HomeMy WebLinkAbout20132828.tiffRESOLUTION
RE: APPROVE SEVEN (7) CHILD PROTECTION AGREEMENTS FOR SERVICES WITH
VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with seven (7) Child Protection Agreements for
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and the providers
listed within Exhibit "A", commencing June 1, 2013, and ending May 31, 2014 with further terms and
conditions being as stated in said agreements, and
WHEREAS, after review, the Board deems it advisable to approve said agreements, copies
of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the seven (7) Child Protection Agreements for Services between the County
of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services, and the providers listed within Exhibit "A", be, and
hereby are, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreements.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 7th day of October, A.D., 2013, nunc pro tunc June 1, 2013.
BOARD OF COUNTY COMMISSIONERS
WELDOUNTY, COLORADO
ATTEST:
� " e
Weld County Clerk to the Board
BY.
Deputy
APP
ounty Attorney
Date of signature: OCT 1 6 2013
liam F. Garcia, Chair
Rademacher, Pro-Tem
can P. Conway
l 1 `^fit-
ike Freeman
Barbara Kirkmey4
W fib 14-1
2013-2828
HR0084
MEMORANDUM
DATE: October 3, 2013
TO:
FROM:
SUBJECT:
William F. Garcia, Chair, Board of Couty Corp miss. er
Judy A. Griego, Director, Human Serv/Ic s Department
Child Protection Agreements for Services between the
Weld County Department of Human Services and
Various Providers
Enclosed for Board approval are Child Protection Agreements for Services between the Department and
Various Providers. These Agreements were reviewed under the Board's Pass -Around Memorandum dated
May 8, 2013, and approved for placement on the Board's Agenda.
There are a total of 67 agreements with various providers; the first 11 agreements were approved by the
Board on July 22, 2013, the next set of agreements were approve by the Board on August 14, 2013, 29
more agreements were presented on September 19, 2013, the following agreements received represent 7
leaving 2 agreements needing to be signed by the Board Chair. The major provisions of these Agreements
are as follows:
No.
Provider/Term
Program Area/ Funding
Source
PY13-14 Rate(s)
Poudre Health Care,
Inc. DBA Poudre
Valley Hospital
(Mountain Crest
Behavioral Healthcare
Center)
06/01/13 - 05/31/14
Home Based Intensive
Services (Aftercare
Wraparound Services)
Core
$1,800.00/Month (In -Home Wraparound)
$60.00/Day (In -Home Wraparound — Partial
Month of Service)
$1,000.00/Month (In -Home Wraparound/
Therapist Only)
$33.00/Day (In -Home Wraparound/Therapist
Only — Partial Month of Service)
$800.00/Month (In -Home Wraparound/
Facilitator Only)
$26.00/Day (In -Home Wraparound/Facilitator
Only — Partial Month of Service)
2
Savio House
06/01/13-05/31/14
Foster Parent Consultation
Core
$56.00/Day
3
Savio House
06/01/13 - 05/31/14
Functional Family Therapy
Core
$820.00/Month (Pro -Rated for any partial
month of service)
4
Savio House
06/01/13 - 05/31/14
Home Based Intensive
Services
Core
$1,600.00/Month (Child Protection — Pro -rated
for any partial month of service)
$1,814.00/Month (Community Based Services
— Adolescent. Pro -Rated for any partial month
of service)
5
Savio House
06/01/13-05/31/14
Life Skills
Core
$50.00/Hour
2013-2828
6
Savio House
06/01/13 — 05/31/14
Multisystemic Therapy or
Multisystemic Therapy-
Problem Sexual Behavior
Core
$1,670.00/Month (Multisystemic Therapy.
Pro -rated for an partial month of service)
$2,537.00/Month (Multisystemic Therapy -
Problem Sexual Behavior. Pro -rated for any
partial month of service)
7
Savio House
06/01/13 — 05/31/14
Sexual Abuse Treatment
(Sexual Abuse Intervention)
Core
$1,833.00/Month (Sexual Abuse Intervention,
Sexual Abuse Intervention -Child Protection.
Pro -rated for any partial month of service)
If you have any questions, give me a call at extension 6510.
I=% as /gay7/L-Prif'Er'N
-
PY-13-14-CORE-0174
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND POUDRE HEALTH CARE, INC., DBA POUDRE VALLEY HOSPITAL
day of This Agreement, made and entered into the
/ e 1A? 5er , 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Poudre Health Care, Inc., dba Poudre Valley Hospital, hereinafter referred to as the
"Contractor".
