Facilitation/Family Team Meeting/Team
Decision Making Meeting)
6
Griffith Centers for
Children
06/01/13 - 05/31/14
Home Based
Intensive Services
Core
$48.00/Hour (Family Preservation Services)
$25.00/Hour (Court Staffing/Court
Facilitation/Family Team Meeting/Team
Decision Making Meeting)
7
Idea Forum, Inc.
06/01/13 - 05/31/14
Monitored
Sobriety Services
CW Admin
$8.00/Episode (Swab)
$15.00/Episode (Urinalysis)
$40.00/Episode (Ethyl Glucuronide — EtG)
$120.00/Episode (Urinalysis —Steroids)
$40.00/Episode (Urinalysis — Synthetic THC aka
"Spice")
$99.00/Episode (Hair Test)
$6.00/Episode (Breathalyzer, 1-3/Week)
$10.00/Episode (Breathalyzer, 4/Day)
8
Idea Forum, Inc.
06/01/13 - 05/31/14
Domestic Violence
Evaluation and
Treatment Services
CW Admin
$55.00/Episode (DV Intake and First Session)
$80.00/Episode/Person (Group Session - Adult)
$15.00/Episode/Person (Group Session - Youth)
$45.00/Episode (Individual Session - Adult)
$25.00/Episode (Individual Session - Youth)
$40.00/Episode/Person (Group Session — Caring
Dads)
$65.00/Episode (Family Session)
$150.00/Episode (Domestic Violence
Evaluation)
9
Johnson Drug Testing
06/01/13 - 05/31/14
Monitored
Sobriety
CW Admin
$13.00/Episode (Instant 5 -Panel)
$20.00/Episode (Instant 10 -Panel)
$32.00/Episode (Instant Oral Swab)
$25.00/Episode (Instant 5 -Panel with
Confirmation)
$25.00/Episode (Instant 10 -Panel with
Confirmation)
$37.50/Episode ((Instant Oral Swab with
Confirmation)
$37.50/Episode (Oral Swab Lab Test)
$16.00/Episode (7 -Panel Lab Test)
$40.00/Episode (Ethyl Glucuronide/EtG)
$90.00/Episode (Hair Follicle)
$125.00/Episode (EtG Hair Follicle)
$90.00/Episode (Body Hair Test)
$125.00/Episode (Fingernail Drug Test)
$125.00/Episode (Toenail Drug Test)
$2.00/Episode (Breathalyzer)
$2.00/Episode (Breathalyzer Confirmation)
$40.00/Episode (Spice Test)
$40.00/Episode (Bath Salts Test)
$75.00/Episode (Comprehensive Metabolic
Panel)
10
Lucero-Haines, Carmen
06/01/13 - 05/31/14
Sexual Abuse
Treatment
Core
$115.00/Hour (Face -to -Face Services)
$100.00/1 -lour (Court Facilitation/Court
Staffing/Family Team Meeting/Team
: Decision Making Meeting)
11
North Range Behavioral
Health
06/01/13 -05/31/14
Mental Health
Services
Core
$250.00/Episode (Level 1 — Behavioral Health
Evaluation)
$800.00/Episode (Level 2 — Partial
Psychological Evaluation)
$1,200.00/Episode (Level 3 — Full
Psychological Evaluation)
$120.00/Hour (Hourly Rate for partially
completed evaluations. Not to exceed the cost
of the full evaluation)
$120.00/Hour (Court Facilitation/Court
Staffing/Family Team Meeting/Team
Decision Making Meeting)
12
North Range Behavioral
Health
06/01/13 - 05/31/14
Functional Family
Therapy
Core
$675.00/Month (Pro -Rated for partial month of
service)
13
North Range Behavioral
Health
06/01/13 - 05/31/14
Multisystemic
Therapy
Core
$1,800.00/Month (Pro -Rated for partial month
of service)
14
North Range Behavioral
Health
06/01/13 -05/31/14
Anger
Management/
Domestic Violence
Evaluation and
Treatment Services
CW Admin
$200.00/Episode (Anger Management or
Domestic Violence Evaluation)
$35.00/Episode/Person (Group Session)
$17.50/15 Minutes (Individual Session)
$50.00/Hour (Court Facilitation/Court
Staffing/Family Team Meeting/Team
Decision Making Meeting)
15
North Range Behavioral
Health
06/01/13 - 05/31/14
Monitored
Sobriety Services
CW Admin
$20.00/Episode (Urinalysis — 5 -Panel: THC,
Cocaine, Amphetamines, Benzodiazepines,
Opiates)
$20.00/Episode (Urinalysis — 7 -Panel: THC,
Cocaine, Amphetamines, Benzodiazepines,
Opiates, Barbiturates, Alcohol)
$20.00/Episode (InstaCheck 5 -Panel)
$20.00/Episode (Multi -Panel Instance
Urinalysis)
$20.00/Episode (Instant Swab)
$35.00/Episode (GCMS — Confimnation of
Positive Result)
$5.00/Episode (Breathalyzer)
$100.00/Episode (Hair Test)
$50.00/Episode (Patch)
$35.00/Episode (Ethyl Glucuronide Test aka
EtG)
$50.00/Episode (Urinalysis — Expanded
Designer Stimulants — 14 -Panel)
$35.00/Episode (Urinalysis — MDPV,
Mephedrone, Methylone — 3 -Panel)
$35.00/Episode (Urinalysis — Synthetic
Cannabinoids — "Spice")
$35.00/Episode (Oral Swab — Synthetic
Cannabinoids — "Spice")
$2.00/Episode (Urinalysis — Single Panel EtG
Add-on for 5- or 7 -Panel UA Only)
$2.00/Episode (Urinalysis — Add-on Panel for
Oxycodone or Buprenorphine for 5- or 7 -Panel
UA Only)
16
Transitions Psychology
Group, LLC
06/01/13 - 05/31/14
Life Skills
Core
$110.00/Hour (Family Theraphy Visitation,
Face -to -Face)
$110.00/Hour (Level 3 Therapeutic Visitation,
Face -to -Face)
$125.00/Hour (Therapeutic Visitation or Life
Skills Parent Coaching)
$110.00/Hour (Court Facilitation/Court
Staffing/Family Team Meeting/Team
Decision Making Meeting)
17
Transitions Psychology
Group, LLC
06/01/13 - 05/31/14
Mental Health
Services
Core
$100.00/Hour (Individual, Family Therapy or
Eye Movement Desensitization and
Reprocessing (EMDR) — In -Office. Face -to -
Face)
$115.00/Hour (Individual or Family Therapy —
In -Home. Face -to -Face)
$180.00/Hour (Co -Therapy. Face -to -Face)
$110.00/Hour (Court Facilitation/Court
Staffing/Family Team Meeting/Team
Decision Making Meeting)
18
Wurth, Helene
06/01/13 -05/31/14
Home Studies and
Relinquishment
Counseling
CW Admin
$1,000.00/Episode (Full Home Study)
$450.00/Episode (Updated Home Study)
$200.00/Episode (Additional Adult)
$50.00/Hour (Cancellation Home Study)
$100.00/Hour (Relinquishment Counseling)
If you have any questions, give me a call at extension 6510.
PY-13-14-CORE-0226
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND ALTERNATIVE HOMES FOR YOUTH
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 Alternative Homes for Youth, hereinafter
referred to as the "Contractor".
WITNESS ETH
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 (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
referent e
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-0226
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 ExhibitAand 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 al I 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 Ma nagement Ma nua l 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 Exhi bit 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 a pplicable 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 It es�c and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
2
PY-13-14-CORE-0226
• 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 Reha bi litation 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; a nd
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1.963; and
• the Education Amend ments 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 R ehabilitation 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 ofsupplies,
equipment, construction and services. This assurance is given in consideration ofand 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 fi I e a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Ovil
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 rend ered 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 a ntitrust 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
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PY-13-14-CORE-0226
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.
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) ifsuch 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
4
PY-13-14-CORE-0226
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 Co mmissioners 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 without60 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 I nsura nce 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/orsuppli es
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.
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PY-13-14-CORE-0226
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 anysubpoena 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 Officeimmediately at970-353-5215, x6503, and
advisethatthe 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 mayin 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 necessaryservices or corrections in performance are
satisfactorily completed.
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PY-13-14-CORE-0226
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 del ivera bl es 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 bylaw.
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
Na me
For Contractor:
Shavna Miller
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 d es igna te i n writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Gri ego, Director
P.O. Box A
Greeley, CO 80632
{9701 352-1551
18. Litigation
For Contractor:
Shavna Miller, Executive Director
1110 M Street
Greetev, CO 80631
(3031881-1247
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-0226
19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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 oth erwise
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at anytime 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 nothi ng i n 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 amend ed.
