HomeMy WebLinkAbout20132839.tiffMEMORANDUM
DATE: October 3, 2013
TO: William F, Garcia, Chair, Board of unty Commissioners
FROM: Judy A. Griego, Director, Hum Os'
RE: Respite Agreement between the l d County Department
of Human Services and Various Providers for Placement on
the Consent Agenda
Enclosed for Board approval are Respite Agreements between the Department and Various
Providers. The template for these agreements was approved by the Board June 24, 2013, for
placement on the Consent Agenda.
The major provisions for these Agreements are as follows:
No.
Provider
Term
Rate
1
Granquist, Jacqueline
July 1, 2013 — June 30, 2014
$16.75 per each four hour
Period. Max. $67.00 per
month for 16 hours
2
Gutierrez, Elisa
Hoffer, Chris
July 1, 2013 — June 30, 2014
$16.75 per each four hour
Period. Max. $67.00 per
month for 16 hours
3
Tovar, Nyriah
July 1, 2013 — June 30, 2014
$16.75 per each four hour
Period. Max. $67.00 per
month for 16 hours
4
VanDenElzen, Dawn
July 1, 2013 — June 30, 2014
$16.75 per each four hour
Period. Max. $67.00 per
month for 16 hours
If you have any questions, give me a call at extension 6510.
_ 3
2013-2839
Hens`
13-14 RESPITE CARE
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
iC
This Agreement, made and entered into the ? day of ethi,Y , 20/2, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Aw c r iv.al inc. Gm:kw; 4 referred to as "Provider".
hS 4-
WITNESSETI-I
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Child Welfare Regular
Administration funding for respite care for county foster care PROVIDERS and
WI-IEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2013, upon proper execution of this Agreement and shall
expire June 30, 2014, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider to any person(s) eligible for child protection services in compliance with
Exhibit A "Scope of Services," a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule," copies of which are attached hereto
and incorporated herein by reference.
b. "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c. PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e. Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER 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
Child Welfare Regular Administration funding must conform to the Single Audit Act of 1984 and OMB
Circular A -I33.
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13-14 RESPITE CARE
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. PROVIDER shall provide proper monthly invoices and itemization of services performed for costs incurred in
the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In the event
of a forfeiture of reimbursements, PROVIDER may appeal such circumstance to the Director of Human
Services. The decision of the Director of Human Services shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit C, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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 that have been or may hereafter be established which relate to the Contract.
PROVIDER 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
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 Acquired Immune Deficiency syndrome
(AIDS) or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973, as
amended, cited above. If necessary, PROVIDER and Human Services will resist in judicial proceedings
any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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.
8. Certifications
PROVIDER certifies that, at the time of entering into this Contract, it has currently in effect all necessary
licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this
contract. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
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13-14 RESPITE CARE
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by PROVIDER and Human Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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 agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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 PROVIDER.
These remedial actions are as follows:
a. Withhold payment to PROVIDER 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 PROVIDER cannot be performed or if performed would be of
no value to Human Services. Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be recovered from
PROVIDER by deduction from subsequent payments under this Agreement or other agreements between
Human Services and PROVIDER, or by Human Services as a debt due to Human Services or otherwise as
provided by law.
12. 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 Human Services:
Heather Walker
Name
For Provider:
13. Notice
Human Services Administrator
Title
Respite Care Provider
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:
To: Human Services To:.\a.tq_U,Q\ttilQ_ GsCo_fiq 5k
Judy A. Griego, Director 1l1a0 to It QC U
P.O. Box A tANnt4SOCE 8055 0
Greeley, CO 80632
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13-14 RESPITE CARE
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual litigation
in which it is a party defendant in a case that involves services provided under this Agreement. PROVIDER,
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
Human Services Director. The term "litigation" includes an assignment for the benefit of creditors, and filings
in bankruptcy, reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty (30) days written notice and is subject
to the availability of funding. PROVIDER reserves the right to suspend services to clients if funding is no longer
available.
16. 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 10
herein.
17. No Third Party Beneficiary. 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.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty of
care which did not previously exist with respect to any person not a party to this Agreement.