CONTRACTOR operates Mountain Crest Behavioral Healthcare Center, a licensed behavioral health care facility
located at 4601 Corbett Drive, Fort Collins, CO 80528. Mountain Crest offers Aftercare Wraparound Services.
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Home Based Intensive Services (Aftercare Wraparound Services); and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1. 2013, upon proper execution of this Agreement and
shall expire May 31, 2014, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
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PY-13-14-CORE-0174
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
PY-13-14-CORE-0174
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
• '.. All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
the Equal Pay Act of 1963; and
the Education Amendments of 1972; and
Immigration Reform and Control Act of 1986, P.L. 99-603
• 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
• Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:.
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
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PY-13-14-CORE-0174
iii. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter in to a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(6). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S.•8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
thatany individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
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PY-13-14-CORE-0174
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
Standard Workman's Compensation and Employer's Liability
o As required by State statute including occupational disease, covering all employees at
work site.
• General Liability (PL and PD) (Minimum).
o Combined single limit - $500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
• Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
• Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
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covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractorprior to the start of any Agreement.
11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and.
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14: Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
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b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below arehereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
Shari Simmons
Name
17. Notice
Administrator
Title
Manager of Residential
Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
Shari Simmons, Manager of Residential
4601 Corbett Drive
Fort Collins, CO 80528
(970) 207-4867
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
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19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17.. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, director indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
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submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents; and sub -contractor, if any, that they are subject to these
confidentiality requirements.
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CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
61waw- � �✓Cea.
Weld County Clerk to the Board
By:
APP
ty Attorney
he Board
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
1
F. Garcia, Chair
CONTRACTOR:
By:
c ls�
Title
OCT 072013
/3.67S' 8
PY-13-14-CORE-0174
EXHIBIT A
SCOPE OF SERVICES
1. The CONTRACTOR will provide Outpatient Wraparound services to those clients referred by the Department.
The 10 principles of this service are:
1. Family Voice and Choice
2. Team -based Planning
3. Natural Supports
4. Collaboration
5. Being Community -Based
6. Being Culturally -Competent
7. Individualized Treatment
8. Strengths -Based Treatment
9. Persistence
10. Outcome -Based Services
2. Services include:
a. Therapist and/or Wraparound Facilitator interaction with youth and family in the home.
b. Intensive individual and family therapy in the home.
c. Assessment of strengths, needs and cultural discovery.
d. Functional assessment.
e. Natural support through team development.
f. Crisis/relapse prevention planning.
g. Youth is connected with community resources as appropriate.
h. Monthly team meetings and Care Plan updates.
i. Court reports and appearances as necessary.
j. Parent education and support.
k. Community Service assistance.
I. Life skills/independent living skill development.
3. Services are available as follows:
a. In -Home Wraparound (Therapist and Facilitator)
b. In -Home Wraparound (Therapist Only) —Utilized when youth or family require in -home therapy only.
c. In -Home Wraparound (Facilitator Only) — Utilized when youth or family require facilitation of team
meetings, education on parenting skills, assistance in accessing community resources, and case
management services.
4. The goal of the Wraparound Aftercare Services Program is to bring the residential program to the youth's
home and community by providing needed support and services that the Wraparound team has agreed upon.
The intent of the services is to solidify the work begun in residential placement and empower families to
implement what is needed for their own unique circumstances, ultimately allowing for self-sufficiency.
5. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three (3) attempts the client does not respond
the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
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7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited
to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported
immediately AND on the required monthly report.
8. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will
be submitted per the online format required by the Department, unless otherwise directed by the
Department.
9. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare
Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team
Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented
service on the initial authorized referral form. This may include an increase or decrease in services hours,
change in frequency, change in location of services, transportation needs, or any change to the initial referral
or subsequent authorizations.
10. Monthly packages include attendance at staffings, Family Team Meetings (FTM) and/or Team Decision
Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise
approved by the Child Welfare Contract and Services Coordinator.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$1,800.00/Month (In -Home Wraparound)
$60.00/Day (In -Home Wraparound - Partial Month of Service)
$1,000.00/Month (In -Home Wraparound/Therapist Only)
$33.00/Day (In -Home Wraparound/Therapist Only - Partial Month of Service)
$800.00/Month (In -Home Wraparound/Facilitator Only)
$26.00/Day (In -Home Wraparound/Facilitator Only - Partial Month of Service)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
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b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
•'-' CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
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Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
• CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
• CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
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EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
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4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Joceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR: Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
INAAIViAMAIV1AAAAAAAAAAAAAA/VViAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
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PY-13-14-CORE-0174
Weld County Contracted Services
Request for Reimbursement
(SAMPLE ONLY. ACTUAL FORM IS IN EXCEL AND WILL BE SENT TO CONTRACTOR.)