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 knowl edge 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 creatinga conflict of
interest. Upon learning of an existi ng appearance of a conflict of interest situation, CONTRACTOR shall
8
PY-13-14-CORE-0226
submit to the Department, a full disclosure statement setting forth the d eta i Is 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 anyfederal 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. Storaee. 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 avai la bl e 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 form identifiable with the applicant/recipient or a
minor's parent or guardian unless in a ccorda nce 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-0226
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 fromthird
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose di rectiy 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 I east 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-0226
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:
A
ounty Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
o, Direct\
1- ony
11
BOARD OF COUNTY COMMISSIONERS
WELD C• 1 , COLORADO
arcia, Chair
CONTRACTOR:
By:
Title
tor
velfor
AUG 1 4 2013
PY- 13- 14-COR E-0226
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Home -Based Intensive Services (Transition Services) to adolescent mal es, ages
13-20, as referred by the Department. Target populations include youth with the following behaviors:
• Sexually Abusive Behaviors
• Substance Abuse Challenges
• Mental Heath Challenges
• Criminogenic Behaviors
• - Dually -diagnosed per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR)
2. Through Transition Services, the CONTRACTOR will ensure the youth has a full time program which may
include any of the following activities, or any combination of the following activities:
• Job skills education including creating a resume, seeking a job, completing job applications, and
participating in mock interviews.
Transportation supportincludingteachinga youth how to access and utilize free and public
transportation.
• Accessing sustainable community resources.
• Probation compliance support.
• School enrollment including high school and college as well as how to apply for financial aid.
• Obtaining vital records.
• Linkage to appropriate recreational activities.
• Offense specific community registration.
• Support in attending community 12 -step group including providing transportation and
accompanying the youth in the meeting.
• Crisis management.
• Case management.
• Wrap -around service coordination.
• Independent living education.
• Attending staffings when appropriate.
• Assistance in locating local cultural and religious support.
• Coordinating community service hours.
• Transportation and advocacy for courtappearances.
• Education on healthy parenting techniques.
3. Each referred client will be assigned a Transitions Coordinator who will gather information in order to
complete a 360 degree assessment of the most effective way to offer support to the youth and his/her
family. CONTRACTOR will create an individualized transition plan for each referred youth to ensure
successful continued placement or reintegration.
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.
12
PY-13-14-CORE-0226
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 a uthori zed referral form. This may include an increase or decrease in services hours,
change in frequency, change in location of services, transportation needs, or any cha nge to the initial
referral or subsequent authorizations.
9. Monthly packages include attendance at staffings, Family Team Meetings (FTM) and/or Team Decision
Making (TDM) meetings. Staff' ngsand/or meetings are not considered billable hours unless otherwise
approved by the Chi Id Welfare Contract and Services Coordinator.
13
PY-13-14-CORE-0226
EXHIBIT B
PAYMENT SCH EDULE
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, 4-8 Hours/Month, No Therapy)
$900.00/Month (Medium, 8-15 Hours/Month, No Therapy)
$1,200.00/Month (High 15+ Hours/Month, No Therapy, Includes On -call Crisis Management)
$900.00/Month (Low, 4-8 Hours/Month, with In -home Therapy up to 3 Hours/Week)
$1,200.00/Month (Medium, 8-15 Hours/Month, with In -home Therapy up to 3 Hours/Week)
$1,500.00/Month (High, 15+ Hours/Month, with In-homeTherapy up to 3 Hours/Week and Crisis
Management)
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 ExhibitAand 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 res ult i n forfeiture of payment.
14
PY-13-14-CORE-0226
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-0226
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 i n 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
• CO NTRACTORs 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 responsi bil ity a re 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 chi ld(ren).
• CONTRACTO Rs must specifically document efforts to engage families in services and to control for safety.
16
PY-13-14-CORE-0226
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 CO NTRACTORs:
• 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 CONTRACTO R'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-0226
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 spedfic 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.
Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Dedsion Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal orwritten 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 receivingface-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-0226
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).
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
b i l ling 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-0226
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
AAAA AMA AAA AAA AAA WA AAA ANtAAAAMA AAA AAA AAAAAMA AAA AAA /UM
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Fiscal Clerk or Contract Coordinator Date
20
PY-13-14-CORE-0226
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Y
O
PY-13-14- CPS -0135
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND CREATIVE TEST COLLECTIONS
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 Creative Test Collections, 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 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.
1
PY-13-14- CPS -0135
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
Department by the 7rh 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
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• 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
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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
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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.
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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.
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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:
Thomas Worrall
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:
Thomas Worrall. Owner
617 Main Street
Windsor, CO 80550
(970) 686-7233
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.
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19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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
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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
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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.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County lerk to the Board
By:
APP
Deputy Clerk to ` e Board
my Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
A. Griego, Director
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY'CDLORADO
F. Garcia, Chair
AUG 14 2013
CONTRACTOR:
JI'
By: G %tcstiV-.c..-S
Contractor
Title
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PY-13-14- CPS -0135
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide timely and quality random monitored sobriety services at 617 Main Street, in
Windsor, CO, to clients referred by the Department.
2. CONTRACTOR will have a qualified monitored sobriety collector on site Monday through Friday, 3-8 p.m.,
Saturday, 11 a.m.-7 p.m., and Sunday 11 a.m.-3 p.m.
3. CONTRACTOR will manage a random monitored sobriety color (Breathalyzer) and animal (Urinalysis)
line/calendar. CONTRACTOR will submit a calendar for the following month to the Department on or
prior to the last business day of the month. The color line is accessible by phone at (970) 686-7235. .
4. CONTRACTOR will only accept referrals when a client has been assigned a color. Clients will be required
to call in seven (7) days a week.
5. CONTRACTOR will only provide services to referred clients who provide picture identification. A
caseworker may provide a client photograph in lieu of formai picture identification if such identification
cannot be provided.
6. CONTRACTOR will ensure best practices are followed for specimen collection, including observation of
male and female clients by same gender staff. CONTRACTOR will have both male and female staff
available during all business hours.
7. CONTRACTOR will not allow clients to make up missed monitoring unless prior approval from the
Department is obtained. Either the caseworker or caseworker's supervisor may provide such approval.
8. CONTRACTOR will confirm any positive, negative or missed monitored sobriety within 24 hours through a
phone call, test result, e-mail and/or fax to the Department (referring caseworker).
9. CONTRACTOR will confirm any non -negative specimen.
10. CONTRACTOR will provide a recap of each referred client's prior months monitoring by the 7th of the
month following the month of service.
11. CONTRACTOR will submit the required monthly billing forms, result and client sign -in sheet (if applicable)
by the 7th of the month following the month of service.
12. Results will be available online 24 hours per day, seven (7) days per week through the Norchem Lab
website (https://intraweb.norchemlab.com/).
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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
$15.00/Episode (Urinalysis - 7 Panel plus Ethlglucuronide/EtG)
$14.50/Episode (Urinalysis - 7 Panel)
$37.00/Episode (Urinalysis - Spice)
$16.00/Episode (Urinalysis - Oxycodone and Suboxone)
$2.00/Episode (Breathalyzer)
$5.00/Episode (Antabuse Monitoring)
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.
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b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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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 wilt 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.
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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.
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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 (TOM) 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- CPS -0135
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 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.
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PY-13-14- CPS -0135
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
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
19
PY-12-13-CPS-0132
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Total Hours Billed
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Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to
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PY-13-14-CORE-0209
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND CROSSROADS COUNSELING, LLC
This Agreement, made and entered into the 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 Crossroads Counseling, LLC, hereinafter referred to as the "Contractor".
WITN ESSETH
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 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.
1
a®,S-- ddSi
PY-13-14-CORE-0209
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. sea, and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
2
PY-13-14-CORE-0209
• 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-0209
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.S -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
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PV -13 -14 -CORE -0209
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 (P1 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.
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PY-13-14-CORE-0209
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-0209
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:
Bob Dix
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. Grieeo, Director
P.O. Box A
Greeley CO 80632
(970) 352-1551
18. Litigation
For Contractor:
Bob Dix. President
1211 Lake Avenue, Suite 203
Berthoud, CO 80513
(970) 685-7469
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.
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PY-13-14-CORE-0209
19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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
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PY-13-14-CORE-0209
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.
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PY-13-14-CORE-0209
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-0209
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST: o
Weld County Clerk to the Board
By:
By:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Garcia, Chair
CONTRACTOR.
AO DOC L P ('
By:
AUG 14 2013
Contractor
Ti e
a ls4 - 07a8,
PY-13-14-CORE-0209
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Offense -Specific Treatment services to youth, ages 11-18, and their families as
referred by the Department.
2. CONTRACTOR offers two programs; Family Solution Directed Therapy and Individual Solution Directed
Therapy.
3. Family Solution Directed Therapy includes:
• Five to seven months of service.
• Wrap -around format that involves the youth's immediate and surrounding community.
• In -home family therapy.
• Minimal individual therapy.
• Strength -based solutions.
• Safety plans.
4. Individual Solution Directed Therapy includes:
• Six to eight months of service.
• Wrap -around format that involves the youth's immediate and surrounding community
• In -home therapy.
• Individual therapy.
• Emancipation emphasis.
• Strength -based solutions.
• Safety plans.
5. Services will be provided by Bob Dix or James Skeen. All services follow Sex Offender Board Management
guidelines, if applicable. Bob Dix is a Full Operating Level SOMB Provider for juveniles.
6. CONTRACTOR will work closely with caseworker, probation officer, Guardian ad Litem and school
counselors, and will participate in court hearings and staffings as requested.
7. CONTRACTOR is sensitive to family ethnicity, culture, values and beliefs.
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.