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 Boar
AP
ney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Williar�r-F. Garcia
OCT 0 7 2013
Page 4 of 9
13-14 RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the Colorado Bureau of
Investigation. A Federal Bureau of Investigation background check will be done if the Provider has been a
resident of the State of Colorado for less than two years. Human Services will clear the Provider through CBI
and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be provided to
Human Services with this agreement. If either certification should expire during the contracted period, the
Provider will send a new current certification copy to Human Services;
3. Provide transportation for the child to appointments during the hours of service as agreed upon with the foster
parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed under
Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are not
eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of Child Welfare Regular Administration funds
for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by
Human Services, Human Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each four
hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly, the itemized voucher and certify that the services authorized were
provided on the date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
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13-14 RESPITE CARE
EXHIBIT C
ASSURANCES
1. PROVIDER 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.
2. 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this Agreement.
PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of
Weld County, its employees, volunteers, and agents. PROVIDER shall provide adequate liability and
worker's compensation insurance for all its employees, volunteers, and agents engaged in the performance of
the Agreement upon request, PROVIDER shall provide Human Services with the acceptable evidence that
such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a duty
of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract 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.
5. If any section, subsection, paragraph, sentence, clause, or phrase of this Contract 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 Contract 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.
6. 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.
7. PROVIDER assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person
shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied
the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. PROVIDER assures that sufficient, auditable, and otherwise adequate records that will provide accurate,
current, separate, and complete disclosure of the status of the funds received under the Contract are maintained
for three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors, and representatives to audit and monitor PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services, for a
period of four (4) years from the date of final payment under this Contract, 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 four (4) year period, or if audit findings have not been resolved after a four (4) year
period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER assures that authorized local, federal, and state auditors and representatives shall, during business
hours, have access to inspect any copy records, and shall be allowed to monitor and review through on -site
visits, all contract activities, supported with funds under this Contract 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.
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13-14 RESPITE CARE
11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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.
13. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular Administration
funds.
14. PROVIDER assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by a federal department or agency.
b. Have not, within a three-year period of 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 statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal,
state, or local) with commission of any of the offenses enumerated in paragraph 14(b) of this
certification; and
d. Have not within a three-year period preceding this Contract, had one or more public transactions
(federal, state, and local) terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services 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 Contract, PROVIDER 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, PROVIDER shall submit to Human Services, 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 Human Services' termination, for cause, of its contract
with PROVIDER.
16. PROVIDER shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. Except for purposes directly connected with the administration of Child
Protection, no information about or obtained from any applicant/recipient in possession of PROVIDER shall
be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with PROVIDER written policies governing access to, duplication and dissemination of, all such
information. PROVIDER shall advise its employees, agents, and subcontractors, if any, that they are subject
to these confidentiality requirements. PROVIDER shall provide its employees, agents, and subcontractors, if
any, with a copy or written explanation of these confidentiality requirements before access to confidential data
is permitted.
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13-14 RESPITE CARE
17. Proprietary information for the purposes of this contract 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 Contract. Any proprietary information removed from the State's site by
PROVIDER in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by PROVIDER for similar information in the course of its own business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal
background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
na
This Agreement, made and entered into the 7'day ofaa, 20/s, by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Elisa Gutierrez and Chris Hoffer referred to as
"Provider".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Child Welfare Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July I, 2013, upon proper execution of this Agreement and shall
expire June 30, 2014, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider to any person(s) eligible for child protection services in compliance with
Exhibit A "Scope of Services," a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule," copies of which are attached hereto
and incorporated herein by reference.
b. "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c. PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e. Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER 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
Child Welfare Regular Administration funding must conform to the Single Audit Act of 1984 and OMB
Circular A-133.
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13-14 RESPITE CARE
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. PROVIDER shall provide proper monthly invoices and itemization of services performed for costs incurred in
the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In the event
of a forfeiture of reimbursements, PROVIDER may appeal such circumstance to the Director of Human
Services. The decision of the Director of Human Services shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit C, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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 that have been or may hereafter be established which relate to the Contract.
PROVIDER 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
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 Acquired Immune Deficiency syndrome
(AIDS) or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973, as
amended, cited above. If necessary, PROVIDER and Human Services will resist in judicial proceedings
any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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.
8. Certifications
PROVIDER certifies that, at the time of entering into this Contract, it has currently in effect all necessary
licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this
contract. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
Page 2 of 9
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9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by PROVIDER and Human Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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 agreement work.