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PY-13-14-CORE-0209
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. Monthly packages include 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-0209
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/Month (Individual Solution Directed Therapy, Low Intensity, 4 Hours/Week, 1+
Session/Week)
$1,400.00/Month (Individual Solution Directed Therapy, Medium Intensity, 6 Hours/Week, 1-2
Sessions/Week)
$1,800.00/Month (Individual Solution Directed Therapy, High Intensity, 8 Hours/Week, 2-3
Sessions/Week)
$1,000.00/Month (Family Solution Directed Therapy, Low Intensity, 4 Hours/Week, 1+
Sessions/Week)
$1,600.00/Month (Family Solution Directed Therapy, Medium Intensity, 7 Hours/Week, 2-3
Sessions/Week)
$2,400.00/Month (Family Solution Directed Therapy, High Intensity, 10 Hours/Week, 3-4
Sessions/Week)
$80.00/Hour (Tapering off services at the end of treatment or stand along clarification.)
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.
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PY-13-14-CORE-0209
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.
15
PY-13-14-CORE-0209
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.
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PY-13-14-CORE-0209
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
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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-0209
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.
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PY-13-14-CORE-0209
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
A AAAAAAAA/ VAAAAAAAAAAAAAAAMAAAAAAAAAAAAAAAAAMAAAAAAAAM
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
20
PV -13 -14 -CORE -0209
Weld County Contracted Services
Request for Reimbursement
(SAMPLE ONLY. ACTUAL FORM IS IN EXCEL AND WILL BE SENT TO CONTRACTOR.)
Program Area (Ex. Lifeskills, Mental Health,
Option B, etc.)
Month/Year of
Service
Submit To:
Tobi Vegter, Core & Service
Contract Coordinator
Weld County Department of
Human Services
P.O. Box A/315 A N. 11th Ave.,
Greeley, 80632
(970) 352-1551, ext. 6392/(970)
346-7667 (Fax)
For Use By. Human Services
Only
Client Name (Per
Referral)
Trails Case ID
(Per referral)
Household
Number
(Per
referral)
Approved
Start
Date (Per
referral)
Approved
End Date
(Per
referral)
Date(s)
of
Service
Actual
Hours
or Units
/Service
Period
Rate
per
Hour
or
Unit
Monthly Total
(Calculates
automatically)
Comments
SAMPLE ENTRY:
Doe, John
1654888
555555
6/1/2009
8/30/2009
06/01,
06/02
12
25
300.00
TOTALS (Calculate Automatically)
12
300.00
21
t
PY-13-14-CORE-0209
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
CONTRACTED SERVICES CLIENT VERIFICATION FORM
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
Notice to CONTRACTOR: All clients served during the service month must complete this verification form at the time of service. No request for payment of services will be honored for billed services
unless accompanied by the appropriate signed Client Verification Form. Payment for services will not exceed maximum hours or sessions authorized by the Department
Section I: (To be completed by the CONTRACTOR)
Primary Client billed:
Household Number. Your Agency's Contact Person: Phone Number
SECTION II (To be completed by client)
Notice to Client Your signature must be obtained at the time of service. Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, fur the
hours and date indicated.
Trails ID
Total Hours Billed
Date
Hours of Service
(Ex. 1:00 — 2:30)
Number of Hours of
Service Provided
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 Greggiones, Foster Parent)
Natioe to CONTRACTOR: Attach all client verification forms to the monthly billing when submitting your billing, Ad requests far payment must be received by the 7 day of the month fallowing
the month of service.
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PY-13-14-CORE-0184
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND GRIFFITH CENTERS FOR CHILDREN
19 � i;3.
ELLi Ln`.bO
This Agreement, made and entered into the 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 Griffith Centers for Children, 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 (Parenting Skills, Visitation); 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
00/3 ..Gag?
PY-13-14-CORE-0184
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
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PY-13-14-CORE-0184
• 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-0184
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-0184
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.
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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
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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:
Christina Murphy
Name
17. Notice
Administrator
Title
Program Supervisor
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:
Christina Murphy, Program Supervisor
1724 Gilpin Street
Denver, CO 80218
(720) 425-5510
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.
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19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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
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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.
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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.
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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 COUNT, COLORADO
William F. Garcia, Chair
AUG 1 4 2013
CONTRACTOR:6r1 Ce-t6rs-fixeh; Orei,
Title
visa eR(3)7
PY-13-14-CORE-0184
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Lifeskills (Parenting Services/Skills, Visitation) to families referred by the
Department. Target populations include:
• Parents or primary caregivers who need in -home parenting instruction and assistance with
household management and accessing community resources.
• Parents with children ages 0-17 years who are at risk of out -of -home placement.
• Parents with children ages 0-17 years who are placed out of the home with relatives or in foster
care.
• Children who are transitioning back home from out -of -home placement.
2. Services include an intensive in -home model with an emphasis on the child's developmental needs.
3. The goal of the intensive in -home program is to improve parenting skills, and increase safety and stability
in the home. Aspects of the program include:
• Services are flexible and individualized to each family, and are based on assessment of parent
and child strengths and needs.
• Each referred family is assigned a LSP specialist who is trained in and specializes in parenting,
child development, and life skills. The LSP assists parents/caregivers with basic parenting skills,
household management, budgeting, organizational skills, and other day-to-day issues that
impede the care and development of children in the home.
• All safety risks are addressed immediately by the LSP.
• The in -home model offers service delivery that overcomes barriers to service access and services
are provided in the environment in which issues most likely arise.
• Services are utilized to stabilize family functioning and address safety risks. This is done through
teaching families to work with community agencies, appropriate parenting skills, stress
reduction, problem -solving and increased communication skills.
• Services are available 24 hours per day, 7 days per week.
• Services include 3-6 hours per week in the referred families' home. Services can be increased as
needed.
• Appointment times are flexible and include evenings and weekends.
• Average length of services is 2 to 6 months.
• CONTRACTOR will coordinate and advocate with school systems, court and the Department.
• Follow up services are available for one year after discharge to aide in long-term success with
pre -approval from the Department.
4. Therapeutic/Supervised Visitation services are available as an in -home model with the option of providing
visits in a community setting or other location designated by the Department. Visitation services will
focus on assessing the parent/caregiver's parenting ability and work with individuals to meet the needs of
the children during visits.
• Objectives of Visitation:
i. Ensure child safety during visits.
ii. Closely monitor parent/child interactions to ensure appropriateness.
iii. Improve parenting skills (effectively meeting the developmental needs of the child(ren)).
5. CONTRACTOR is sensitive to family ethnicity, culture, values and beliefs.
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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.
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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
$38.00/Hour (Parenting Skills)
$36.00/Hour (Therapeutic Visitation)
$25.00/Hour (Court Staffing/Court Facilitation/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.
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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.
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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
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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-0184
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).
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-0184
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-0184
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PY-13-14-CORE-0185
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND GRIFFITH CENTERS FOR CHILDREN
This Agreement, made and entered into the 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 Griffith Centers for Children, 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.
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PY-13-14-CORE-0185
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
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PY-13-14-CORE-0185
• 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
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PY-13-14-CORE-0185
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
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PY-13-14-CORE-0185
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.
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PY-13-14-CORE-0185
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
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PY-13-14-CORE-0185
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:
Christina Murphy
Name
17. Notice
Administrator
Title
Program Supervisor
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:
Christina Murphy, Program Supervisor
1724 Gilpin Street
Denver, CO 80218
(720) 425-5510
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.
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PY-13-14-CORE-0185
19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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
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PY-13-14-CORE-0185
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.StoraRe, 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.
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PY-13-14-CORE-0185
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.
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PY-13-14-CORE-0185
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
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
my Attorney
11
BOARD OF COUNTY COMMISSIONERS
WELD COCOLORADO
Garcia, Chair
AUG 1 4 2013
CONTRACTOR:64410'24er-scar QlGrevA
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Title
PY-13-14-CORE-0185
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals and families (all ages) referred by the
Department, to address mental health and behavioral issues, as well as issues around abuse/neglect,
reunification and/or trauma.
2. CONTRACTOR will provide services in the office or a client's home/community and can be utilized in
conjunction with or as a follow up to in -home services.
3. Services are conducted by Master's level mental health professionals. Every effort will be made to
maintain the same therapist if the client has previously received services in order to maintain continuity
of services.
4. Intervention strategies include Behavioral, Cognitive -Behavioral, Family Systems, Play Therapy as well as
Brief and Present -Focused.
5. Sessions are weekly unless otherwise directed by the Department.
6. Pager access 24 hours a day, 7 days a week.
7. CONTRACTOR offers a pre-treatment assessment which is conducted by a licensed mental health
professional in an office setting on in the client's home. Assessment will result in recommendations for
immediate interventions and goals and can be completed in one (1) to two (2) one -hour sessions.
8. CONTRACTOR is sensitive to family ethnicity, culture, values and beliefs.
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.
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PY-13-14-CORE-0185
14. 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.
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PY-13-14-CORE-0185
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
$52.00/Hour (Individual Therapy)
$56.00/Hour (Family Therapy)
$150.00/Episode (Mental Health Pre -Treatment Assessment)
$25.00/Hour (Court Staffing/Court Facilitation/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.
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PV -13 -14 -CORE -0185
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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PY-13-14-CORE-0185
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.