10. Modification of Aareement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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 PROVIDER.
These remedial actions are as follows:
a. Withhold payment to PROVIDER 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 PROVIDER cannot be performed or if performed would be of
no value to Human Services. Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be recovered from
PROVIDER by deduction from subsequent payments under this Agreement or other agreements between
Human Services and PROVIDER, or by Human Services as a debt due to Human Services or otherwise as
provided by law.
12. 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 Human Services:
Heather Walker
Name
For Provider:
Human Services Administrator
Title
Respite Care Provider
Name Title
13. Notice
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:
To: Human Services
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
To: Chris Hoffer and Elisa Guterrez
10101 W 13h St Rd.
Greeley, CO 80634
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13-14 RESPITE CARE
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual litigation
in which it is a party defendant in a case that involves services provided under this Agreement. PROVIDER,
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
Human Services Director. The term "litigation" includes an assignment for the benefit of creditors, and filings
in bankruptcy, reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty (30) days written notice and is subject
to the availability of funding. PROVIDER reserves the right to suspend services to clients if funding is no longer
available.
16. 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 10
herein.
17. No Third Party Beneficiary. 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.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty of
care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY; COLORADO
ATTEST:
r
Weld County to the Bo
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
Chair William F. Garcia
OCT 0 7 2013
PROVIDER
E\iSa GtAcrrez
Respite Provider
Page 4 of 9
13-14 RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the Colorado Bureau of
Investigation. A Federal Bureau of Investigation background check will be done if the Provider has been a
resident of the State of Colorado for less than two years. Human Services will clear the Provider through CBI
and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be provided to
Human Services with this agreement. If either certification should expire during the contracted period, the
Provider will send a new current certification copy to Human Services;
3. Provide transportation for the child to appointments during the hours of service as agreed upon with the foster
parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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13-14 RESPITE CARE
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed under
Child Welfare Regular Administration funding.
Expenses inured by PROVIDER, in association with said project prior to the term of this agreement, are not
eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of Child Welfare Regular Administration funds
for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by
Human Services, Human Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each four
hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly, the itemized voucher and certify that the services authorized were
provided on the date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
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13-14 RESPITE CARE
EXHIBIT C
ASSURANCES
1. PROVIDER 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.
2. 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this Agreement.
PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of
Weld County, its employees, volunteers, and agents. PROVIDER shall provide adequate liability and
worker's compensation insurance for all its employees, volunteers, and agents engaged in the performance of
the Agreement upon request, PROVIDER shall provide Human Services with the acceptable evidence that
such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a duty
of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract 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.
5. If any section, subsection, paragraph, sentence, clause, or phrase of this Contract 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 Contract 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.
6. 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.
7. PROVIDER assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person
shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied
the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. PROVIDER assures that sufficient, auditable, and otherwise adequate records that will provide accurate,
current, separate, and complete disclosure of the status of the funds received under the Contract are maintained
for three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors, and representatives to audit and monitor PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services, for a
period of four (4) years from the date of final payment under this Contract, 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 four (4) year period, or if audit findings have not been resolved after a four (4) year
period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER assures that authorized local, federal, and state auditors and representatives shall, during business
hours, have access to inspect any copy records, and shall be allowed to monitor and review through on -site
visits, all contract activities, supported with funds under this Contract 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.
Page 7 of 9
13-14 RESPITE CARE
II, This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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.
13. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular Administration
funds.
14. PROVIDER assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by a federal department or agency.
b. Have not, within a three-year period of 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 statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal,
state, or local) with commission of any of the offenses enumerated in paragraph 14(b) of this
certification; and
d. Have not within a three-year period preceding this Contract, had one or more public transactions
(federal, state, and local) terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services 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 Contract, PROVIDER 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, PROVIDER shall submit to Human Services, 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 Human Services' termination, for cause, of its contract
with PROVIDER.
16. PROVIDER shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. Except for purposes directly connected with the administration of Child
Protection, no information about or obtained from any applicant/recipient in possession of PROVIDER shall
be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with PROVIDER written policies governing access to, duplication and dissemination of, all such
information. PROVIDER shall advise its employees, agents, and subcontractors, if any, that they are subject
to these confidentiality requirements. PROVIDER shall provide its employees, agents, and subcontractors, if
any, with a copy or written explanation of these confidentiality requirements before access to confidential data
is permitted.