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PY-13-14-CORE-0185
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.
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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-0185
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 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
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PY-13-14-CORE-0185
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-0185
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PY-13-14-CORE-0183
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND GRIFFITH CENTERS FOR CHILDREN
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This Agreement, made and entered into the 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 Griffith Centers for Children, hereinafter referred to as the "Contractor".
WITNESSETH
ESSETH
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 (Family Preservation 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.
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X1E- o?cQ8
PY-13-14-CORE-0183
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
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PY-13-14-CORE-0183
• 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-0183
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-0183
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.
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PY-13-14-CORE-O183
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.
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PY-13-14-CORE-0183
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:
Christina Murphy
Name
17. Notice
Administrator
Title
Program Supervisor
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:
Christina Murphy, Program Supervisor
1724 Gilpin Street
Denver, CO 80218
(720) 425-5510
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.
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19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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-0183
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.
PY-13-14-CORE-0183
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-0183
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
ounty Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUCOLORADO
William
arcia, Chair
AUG 14 2013
CONTRACTOR: 6 42,4. l.:Cr t -fry -Far l,:.F1t �rc
By:
ontracto
CFO -1171-P113
Title
4)O/.S-4)0789
PY-13-14-CORE-0183
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Home -Based Intensive Services (Family Preservation Services) for high -risk
families designed to prevent out -of -home placements or prepare families for reunification, as referred by
the Department. Target populations include:
• Families who are in crisis or experiencing major struggles in functioning.
• Families with youth in the home who are acting out behaviorally or sexually.
• Families with children and youth ages 0-17 years.
• Children who are at risk for out -of -home placement, or transitioning back into the home from
foster care, residential treatment, Department of Youth Corrections or other out -of -home
placement.
• Foster families with children or youth who meet the above criteria.
• "Families" is defined as children and/or youth residing with parents, relatives, guardians or foster
parents.
2. Family Preservation Services are modeled after the National Family Preservation Network's definition of
Intensive Family Preservation Services (IFPS). IFPS is defined as:
• "IFPS services are designed to support families in crisis in which children are either at imminent
risk of placement or have been placed out of the home. The services are for birth and adoptive
families and are effective as reunification services as well as for placement prevention."
3. The goal of the program is to keep children safe and avoid both unnecessary removal and long
separations from family in out -of -home care. Aspects of the program include:
• Services are flexible and individualized to each family.
• The home -based model offers service delivery that overcomes barriers to service access and
services are provided in the environment in which issues most likely arise.
• Services are utilized to stabilize family functioning and address safety risks. This is done through
teaching families to work with community agencies, appropriate parenting skills, stress
reduction, problem -solving and increased communication skills.
• Services are available 24 hours per day, 7 days per week.
• Services include 3-6 hours per week in the referred families' home. Services can be increased as
needed.
• Appointment times are flexible and include evenings and weekends.
4. Intervention strategies include:
• Treatment goals that are mutually agreed upon by family, CONTRACTOR and other professionals
involved with the family such as the referring caseworker.
• Interventions aimed at the individual, entire family or appropriate community members.
• A strengths -based psycho -educational model that focuses on skill -building.
• Other skills areas includes anger management, problem -solving, household management, and
accessing community resources.
5. Average length of services is 2 to 6 months.
6. CONTRACTOR will coordinate and advocate with school systems, court and the Department.
7. Follow up services are available for one year after discharge to aide in long-term success with pre -
approval from the Department.
8. CONTRACTOR is sensitive to family ethnicity, culture, values and beliefs.
12
PY-13-14-CORE-0183
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. 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-0183
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
$48.00/Hour (Family Preservation Services)
$25.00/Hour (Court Staffing/Court Facilitation/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 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.
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-0183
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-0183
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-0183
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-0183
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 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`" 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-0183
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-CORE-0183
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PY-13-14-CORE-0183
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PY-13-14-CPS-0108
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND IDEA FORUM, INC.
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 Idea Forum, 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 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.
1
PY-13-14-CPS-0108
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
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• 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
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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
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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.
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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
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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:
Marcela Paiz
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
1970)352-1551
18. Litigation
For Contractor:
Marcela Paiz, President/Chief Executive Officer
2560 West 29`h Avenue
Denver, CO 80211
(303) 477-8280
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.
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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 18. 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
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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.
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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.
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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
ty Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
CONTRACTOR:
11
BOARD OF COUNTY COMMISSIONERS
WELD COU :11/ COLORADO
By:
m F. Garcia, Chair
AUG 14 2013
c2o/se-aa8�
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide timely and quality monitored sobriety services to adult and adolescent clients,
both male and female, referred by the Department, as follows:
a. Services are available in Denver, Aurora, Brighton and Thornton, CO. Hours of service for all
sites are Monday through Thursday, 9 a.m.-9 p.m.; Friday, 9 a.m.-8 p.m.; Saturday, 9 a.m.-1
p.m.
b. CONTRACTOR will provide qualified monitored sobriety collectors.
c. CONTRACTOR is a licensed provider sensitive to multicultural issues and can provide all
services in both English and Spanish.
d. CONTRACTOR will confirm all positive and negative Breathalyzer monitored sobriety results
within 24 hours through a phone call, test result, e-mail and/or fax to the referring
caseworker.
e. CONTRACTOR will confirm all positive and negative laboratory Urinalysis results will be
confirmed once processing has occurred through Redwood Toxicology (usually within three
days). Confirmation will occur through a phone call, test result, e-mail and/or fax to the
referring caseworker.
f. CONTRACTOR will report all positive and negative Instant Urinalysis results within 24 hours.
If the result is positive, it will be sent to Redwood for final confirmation. Confirmation will
occur through a phone call, test result, e-mail and/or fax to the referring caseworker.
g.
CONTRACTOR will submit a copy of the valid Authorization for Services form, result and
client sign -in sheet (if applicable) with each monthly billing.
h. All processed (laboratory) test results will be available online 24 hours per day, seven (7)
days per week online at Redwood Toxicology (www.webtoxicology.com).
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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
$8.00/Episode (Swab)
$15.00/Episode (Urinalysis)
$40.00/Episode (Ethyl Glucuronide - EtG)
$120.00/Episode (Urinalysis - Steroids)
$40.00/Episode (Urinalysis - Synthetic THC aka "Spice")
$99.00/Episode (Hair Test)
$6.00/Week (Breathalyzer, 1-3/Week)
$10.00/Week (Breathalyzer, 4/Day)
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.
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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.
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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.
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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.
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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-CPS-0108
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-CPS-0108
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
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
/ _
Core & Service Contract Coordinator Date
19
PY-13-14-CPS-0108
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-13-14-CPS-0108
CONTRACTED SERVICES CLIENT VERIFICATION FORM
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
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Phone Number
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Number of Hours of
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Hours of Service
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PY-13-14-CPS-0117
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND IDEA FORUM, INC.
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 Idea Forum, 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 to the
Department for Domestic Violence Evaluation and 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
Child Welfare Administration funding during the duration of this Agreement.
1
PY-13-14-CPS-0117
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-0117
• 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.
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-CPS-0117
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-0117
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-O117
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-CPS-0117
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:
Marcela Paiz
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:
Marcela Paiz, President/Chief Executive Officer
2560 West 29th Avenue
Denver, CO 80211
1303) 477-8280
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-CPS-0117
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 18. 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-0117
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-0117
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-0117
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 County Clerk to the Board
By:
APP
C!%ty Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
WELD COUNTY.. COLORADO
am F. Garcia, Chair
CONTRACTOR:
AUG 1 4 2013
PY-13-14-CPS-0117
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Domestic Violence evaluation and treatment services to clients referred by the
Department.
2. Domestic Violence treatment is provided as mandated by the Colorado Domestic Violence Offender
Management (DVOMB) Standards.
Level A (Low Risk):
Level B (Moderate
Risk):
Level C (High 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 adjunct therapy per month required.
- 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 weekly skills group required.
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
3. Completion of Domestic Violence treatment is solely determined by gaining and demonstrating competencies
established by the DVOMB to reduce level of risk and need.
4. CONTRACTOR has four (4) approved Domestic Violence Treatment providers on staff including staff approved
to work with female offenders.
5. CONTRACTOR is a licensed provider sensitive to multicultural issues and can provide all services in both
English and Spanish.
6. Services are available in Denver, Aurora, Brighton and Thornton, CO. Hours of service for all sites are Monday
through Thursday, 9 a.m.-9 p.m.; Friday, 9 a.m.-8 p.m.; Saturday, 9 a.m.-1 p.m.
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.
12
PY-13-14-CPS-0117
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.
13
PY-13-14-CPS-0117
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/Episode (DV Intake and First Session)
$25.00/Episode/Per Person (Group Session - Adult)
$15.00/Episode/Per Person (Group Session - Youth)
$45.00/Episode (Individual Session -Adult)
$25.00/Episode (Individual Session - Youth)
$40.00/Episode/Person (Group Session - Caring Dads)
$65.00/Episode (Family Session)
$150.00/Episode (Domestic Violence Evaluation)
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`" 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
PV -13 -14 -CPS -0117
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-CPS-0117
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-0117
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-0117
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 -0117
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-CPS-0117
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-0117
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PY-13-14-CPS-0117
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PY-13-14- CPS -0132
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND JOHNSON DRUG TESTING, LLC
This Agreement, made and entered into the day of , 2013, by and between the Board of
Weld County Commissioners, hereinafter referred to as the "Department" and Johnson Drug Testing, 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 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
PY-13-14- CPS -0132
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
PY-13-14- CPS -0132
• 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
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
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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
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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.
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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.
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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:
Shane T. Johnson
Name
17. Notice
Administrator
Title
Operations Manager
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:
Shane T. Johnson, Operations Manager
605 South College Avenue
Fort Collins, CO 80524
(970) 493-2222
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.
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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
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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
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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.
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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
By:
-,
m F. Garcia, Chair
Contractor
V
AUG 1 4 2013
Title
aox,.0- as,9
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide timely and quality random monitored sobriety services to client referred by the
Department.
2. The Department will provide "office space", located in the Weld County Department of Human Services'
Building A, located at 315 North 11th Avenue, Greeley, Colorado, hereinafter referred as "the Premises",
as follows:
a. Department will provide one work space to the CONTRACTOR, as the Lessee, which will be located at
the Premises.
b. In consideration of leasing of the aforesaid, the parties covenant and agree as follow:
i. The Department will charge no rent to the CONTRACTOR for use of the Premises;
H. CONTRACTOR agrees to use ordinary care when using the Premises;
iii. CONTRACTOR may not sublet any part of the Premises;
iv. CONTRACTOR may not use the Premises for any purpose other than conducting the
business and duties under the Agreement;
v. CONTRACTOR shall keep the Premises clean and in sanitary condition;
3. CONTRACTOR will ensure all staff present a professional image while on the Premises, including wearing
neat and appropriate attire at all times.
4. CONTRACTOR will have a qualified monitored sobriety collector on site Monday through Friday, 2-7 p.m.,
and will conduct random weekend monitoring two (2) Saturdays and one (1) Sunday per month, 10 a.m.-1
p.m., or as modified by the Department.
5. CONTRACTOR will manage a random monitored sobriety color line and provide the color line calendar for
the following month to the Department on or prior to the last business day of the month. The color line is
accessible by phone at (970) 295-8008, website(www.fortcollinsdrugtesting.com), and Facebook.
6. CONTRACTOR will only accept referrals when a client has been assigned a color. Clients will be required
to call in seven (7) days a week.
7. CONTRACTOR will only provide services to referred clients who provide picture identification. A
caseworker may provide a client photograph in lieu of formal picture identification if such identification
cannot be provided.
8. CONTRACTOR will ensure best practices are followed for specimen collection, including observation of
male and female clients by same gender staff. CONTRACTOR will have both male and female staff
available during all business hours.
9. CONTRACTOR will not allow clients to make up missed monitoring unless prior approval from the
Department is obtained. Either the caseworker or caseworker's supervisor may provide such approval.
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10. CONTRACTOR will confirm any positive, negative or missed monitored sobriety within 24 hours through a
phone call, test result, e-mail and/or fax to the Department (referring caseworker).
11. CONTRACTOR will confirm any non -negative specimen with gas chromatography/mass spectrometry
(GC/MS).
12. CONTRACTOR will provide a recap of each referred client's prior months monitoring by the 7th of the
month following the month of service.
13. CONTRACTOR will submit the required monthly billing forms, result and client sign -in sheet (if applicable)
by the 7th of the month following the month of service.
14. Results will be available online 24 hours per day, seven (7) days per week through the Redwood
Toxicology website (www. redwoodtoxicology.com).
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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
$13.00/Episode (Instant 5 -Panel)
$20.00/Episode (Instant 10 -Panel)
$32.00/Episode (Instant Oral Swab)
$25.00/Episode (Instant 5 -Panel with Confirmation)
$25.00/Episode (Instant 10 -Panel with Confirmation)
$37.50/Episode (Instant Oral Swab with Confirmation)
$37.50/Episode (Oral Swab Lab Test)
$16.00/Episode (7 -Panel Lab Test)
$40.00/Episode (Ethyl Glucuronide/EtG)
$90.00/Episode (Hair Follicle)
$125.00/Episode (EtG Hair Follicle)
$90.00/Episode (Body Hair Test)
$125.00/Episode (Fingernail Drug Test)
$125.00/Episode (Toenail Drug Test)
$2.00/Episode (Breathalyzer)
$2.00/Episode (Breathalyzer Confirmation)
$40.00/Episode (Spice Test)
$40.00/Episode (Bath Salts Test)
$75.00/Episode (Comprehensive Metabolic Panel)
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.
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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.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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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.
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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.
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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).
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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 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 nth 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 -0132
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
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
20
PY-12-13-CPS-0132
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PY-13-14-CORE-0228
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND CARMEN LUCERO-HAINES
406 02
This Agreement, made and entered into the day of , 2013, by and between the Board of Weld
County Commissioners, hereinafter referred to as the "Department" and Carmen Lucero-Haines, 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 (Victims, Non -offending Caretakers); 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-0228
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
PV -13 -14 -CORE -0228
• 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-0228
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-0228
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-0228
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.
6
PY-13-14-CORE-0228
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:
Carmen Lucero-Haines
Name
17. Notice
Administrator
Title
Therapist
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:
Carmen Lucero-Haines
1015 37th Avenue Court. #102
Greeley, CO 80634
(970) 352-6830, ext. 4
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-0228
19. Termination
This Agreement may be terminated at any time by either party giving thirty (3) days written notice to the
individuals identified in paragraph 18. 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-0228
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-0228
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-0228
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
/County Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
CONTRACTOR:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY LORADO
By:
_7
am F. Garcia, Chair
AUG 1 4 2013
'" tiettileA-1
Contractor
T le
PY-13-14-CORE-0228
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide time limited, outcome focused therapy for the treatment of the non -offending
parent, the victim and siblings of the victim in sexual abuse cases referred by the Department.
2. CONTRACTOR will provide safe, therapeutic and structured environment designed to engage and fortify
the family system. Services will be provided at 1015 37th Avenue Court, Suite 102, in Greeley.
3. CONTRACTOR utilizes a therapeutic model that includes Trauma Focused Cognitive Behavioral Therapy,
Eye Movement Desensitization and Reprocessing (EMDR), Solution Focused Therapy, Narrative and
Interpersonal Counseling, and Cognitive Behavioral Therapy.
4. All services will be provided by Carmen Lucero-Haines, MA, LPC, CAC II.
5. CONTRACTOR is bilingual and can provide services in 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 (TOM) 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-0228
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
$115.00/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.
13
PY-13-14-CORE-0228
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
1.4
PY-13-14-CORE-0228
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-0228
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-0228
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 -0228
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"' 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-0228
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
AMAAAM
FOR COUNTY USE ONLY:
CONTRACTOR Signature Date
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
19
PY-13-14-CORE-0228
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PY-13-14-CORE-0228
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PY-13-14-CORE-0142
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement, made and entered into the 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 North Range Behavioral Health, 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.
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-0142
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 delay 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-0142
• 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-0142
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
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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.
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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.
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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:
Larry D. Pottorff
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:
Larry D. Pottorff, Executive Director
1300 North 17th Avenue
Greeley, CO 80631
(970) 347-2373
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.
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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 18. 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 §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
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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.
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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.
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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
unty attorney
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTy..COLORADO
AUG 14 2013
CONTRACTOR:
NORTH RANGE BEHAVIORAL HEALTH
BV:
Executive Director
Title
&&/.4- ���'%
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR is the community mental health center serving Weld County.
2. CONTRACTOR will provide the following services under this contract:
a. Level 1— Behavioral Health Evaluation: Useful for ruling in/out basic mental health and
substance abuse issues, advising on provisional diagnoses, and making recommendations for
treatment when appropriate. Approximate completion time is three (3) to six (6) hours.
- Review of Department records, and if applicable, NRBH records.
Clinical interview and integrated diagnostic evaluation (assessment of mental health and
substance abuse issues).
Possible administration of brief screening inventories (e.g., Beck Inventories, State -Trait
Inventories, Personality Assessment Screener).
Feedback to client.
Written report addressing relevant psychosocial history, diagnostic formulation, and
treatment recommendations.
b. Level 2- Partial Psychological Evaluation: Useful for ruling in/out mental health, substance
abuse, cognitive, and/or personality issues, advising on diagnoses, and making treatment
recommendations. Approximate complete time is eight (8) to 14 hours.
Review of Department records, and if applicable, NRBH records.
Clinical interview and integrated diagnostic evaluation (assessment of mental health and
substance abuse issues).
- Administration of a partial test battery, such as administration of just cognitive or just
personality testing (e.g., Wechsler IQ tests, MMPI, MCMI, PAI, etc.).
- Consultation with collateral sources.
- Feedback to client.
Written report addressing relevant psychosocial history, diagnostic formulation, and
treatment recommendations.
c. Level 3 — Full Psychological Evaluation: Useful in identifying more significant behavioral health
issues and diagnoses, as well as addressing personality issues, intellectual functioning, the ability
to manage emotions, parenting issues and potential safety of the children in the home,
placement issues, and treatment recommendations. Approximate completion time is 16 to 20
hours.