Page 8 of 9
13-14 RESPITE CARE
17. Proprietary information for the purposes of this contract 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 Contract. Any proprietary information removed from the State's site by
PROVIDER in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by PROVIDER for similar information in the course of its own business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal
background checks for all employees, contractors, and sub -contractors.
Page 9 of 9
13-14 RESPITE CARE
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the-/ day of ib , 20/3 by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Nyriah Tovar referred to as "Provider".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Child Welfare Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2013, upon proper execution of this Agreement and shall
expire June 30, 2014, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider to any person(s) eligible for child protection services in compliance with
Exhibit A "Scope of Services," a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule," copies of which are attached hereto
and incorporated herein by reference.
b. "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c. PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e. Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effect; date of this Contract until completion of this Contract, PROVIDER 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
Child Welfare Regular Administration funding must conform to the Single Audit Act of 1984 and OMB
Circular A-133.
Page 1 of 9
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13-14 RESPITE CARE
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. PROVIDER shall provide proper monthly invoices and itemization of services performed for costs incurred in
the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In the event
of a forfeiture of reimbursements, PROVIDER may appeal such circumstance to the Director of Human
Services. The decision of the Director of Human Services shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit C, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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 that have been or may hereafter be established which relate to the Contract.
PROVIDER 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
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 Acquired Immune Deficiency syndrome
(AIDS) or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973, as
amended, cited above. If necessary, PROVIDER and Human Services will resist in judicial proceedings
any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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.
8. Certifications
PROVIDER certifies that, at the time of entering into this Contract, it has currently in effect all necessary
licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this
contract. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
Page 2 of 9
13-14 RESPITE CARE
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by PROVIDER and Human Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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 agreement work.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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 PROVIDER.
These remedial actions are as follows:
a. Withhold payment to PROVIDER until the necetsary 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 PROVIDER cannot be performed or if performed would be of
no value to Human Services. Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be recovered from
PROVIDER by deduction from subsequent payments under this Agreement or other agreements between
Human Services and PROVIDER, or by Human Services as a debt due to Human Services or otherwise as
provided by law.
12. 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 Human Services:
Heather Walker
Name
For Provider:
Human Services Administrator
Title
Respite Care Provider
Nam- Title
13. Notice
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:
To: Human Services
Judy A. Griego, Director
P.O. Box A
Greeley. CO 80632
To: Nvria Tovar
1020 Cottonwood Dr.
Windsor, CO 80550
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13-14 RESPITE CARE
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual litigation
in which it is a party defendant in a case that involves services provided under this Agreement. PROVIDER,
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
Human Services Director. The term "litigation" includes an assignment for the benefit of creditors, and filings
in bankruptcy, reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty (30) days written notice and is subject
to the availability of funding. PROVIDER reserves the right to suspend services to clients if funding is no longer
available.
16. 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 10
herein.
17. No Third Party Beneficiary. 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.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty of
care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Al LEST:
Weld County Clerk to the Board ��Chair WGarcia
BY:
AP
Deputy Clerk
Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
0CT 0 7 2013
PROVIDER
Nvriah Tovar
Respite Provider
Page 4 of 9
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13-14 RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the Colorado Bureau of
Investigation. A Federal Bureau of Investigation background check will be done if the Provider has been a
resident of the State of Colorado for less than two years. Human Services will clear the Provider through CBI
and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be provided to
Human Services with this agreement. If either certification should expire during the contracted period, the
Provider will send a new current certification copy to Human Services;
3. Provide transportation for the child to appointments during the hours of service as agreed upon with the foster
parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed under
Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are not
eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of Child Welfare Regular Administration funds
for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by
Human Services, Human Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each four
hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly, the itemized voucher and certify that the services authorized were
provided on the date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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.
2. 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this Agreement.
PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of
Weld County, its employees, volunteers, and agents. PROVIDER shall provide adequate liability and
worker's compensation insurance for all its employees, volunteers, and agents engaged in the performance of
the Agreement upon request, PROVIDER shall provide Human Services with the acceptable evidence that
such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a duty
of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract 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.
5. If any section, subsection, paragraph, sentence, clause, or phrase of this Contract 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 Contract 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.
6. 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.