- Review of all available records including Department records, prior evaluation and
behavioral health treatment records, police records, medical records, records from other
agencies involved in the case, and if applicable, NRBH records.
Extensive integrated clinical evaluation (multiple sessions).
- Administration of a formal battery of tests (multiple tests) to assess personality, emotional
and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQ tests, MMPI, MCMI,
PAI, STAXI, STAI, Beck screens, TSI, PSI, etc.).
- Consultation with collateral sources.
- Feedback to client.
Written report addressing psychosocial history, personality issues, emotional functioning
and regulation abilities, and/or intellectual functioning and/or parenting/family issues,
substance abuse, and diagnostic formulation, as well as treatment recommendations and
prognosis.
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d. Level 4 —Extended Psychological Evaluation: Useful in identifying more significant mental health
and substance abuse issues and diagnoses, as well as addressing personality issues, intellectual
functioning, the ability to manage emotions, parenting issues and potential safety of the
child(ren) in the home, placement issues, and treatment recommendations.
To be utilized when impairment in cognitive functioning is suspected/known, when the client is
unable to read or write, when there are major memory deficits, when resistance leads to invalid
measures and instruments need to be re -administered, and/or when other significant barriers to
testing are present.
Review of all available records including Department records, prior evaluation and
behavioral health treatment records, police records, medical records, records from other
agencies involved in the case, and if applicable, NRBH records.
Extensive integrated clinical evaluation (multiple sessions).
Administration of a formal battery of tests (multiple tests) to assess personality, emotional
and/or cognitive functioning, and/or parenting issues (e.g., Wechsler IQtests, MMPI, MCMI,
PA!, STAXI, STAI, Beck screens, TSI, PSI, etc.).
- Consultation with collateral sources.
- Feedback to client.
- Written report addressing psychosocial history, personality issues, emotional functioning
and regulation abilities, and/or intellectual functioning and/or parenting/family issues,
substance abuse, and diagnostic formulation, as well as treatment recommendations and
prognosis.
3. For partially completed evaluations, CONTRACTOR will submit a written report of any finding that can be
appropriately offered based upon the information gathered.
4. Evaluations will be conducted at an NRBH location or another suitable location (e.g., client's home,
school, detention center, etc.), depending upon the circumstances.
5. Evaluations will be conducted by a qualified NRBH provider.
6. CONTRACTOR will submit the written report, following completion of the evaluation, within forty-five (45)
days from the point of initial contact with the client, provided the client can be reached for appointments
and the client attends appointments as scheduled. The Department may choose to extend the referral as
deemed appropriate or the referral may be closed if the client fails to follow through.
7. CONTRACTOR will communicate with the referring caseworker and the Child Welfare Contract and
Services Coordinator regarding any issues contacting the client, missed appointments, or other issues that
arise that prevent the completion of the referred evaluation.
S. 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.
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.
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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 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.
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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
$250.00/Episode (Level 1 - Behavioral Health Evaluation)
$800.00/Episode (Level 2 - Partial Psychological Evaluation)
$1,200.00/Episode (Level 3 - Full Psychological Evaluation)
$1,800.00/Episode (Level 4 - Extended Psychological Evaluation)
$120.00/Hour (Hourly rate for partially completed evaluations. Not to exceed the cost of the full
evaluation.)
$120.00/Hour (Court Staffing/Court Facilitation/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 delay of payment.
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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.
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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.
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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.
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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).
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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 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 11`h Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
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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
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
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Core & Service Contract Coordinator Date
21
PY-13-14-CORE-0142
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-13-14-CORE-0142
CONTRACTED SERVICES CLIENT VERIFICATION FORM
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PY-13-14- CORE -0120
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement, made and entered into the 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 North Range Behavioral Health, 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
Functional Family Therapy (FFT); 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
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020E- aa6s1
PY-13-14- CORE -0120
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 delay 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 -0120
• 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.
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PY-13-14- CORE -0120
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-O12O
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.
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PY-13-14- CORE -0120
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.
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PY-13-14- CORE -0120
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:
Larry D. Pottorff
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:
Larry D. Pottorff, Executive Director
1300 North 17th Avenue
Greeley, CO 80631
(970) 347-2373
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.
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PY-13-14- CORE -0120
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 18. 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 -0120
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.
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PY-13-14- CORE -0120
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 -0120
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
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
o y sttorney
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNRADO
arcia, Chair
AUG 1 4 2013
CONTRACTOR:
NORTH RANGE BEHAVIORAL HEALTH
By:
Executive Director
Title
PY-13-14- CORE-O12O
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provided Functional Family Therapy (FFT) services to male and female youth within the
approximate age range of 11-17 years of age, and their families, residing in Weld County, as referred by
the Department.
2. CONTRACTOR has offices in both Greeley and Fort Lupton, CO.
3. Services are provided in -home in accordance with the National Functional Family Therapy (FFT) model,
and its standards and guidelines. All services are overseen/supervised by a FFT National Consultant.
4. Youth and family are deemed eligible for services based on one or more of the following inclusionary
criteria:
a. Child must be at risk of out -of -home placement or transitioning back from placement within 30
days.
b. Child is displaying moderate to severe behavioral problems in the home/school/community.
c. Child is involved in criminal behaviors to include substance abuse.
d. Child demonstrates verbal and/or physical aggressions at home/school/community.
e. Child is engaged with deviant peer group.
f. Child is struggling with school behaviors to include failing grades, truancy and anti -social
behaviors.
g. Family has persistent conflict and negative child -parent relationship.
h. Caregiver is abusing substances.
i. Family has limited resources and would benefit from psycho -education and parenting skill
development.
5. FFT utilizes Family Interventions, Cognitive Behavioral Therapy, Family Therapy, school and community
interventions, and substance abuse intervention, as clinically appropriate.
6. The goal of services is to:
a. Empower families with the skills and resources need to independently address the difficulties
they are having raising their children.
b. Empower youth to cope with family, peer, school and neighborhood problems.
c. Build community and natural support systems.
d. Decrease negativity and blame among family members.
e. Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues
7. Service duration is two (2) to six (6) months for one (1) to two (2) hours per week.
8. Services include:
a. Case Management
b. School Interventions
c. Advocacy
d. Court/Staffing Participation
e. Sustainability Planning
f. Booster Services After Discharge
9. CONTRACTOR has the ability to provide bilingual services (Spanish).
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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 Child Welfare Contract and
Services 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. Monthly rate is 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 -0120
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
$675.00/Month (Pro -rated for 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 delay 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 -0120
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 -0120
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 -0120
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 -0120
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 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.
18
PY-13-14- CORE -0120
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 -0120
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PY-13-14- CORE -0120
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(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
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Number of Hours of
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PY-13-14-CORE-0146
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement, made and entered into the 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 North Range Behavioral Health, 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
Multisystemic Therapy (MST); 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-0146
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 delay 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-0146
• 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-0146
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-0146
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
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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-0146
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:
Larry D. Pottorff
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:
Larry D. Pottorff, Executive Director
1300 North 17th Avenue
Greeley, CO 80631
$70) 347-2373
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
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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 18. 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
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PY-13-14-CORE-0146
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.
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PY-13-14-CORE-0146
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-0146
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
APP
0
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUN.AC, COLORADO
cia, Chair
AUG 14 2013
CONTRACTOR:
NORTH RANGE BEHAVIORAL
By:
070/3 '9
PY-13-14-CORE-0146
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Multisystemic Therapy services to male and female youth within the
approximate age range of 12-17 years of age, and their families, residing in Weld County, as referred by
the Department.
2. CONTRACTOR has offices in both Greeley and Fort Lupton, CO.
3. Services are provided in -home in accordance with the National Multisystemic Therapy (MST) model, and
its standards and guidelines. All services are overseen/supervised by a MST National Consultant.
4. Youth and family are deemed eligible for services based on one or more of the following inclusionary
criteria:
a. Child must be at risk of out -of -home placement ortransitioning back from placement within 30
days.
b. Child is involved in criminal behaviors.
c. Persistent family conflict.
d. Child and/or caregiver is abusing substances.
e. Behavior is chronic.
f. Child is engaged with deviant peers.
g. Child is struggling at school.
h. Family has few resources.
i. Parents would benefit from psycho -education and skill development.
j. Child is displaying moderate to severe behavior problems.
5. MST utilizes In -home Caregiver Interventions, Cognitive Behavioral Therapy, Family Therapy, Individual
Therapy, as well as school and community interventions.
6. The goal of services is to:
a. Empower caregivers with the skills and resources needed to independently address the
difficulties related to managing their children.
b. Empower youth to cope with family, peer, school and neighborhood problems.
c. Build community and natural support systems.
d. Decrease anti -social behavior.
7. Service duration is two (2) to five (5) months for three (3) to five (5) hours per week.
8. Services include:
a. 24/7 On -call Services
b. Case Management
c. School Interventions
d. Advocacy
e. Court/Staffing Participation
f. Sustainability Planning
9. CONTRACTOR has the ability to provide bilingual services (Spanish).
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 Child Welfare Contract and
Services Coordinator immediately.
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PY-13-14-CORE-0146
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. Monthly rate is 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-0146
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
$1,800.00/Month (Pro -rated for 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 /-th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in delay 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-0146
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-0146
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 additionalservices 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-0146
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-0146
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 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.
18
PY-13-14-CORE-0146
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-0146
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PY-13-14-CORE-0146
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PY-13-14-CPS-0094
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement, made and entered into the 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 North Range Behavioral Health, hereinafter referred to as the "Contractor".
WITN ESSETH
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 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 Junel, 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
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
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PY-13-14-CPS-0094
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7`" day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in delay 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.
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PY-13-14-CPS-0094
• 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.
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PY-13-14-CPS-0094
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.
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PY-13-14-CPS-0094
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.
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PY-13-14-CPS-0094
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-0094
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:
Larry D. Pottorff
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:
Larry D. Pottorff, Executive Director
1300 North 17th Avenue
Greeley, CO 80631
(970) 347-2373
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.
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PY-13-14-CPS-0094
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 18. 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
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PY-13-14-CPS-0094
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.
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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-0094
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
C Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUN Y RADO
gcia, Chair
AUG 14 2013
CONTRACTOR:
NORTH RANGE BEHAVIORAL HEALTH
By:
Executive Director
Title
0,907.3 c372 a y
PY-13-14-CPS-0094
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Anger Management and Domestic Violence services to males and females, 18
years and older, at 1260 H Street, in Greeley.
2. Services will be provided at the North Range Behavioral Health Adult Outpatient facility, located at 1260 H
Street, in Greeley, CO.
3. All services will be provided by academically qualified and/or licensed Domestic Violence Offender
Management Board (DVOMB) approved staff.
4. CONTRACTOR will provide the following services under this contract:
Anger Management
(Minimum 20 Weeks of Treatment)
Domestic Violence
(Length of treatment will comply with
Domestic Violence Offender management
Board (DVOMB) regulations based on
placement criteria for treatment levels A, B or
C.) Track (level) is determined by assessment
DVOMB approved screening tools. Tracks are
as follows:
- Track A: One (1) group session per
week. Minimum of two (2)
treatment plan reviews taking place
every 2-3 months, depending on
progress on the required Core
Competencies (see below).
Track B: One (1) group session per
week and one (1) additional contact
per month. Minimum of three (3)
treatment plan reviews taking place
every 2-3 months, depending upon
progress on the required Core
Competencies (see below).
- Track C: One (1) group session per
week and one (1) additional contact
per week. Minimum of three (3)
treatment plan reviews taking place
every 2-3 months, depending upon
progress on the required Core
Competencies (see below).
• Group Process and Skills
• Cognitive -Behavioral Skills
• Passive, Aggressive and Assertive
Behaviors
• Victim Empathy
• Treatment Goals
• Substance Abuse
• Stages of Change
• Parenting
• Men's Issues/Women's Issues (as
applicable)
• Effects on Children (DV only)
• Steps to Problem Solving
• Steps to Conflict Resolution
• Characteristics of Assaultive Adults
• Attitudes Toward the Opposite Sex
• Sex Role Training
• Socio-cultural Basis for Violence
• Provocation
• Appropriate Containment and
Expressions of Anger
• Experiencing Emotions and Feelings
Beyond Anger
• Grief and Loss
• Depression and Anxiety
• Stress Management
• Relapse/Recidivism Prevention
• Healthy Relationships
• Sexuality
• Spirituality
• Resources
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PY-13-14-CPS-0094
Additional contacts will be in a group or
individual setting depending on the clinical
need.
Core Competencies (per DVOMB regulations):
A. Commitment to eliminate abusive
behavior.
B. Personal Change Plan work.
Demonstrate change.
C. Complete the Personal Change Plan
Worksheet.
D. Recognize and demonstrate
empathy.
E. Accept full responsibility for the
offense and abusive history.
F. Identify and reduce pattern of power
and control behaviors, beliefs and
attitudes of entitlement.
G. Accountable for abusive behaviors,
accept consequences, take steps to
reconciliation to prevent future
abusive behaviors.
H. Accept that abusive behavior should
have and has consequences.
I. Participate and cooperate in
treatment.
J. Ability to define types of DV.
K. Understand, identify and manage
own pattern of violence.
L. Understand intergenerational effects
of violence.
M. Understand and use healthy
communication skills.
N. Understand and use time outs.
0. Recognize financial responsibilities
as required.
P. No new violence or abusive
offences.
Q. Prohibited from purchasing,
possessing, or using firearms and
ammunition.
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PY-13-14-CPS-0094
5. Anger Management and Domestic Violence Intakes will be completed with recommendations before the
client is placed into treatment. The intake will determine the best placement for the client in regards to
treatment, which may include group session and/or individual sessions. CONTRACTOR will provide a copy
of the intake to the caseworker.
6. Individual sessions may be determined necessary at intake but 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.
7. If the client is assessed at a higher level of care than what is offered by CONTRACTOR, a recommendation
to an agency that offers that level will be made.
8. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's Standards
and Guidelines.
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 Child Welfare Contract and
Services 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 of a
parent 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. 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
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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
$200.00/Episode (Anger Management or Domestic Violence Evaluation)
$35.00/Episode/Per Person (Group Session)
$17.50/15 Minutes (Individual Session)
$50.00/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 delay 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-CPS-0094
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
16
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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.
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PY-13-14-CPS-0094
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-0094
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-0094
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 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 11`h Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
20
PY-13-14-CPS-0094
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
AAAAAAAMAAAAAAAAAAAAAAAAMAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
21
PY-13-14-CPS-0094
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PY-13-14-CPS-0094
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PY-13-14- CPS -0109
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement, made and entered into the 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 North Range Behavioral Health, 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 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
PY-13-14- CPS -0109
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 delay 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- CPS -0109
• 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;
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
PV -13-14- CPS -0109
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 -0109
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 -0109
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.
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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:
Larry D. Pottorff
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:
Larry D. Pottorff, Executive Director
1300 North 17th Avenue
Greeley, CO 80631
(970) 347-2373
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.
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19. Termination
This Agreement maybe terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 18. No portion ofthis 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 -0109
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.
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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
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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 e. TY COMMISSIONERS
WELD COQ. TY, OLORADO
CONTRACTOR:
NORTH RANGE BEHAVIORAL HEALTH
By:
Executive Director
Title
PY-13-14- CPS -0109
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:
a. Services will be provided at the North Range Behavioral Health Crisis Stabilization Services
facility in Greeley, CO, at 1140 M Street, or in Fort Lupton, CO, at 145 1s` Street.
b. CONTRACTOR will provide a qualified monitored sobriety collector 24 hours a day/seven (7)
days a week at the Greeley site. At the Fort Lupton site, the CONTRACTOR will provide a
qualified monitored sobriety collector Monday thru Thursday, 10:00 a.m.-5:00 p.m. for
Urinalysis Testing and 10:00 a.m.-7:00 p.m. for Breathalyzer Testing. On Fridays, Urinalysis
Testing will be available 10:00 a.m.-12 p.m. and Breathalyzer Testing will be available 10:00
a.m.-5:00 p.m. Services are not available in Fort Lupton on Saturdays and Sundays.
c. CONTRACTOR will confirm all positive and negative Breathalyzer monitored sobriety results
within 24 hours through a phone call, test result, e-mail and/or fax to the referring
caseworker.
d. CONTRACTOR will confirm all positive and negative laboratory Urinalysis results will be
confirmed once processing has occurred through Redwood Toxicology (usually within three
days). Confirmation will occur through a phone call, test result, e-mail and/or fax to the
referring caseworker.
e. CONTRACTOR will report all positive and negative Instant Urinalysis results within 24 hours.
If the result is positive, it will be sent to Redwood for final confirmation. Confirmation will
occur through a phone call, test result, e-mail and/or fax to the referring caseworker.
f. CONTRACTOR will submit a copy of the valid Authorization for Services form, result and
client sign -in sheet (if applicable) with each monthly billing.
2. All processed (laboratory) test results will be available online 24 hours per day, seven (7) days per
week online at Redwood Toxicology (www.webtoxicology.com).
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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
$$20.00/Episode (Urinalysis -5 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates)
$20.00/Episode (Urinalysis -7 Panel: THC, Cocaine, Amphetamines, Benzodiazepines, Opiates,
Barbiturates, Alcohol)
$20.00/Episode (InstaCheck 5 Panel)
$20.00/Episode (Multi -Panel Instant Urinalysis)
$20.00/Episode (Instant Swab)
$35.00/Episode (GCMS - Confirmation of Positive Result)
$5.00/Episode (Breathalyzer)
$100.00/Episode (Hair Test)
$50.00/Episode (Patch)
$35.00/Episode (Ethyl Glucuronide Test aka EtG)
$50.00/Episode (Urinalysis - Expanded Designer Stimulants - 14 Panel)
$35.00/Episode (Urinalysis - MDPV, Mephedrone, Methylone - 3 Panel)
$35.00/Episode (Urinalysis - Synthetic Cannabinoids - "Spice")
$35.00/Episode (Oral Swab - Synthetic Cannabinoids - "Spice")
$2.00/Episode (Urinalysis -Single Panel EtG Add-on for 5 -or 7 -Panel UA Only)
$2.00/Episode (Urinalysis - Add-on Panel for Oxycodone or Buprenorphine for 5- or 7 -Panel UA Only)
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.