7. PROVIDER assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person
shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied
the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. PROVIDER assures that sufficient, auditable, and otherwise adequate records that will provide accurate,
current, separate, and complete disclosure of the status of the funds received under the Contract are maintained
for three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors, and representatives to audit and monitor PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services, for a
period of four (4) years from the date of final payment under this Contract, 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 four (4) year period, or if audit findings have not been resolved after a four (4) year
period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER assures that authorized local, federal, and state auditors and representatives shall, during business
hours, have access to inspect any copy records, and shall be allowed to monitor and review through on -site
visits, all contract activities, supported with funds under this Contract 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.
Page 7 of 9
13-14 RESPITE CARE
11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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.
13. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular Administration
funds.
14. PROVIDER assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by a federal department or agency.
b. Have not, within a three-year period of 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 statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal,
state, or local) with commission of any of the offenses enumerated in paragraph I4(b) of this
certification; and
d. Have not within a three-year period preceding this Contract, had one or more public transactions
(federal, state, and local) terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services 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 Contract, PROVIDER 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, PROVIDER shall submit to Human Services, 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 Human Services' termination, for cause, of its contract
with PROVIDER.
16. PROVIDER shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. Except for purposes directly connected with the administration of Child
Protection, no information about or obtained from any applicant/recipient in possession of PROVIDER shall
be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with PROVIDER written policies governing access to, duplication and dissemination of, all such
information. PROVIDER shall advise its employees, agents, and subcontractors, if any, that they are subject
to these confidentiality requirements. PROVIDER shall provide its employees, agents, and subcontractors, if
any, with a copy or written explanation of these confidentiality requirements before access to confidential data
is permitted.
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17. Proprietary information for the purposes of this contract 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 conceming the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site by
PROVIDER in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by PROVIDER for similar information in the course of its own business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal
background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 9 day of(YCkdj(�l , 2(✓j, by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Dawn VanDenElzen ' referred to as "Provider".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Services has provided Child Welfare Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2013, upon proper execution of this Agreement and shall
expire June 30, 2014, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider to any person(s) eligible for child protection services in compliance with
Exhibit A "Scope of Services," a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule," copies of which are attached hereto
and incorporated herein by reference.
b. "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c. PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to. Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e. Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall comply
with the administrative requifements, 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
Child Welfare Regular Administration funding must conform to the Single Audit•Act of 1984 and OMB
Circular A-133.
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13-14 RESPITE CARE
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a PROVIDER shall provide proper monthly invoices and itemization of services performed for costs incurred in
the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In the event
of a forfeiture of reimbursements, PROVIDER may appeal such circumstance to the Director of Human
Services. The decision of the Director of Human Services shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit C, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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 that have been or may hereafter be established which relate to the Contract
PROVIDER acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d -1 et sue,, and its implementing regulation,
45 C.F.R. Part 80 et seq.; and
Section 504 of the Rehabilitation Act 01 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 Acquired Immune Deficiency syndrome
(AIDS) or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973, as
amended, cited above. If necessary, PROVIDER and Human Services will resist in judicial proceedings
any efforts to obtain access to client records except as permitted by 42 CFRPart 2.
Included in 45 C.F.R Part 74 Appendix G 9, which requires that affirmative steps be taken to assure that small
and minority businesses are ntili7ed, 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.
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.
8. Certifications
PROVIDER certifies that, at the time of entering into this Contract, it has currently in effect all necessary
licenses, approvals, insurance, etc., required to properly provide the services and/or supplies covered by this
contract A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
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9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by PROVIDER and Human Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and PROVIDER
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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 agreement work.
10. Modification of Agreement
All modifications to this agreement shalt be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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 PROVIDER.
These remedial actions are as follows:
a. Withhold payment to PROVIDER 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 PROVIDER cannot be performed or if performed would be of
no value to Human Services. Denial of the amount of payment shall be reasonably related to the amount of
work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be recovered from
PROVIDER by deduction from subsequent payments under this Agreement or other agreements between
Human Services and PROVIDER, or by Human Services as a debt due to Human Services or otherwise as
provided by law.
12. 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 Human Services:
Heather Walker
Name
For Provider:
Human Services Administrator
Title
4040,,, et..r/ i9�' z Respite Care Provider
Name Title
13. Notice
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:
To: Human Services' •
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
To: paw, Yin e 2.0%-/
SR/1" w• Id 1"%iy. z ..