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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 delay 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
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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- CPS -0109
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
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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- CPS -0109
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 7m 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 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.
18
PY-13-14- CPS -0109
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- CPS -0109
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PY-13-14- CPS -0109
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PY-13-14-CORE-0129
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TRANSITIONS PSYCHOLOGY GROUP, LLC
This Agreement, made and entered into the 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 Transitions Psychology Group, LLC, hereinafter referred to as the "Contractor".
WITNESSETH
ESSETH
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 (Therapeutic Visitation, Parent Coaching); 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
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established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 76 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. 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.
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• 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.
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.
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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.
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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.
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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.
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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:
Norma A. Alkire
Name
Gregory S. Creed
Name
17. Notice
Administrator
Title
Co -Director
Title
Co -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
For Contractor:
Norma A. Alkire
Gregory S. Creed
7251 West 20`h Street, Unit M-2
Greeley, CO 80634
(970) 336-1123
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18. Litigation
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
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.
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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
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.
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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
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.
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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
Deputy Clerk to ' e Board
ty Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
CONTRACTOR:
11
BOARD OF COUMMISSIONERS
WELD COU DO
Garcia, Chair
AUG 14 2013
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PY-13-14-CORE-0129
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Life Skills services to clients referred by the Department, primarily in the Greeley
area. Services include:
a. Family Therapy Visitation — Family contact in the presence of a Master's or Doctoral level therapist to
ensure protection of the children emotionally and assist in the healing of the parent -child
relationship damaged by severe abuse and/or neglect.
b. Therapeutic Visitation — Supervision and evaluation of parent -child interactions for referred clients
and their minor children by a Master's or Doctoral level therapist. An enhanced supervised visitation
program that incorporates concepts from a variety of therapeutic disciplines such as individual,
couples and family therapy, play therapy, music therapy, parent -child interactional therapy and
parenting skills education. This blended approach is utilized to develop individualized interventions
for the family.
All contact between the parent and the child is structured to provide for the safety and well-being of
the children while maintaining the continuity of family relationships. Parents are given the
opportunity to learn and practice positive parenting.
Parents are continually assessed regarding their capacity to appropriately care for their children.
CONTRACTOR utilizes, as clinically appropriate, the Life Skills Assessment (LSA) tool developed by the
CONTRACTOR to assess areas of family functioning including household management and
environment, parenting styles and capabilities, family interactions and safety, and commitment. A
copy of this tool has been provided to the Department.
Services are available both in -office and in -home to address the continuum of care issues as the
client progresses to a less restrictive setting.
c. Life Skills Parent Coaching —Services are designed to address family needs to prevent placement of
children or facilitate the reunification process when children return home, and enhance the parent's
capacity to provide for their children's needs. Services occur in the client's home.
2. CONTRACTOR retains an office in Greeley, located at 7251 West 20th Street, M-2.
3. For referrals requiring transportation outside a 25 -mile radius of the CONTRACTOR'S office, the Department
will approve additional hours for transportation. CONTRACTOR will only bill for travel from the pick-up
location to the visit and back. Travel time to or from the office, or other location, to the pick up or drop off
location is not an allowable charge.
4. All services will be provided by Master's, or higher, level therapists. CONTRACTOR has one (1) bilingual
(Spanish/English) staff member.
5. CONTRACTOR will utilize a team approach to link mental health services with existing services, such as
Lifeskills or other community services to ensure a continuum of care.
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.
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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 (TOM) meetings and Family Team Meetings
(FM), when approved by the Department prior to the TDM or FM 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.
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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 (Family Therapy Visitation, Face -to -Face)
$110.00/Hour (Level 3 Therapeutic Visitation, Face -to -Face)
$125.00/Hour (Therapeutic Visitation or Life Skills Parent Coaching)
$110.00/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.
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b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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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-0129
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-0129
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-0129
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-0129
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.
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Printed Name of SignerCCDNTRACTOR Signature Date
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
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Core & Service Contract Coordinator Date
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-13-14-CORE-0129
CONTRACTED SERVICES CLIENT VERIFICATION FORM
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
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(Ex. 1:00 - 2:30)
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PY-13-14-CORE-0144
I
CHILD PROTECTION AGREEMENT OR SERVICES BETWEEN
THE WELD COUNTY DEPARTME T OF HUMAN SERVICES
AND TRANSITIONS PSYCH LOGY GROUP, LLC
This Agreement, made and entered into the 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 Transitions Psychology Group, 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
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.
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-0144
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
PV -13 -14 -CORE -0144
• 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-0144
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-0144
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
AY -13 -14 -CORE -0144
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-0144
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:
Norma A. Alkire
Name
Gregory S. Creed
Name
17. Notice
Administrator
Title
Co -Director
Title
Co -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
For Contractor:
Norma A. Alkire
Gregory S. Creed
7251 West 20th Street, Unit M-2
Greeley, CO 80634
(970) 336-1123
7
PY-13-14-CORE-0144
18. Litigation
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
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.
8
PY-13-14-CORE-0144
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
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.
9
PY-13-14-CORE-0144
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
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-0144
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
orney
CONTRACTOR:
e Board
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUN,kG,RADO
By:
F. Garcia, Chair
AUG 1 4 2013
Let
Contractor
Co —1 6r
Title
ontractor
Title
aokg- as 97
PY-13-14-CORE-0144
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide mental health services to clients referred by the Department, primarily in the
Greeley area. Services include:
a. Individual Counseling — Services are available for adults and adolescents and are designed to address
a wide variety of issues that impact the individual and family. The goal of the service is to remove
any barriers to safety and well being in the home which may include, but are not limited to, behavior
problems, depression, anxiety, stress, trauma, grief and loss, health, self-image, character and
treatment compliance.
b. Family Counseling — Services are available to families to address communication, togetherness,
flexibility, family structure, family lifecycle, and multi -generational issues. Family interactions and
resiliencies also are assessed and treated.
c. Co -Therapy — Services are provided by two Master's, or higher, level family systems therapists to
bridge services between programs and promote change in referred families in complex cases.
Services are limited to one (1) to three (3) sessions per referred family and require pre -approval from
the Department's Core and Service Contract Coordinator.
d. Play Therapy — Services are available for children two (2) and older.
e. Eye Movement Desensitization and Reprocessing (EMDR) Counseling
2. CONTRACTOR retains an office in Greeley, located at 7251 West 20`h Street, M-2.
3. For referrals requiring transportation outside a 25 -mile radius of the CONTRACTOR'S office, the Department
will approve additional hours for transportation. CONTRACTOR will only bill for travel from the pick-up
location to the visit and back. Travel time to or from the office, or other location, to the pick up or drop off
location is not an allowable charge.
4. All services will be provided by Master's, or higher, level therapists. CONTRACTOR has one (1) bilingual
(Spanish/English) staff member.
5. CONTRACTOR will utilize a team approach to link mental health services with existing services, such as Life
Skills or other community services to ensure a continuum of care.
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-0144
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-0144
EXHIBIT 8
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 (Individual, Family Therapy or Eye Movement Desensitization and Reprocessing
(EMDR) - In Office. Face -to -Face.)
$115.00/Hour (Individual or Family Therapy - In Home. Face -to -Face.)
$180.00/Hour (Co -Therapy. Face -to -Face.)
$110.00/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-0144
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-0144
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-0144
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-0144
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-0144
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 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`" 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-0144
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.
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Printed Name of Signer
CONTRACTOR Signature
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
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Core & Service Contract Coordinator Date
20
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Date
PY-13-14-CORE-0144
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-13-14-CORE-0144
CONTRACTED SERVICES CLIENT VERIFICATION FORM
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
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PY-13-14-HS-0044
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND HELENE WURTH
This Agreement, made and entered into the 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 Helene Wurth, 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 Relinquishment Counseling; 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
&O/ -aog9
PY-13-14-HS-0044
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 a seq.; and
2
PY-13-14-HS-0044
• 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
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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
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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.
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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.
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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:
Helene Wurth
Name
17. Notice
Administrator
Title
Private Practice
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:
Helene Wurth, Private Practice
4306 Beaver Creek Drive
Fort Collins, CO 80526
(970) 631-6235
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.
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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 18. 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
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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.
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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.
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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 . he Board -. IVA
V 3
E► A OF
y ttorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COU LORADO
By:
F. Garcia, Chair
CONTRACTOR:
AUG 14 2013
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PY-13-14-HS-0044
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide home study and relinquishment counseling services for families within Weld
County, as 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 on the State's approved home study vendor list.
CONTRACTOR also is certified as a SAFE supervisor.
3. CONTRACTOR will attend SAFE Refresher training during the term of this 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. All services will be provided by Helene Wurth, BSW.
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 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 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.
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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)
$450.00/Episode (Updated Home Study)
$200.00/Person (Additional Adult)
$50.00/Hour (Cancellation Home Study)
$100.00/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 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.
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b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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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.
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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.
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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).
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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.
18
PY-13-14-HS-0044
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:
Coordinator or Fiscal Clerk
Date
19
PY-13-14-H5-0044
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4
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-13-14-HS-0044
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 billed:
Phone Number
Your Agency's Contact Person:
Household Number:
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Notice to CONTRACTOR: Atta
the month of service.
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