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14. Litigation
PROVIDER shalt promptly notify Human Services in the event that PROVIDER learns of any actual litigation
in which it is a party defendant in a case that involves services provided under this Agreement PROVIDER,
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
Human Services Director. The term "litigation" includes an assignment for the benefit of creditors, and filings
in bankruptcy, reorganization and/or foreclosure.
15. Termination
This Agreement may be terminated at any time by either party given thirty (30) days written notice and is subject
to the availability of funding. PROVIDER reserves the right to suspend services to clients if funding is no longer
available.
16. 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 10
herein.
17. No Third Party Beneficiary. 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.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty of
care which did not previously exist with respect to any person not a party to this Agreement
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
Weld County Clerk to the card
BY:
Deputy Clerk
APP
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY„ COLORADO
v(� /
William F. Garcia
OCT 072013
PROVIDER
Respite Provider
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13-14 RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
Complete a fingerprint card for a background check at the PROVIDERS expense with the Colorado Bureau of
Investigation. A Federal Bureau of Investigation background check will be done if the Provider has been a
resident of the State of Colorado for less than two years. Human Services will clear the Provider through CBI
and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be provided to
Human Services with this agreement. If either certification should expire during the contracted period, the
Provider will send a new current certification copy to Human Services;
3. Provide transportation for the child to appointments during the hours of service as agreed upon with the foster
parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed under
Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are not
eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in part,
is subject to and contingent upon the continuing availability of Child Welfare Regular Administration funds
for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as determined by
Human Services, Human Services may immediately terminate this Contract or amend it accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each four
hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly, the itemized voucher and certify that the services authorized were
provided on the date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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.
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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this Agreement.
PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of
Weld County, its employees, volunteers, and agents. PROVIDER shall provide adequate liability and
worker's compensation insurance for all its employees, volunteers, and agents engaged in the performance of
the Agreement upon request, PROVIDER shall provide Human Services with the acceptable evidence that
such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a duty
of care with respect to any persons not a party of this Agreement
4. No portion of this Contract 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.
S. If any section, subsection, paragraph, sentence, clause, or phrase of this Contract 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 Contract 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.
6. 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.
7. PROVIDER assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person
shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied
the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. PROVIDER assures that sufficient, auditable, and otherwise adequate records that will provide accurate,
current, separate, and complete disclosure of the status of the funds received under the Contract are maintained
for three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow
authorized local, Federal, and State auditors, and representatives to audit and monitor PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, ina central location andcustodian, in behalf of Human Services, for a
period of four (4) years from the date of final payment under this Contract, 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 four (4) year period, or if audit findings have not been resolved after a four (4) year
period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER assures that authorized local, federal, and state auditors and representatives shall, during business
hours, have access to inspect any copy records, and shall be allowed to monitor and review through on -site
visits, all contract activities, supported with funds under this Contract 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.
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11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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.
13. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular Administration
funds.
14. PROVIDER assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transaction by a federal department or agency.
b. Have not, within a three-year period of 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 statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal,
state, or local) with commission of any of the offenses enumerated in paragraph 14(b) of this
certification; and
d. Have not within a three-year period preceding this Contract, had one or more public transactions
(federal, state, and local) terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services 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 Contract, PROVIDER 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, PROVIDER shall submit to Human Services, 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 Human Services' termination, for cause, of its contract
with PROVIDER.
16. PROVIDER shall protect the confidentiality of all applicant records and other materials that are maintained in
accordance with this Contract. Except for purposes directly connected with the administration of Child
Protection, no information about or obtained from any applicant/recipient in possession of PROVIDER shall
be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with PROVIDER written policies governing access to, duplication and dissemination of, all such
information. PROVIDER shall advise its employees, agents, and subcontractors, if any, that they are subject
to these confidentiality requirements. PROVIDER shall provide its employees, agents, and subcontractors, if
any, with a copy or written explanation of these confidentiality requirements before access to confidential data
is permitted.
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17. Proprietary information for the purposes of this contract 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 Contract. My proprietary information removed from the State's site by
PROVIDER in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by PROVIDER for similar information in the course of its own business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal
background checks for all employees, contractors, and sub -contractors.
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