Program Area (Ex. Lifeskills, Mental Health,
Option B, etc.)
Month/Year of
Service
Submit To.
Jocelyn Flores, Fiscal Clerk.
Weld County Department of
Human Services:.
P.O Box A/315 AM; )7thAve
Greeley. 80632;;,
(970) 352-t5. 6572 ;
(970) 346-7667,(F
For Use ByyHuman-Services
Client Name (Per
Referral)
SAMPLE ENTRY:
Doe, John
Trails Case ID
(Per referral)
1654888
Household
Number
(Per
referral)
555555
Approved
Start
Date (Per
referral)
6/1/2009
Approved
End Date
(Per
referral)
8/30/2009
Date(s)
of
Service
06/01,
06/02
Actual
Hours
or Units
/Service
Period
12
Hour LMonthl
or '(Calculi
Unit iutonraii
25
pi
.... ............
OT/
21
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PY-13-14-CORE-0174
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
CONTRACTED SERVICES CLIENT VERIFICATION FORM
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
Notice to CONTRACTOR: All clients served during the servke month must complete this verification form at the time of service. No request for payment of services will be honored for billed services
unless accompanied by the appropriate signed Client Verification Form. Payment for services will not exceed maximum hours or sessions authorized by the Department.
Section I: (To be completed by the CONTRACTOR)
Primary Client billed: Trails ID Total Hours Billed
Household Number. Your Agency's Contact Person: Phone Number
SECTION II (To be completed by client)
plaice aa'dick: Your signature must be obtained pt the time of Service. Your signature verifies that services were provided by the service CONTRACTOR for direct face-to-face contact only, for the
hours and date indicated.
Date
Hours of Service
(Ex. 1:00 — 2:30)
Number of Hours of
Service Provided
Client/Participant Signature (Please have all those attending sign. In the case of a child who is not able to
sign, please have someone sign for the child; i.e., Sally Smith by Gregg Jones, Foster Parent)
Notke to CONTRACT OR: Attach all dient venfrc'ation fon'msta the monthly billing when submitting your billing: All requestsforpaymentmust be received by the:7'" day of the month following
the month of service..
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CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SAVIO HOUSE
0 /q. /3,_*--
��'l<rIJL!)L�11,9
CIG J
This Agreement, made and entered into the 2 day ofi1& , 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Savio House, hereinafter referred to as the "Contractor".
WITN ESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Foster Parent Consultation (FPC); and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and
shall expire May 31, 2014 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
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a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
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• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
• Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
iii. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
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PY-13-14-CORE-0219
iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter in to a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department,
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
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PY-13-14-CORE-0219
Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
• Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
• General Liability (PL and PD) (Minimum).
o Combined single limit - $500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
• Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
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11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
6
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c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
William S. Hildenbrand
Name
17. Notice
Administrator
Title
Executive Director
Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
William S. Hildenbrand, Executive Director
325 King Street
Denver, CO 80219
(303)225-4014
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
7
PY-13-14-CORE-0219
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, director indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
8
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CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these
confidentiality requirements.
CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
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26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
10
PY-13-14-CORE-0219
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
//
liam F. Garcia, Chair
CONTRACTOR:
By
OCT 072013
zwia
Contractor
c2xCCU7/ve Li2FCToit
Title
PY-13-14-CORE-0219
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide consultation for children and youth residing in Weld County foster homes, as
referred by the Department. The goal of the program is to enhance and improve the quality of care
being provided to Weld County's children and youth.
2. CONTRACTOR will provide services face-to-face in the foster home of the referred child or youth.
3. CONTRACTOR has staff proficient in Spanish and American Sign Language.
4. CONTRACTOR will work collaboratively with children, foster parents, caseworkers, foster care
coordinators and other service providers to identify and address issues, in a solution -focused manner,
which could potentially disrupt placements.
5. CONTRACTOR will make recommendations to foster family following assessment of the child.
CONTRACTOR will document recommendations and follow through of foster family with regard to
recommendations.
6. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care
for the foster children in their home and report this information on a monthly basis to the Department.
7. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless otherwise directed
by the Department.
11. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare
Contract and Services Coordinator, a Department -facilitated Team Decision Making (TOM) or Family
Team Meeting (FTM), or by court order. A change is defined as anything outside of the approved
documented service on the initial authorized referral form. This may include an increase or decrease in
services hours, change in frequency, change in location of services, transportation needs, or any change
to the initial referral or subsequent authorizations.
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PY-13-14-CORE-0219
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$56.00/Hour (Foster Parent Consultation, Face -to -Face)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
• CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
14
PY-13-14-CORE-0219
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
• CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
• CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
15
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EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
16
PY-13-14-CORE-0219
4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7`h of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Joceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
17
PY-13-14-CORE-0219
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR: Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
18
PY-13-14-CORE-0219
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(Ex. 1:00- 2:30)
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PY-13-14-CORE-0231
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SAVIO HOUSE
This Agreement, made and entered into the / d ay of/1fJ , 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Savio House, hereinafter referred to as the "Contractor".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
9/'/34 -J
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WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Functional Family Therapy (FFT); and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and
shall expire May 31, 2014 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
1
02e/1/4.4- ii9c12aeg
PY-13-14-CORE-0231
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
• Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
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• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9,. which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
Hi. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
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iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter in to a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(6). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
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Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
General Liability (PL and PD) (Minimum).
o Combined single limit - $500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
PY-13-14-CORE-0231
11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13, Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
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c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
William S. Hildenbrand
Name
17. Notice
Administrator
Title
Executive Director
Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
William S. Hildenbrand, Executive Director
325 King Street
Denver, CO 80219
(303) 225-4014
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
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appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases mightbe declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
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CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these
confidentiality requirements.
CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
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26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
By:
APPR
Co
Deputy Cler the Board
TO
. rney
tt
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD CO Po ,C
By:
CONTRACTOR:
Garcia, Chair
DO
OCT 0 7 2013
Contractor
(x Ec 41, YG 21 R.GC fO
Title
670/ - d&9�
PY-13-14-CORE-0231
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provided Functional Family Therapy (FFT) services to male and female youth within the
approximate age range of 11-18 years of age, and their families, residing in Weld County, as referred by
the Department.
2. CONTRACTOR has an office in Denver.
3. Services are usually provided in -home in accordance with the National Functional Family Therapy (FFT)
model, and its standards and guidelines. All services are overseen/supervised by a FFT National
Consultant.
4. Youth and family are deemed eligible for services based on one or more of the following inclusionary
criteria:
a. Child must be at risk of out -of -home placement or transitioning back from placement within 30
days.
b. Child is displaying moderate to severe behavioral problems in the home/school/community.
c. Child is involved in criminal behaviors to include substance abuse.
d. Child demonstrates verbal and/or physical aggressions at home/school/community.
e. Child is engaged with deviant peer group.
f. Child is struggling with school behaviors to include failing grades, truancy and anti -social
behaviors.
g. Family has persistent conflict and negative child -parent relationship.
h. Caregiver is abusing substances.
i. Family has limited resources and would benefit from psycho -education and parenting skill
development.
5. FFT utilizes Family Interventions, Cognitive Behavioral Therapy, Family Therapy, school and community
interventions, and substance abuse intervention, as clinically appropriate.
6. The goal of services is to:
a. Empower families with the skills and resources need to independently address the difficulties
they are having raising their children.
b. Empower youth to cope with family, peer, school and neighborhood problems.
c. Build community and natural support systems.
d. Decrease negativity and blame among family members.
e. Decrease anti -social behavior to include legal contacts, truancy and substance abuse issues
7. Service duration is an average of 3.5 months for up to four (4) hours per week, broken down as follows:
a. Two (2) hours in -home therapy with family (including transportation);
b. One (1) hour of group and individual consultation/supervision;
c. Thirty (30) minutes session preparation; and,
d. Thirty (30) minutes administrative duties.
S. Services include:
a. Case Management
b. School Interventions
c. Advocacy
d. Court/Staffing Participation
e. Sustainability Planning
f. 24/7 access to FFTtherapist via FFT emergency phone
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9, CONTRACTOR does not offer bilingual (Spanish) services.
10. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Child Welfare Contract and
Services Coordinator immediately.
11. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
12. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
13. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department, unless otherwise directed by the
Department.
14. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare
Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team
Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented
service on the initial authorized referral form. This may include an increase or decrease in services hours,
change in frequency, change in location of services, transportation needs, or any change to the initial
referral or subsequent authorizations.
15. Monthly rate is inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team Decision
Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless otherwise
approved by the Child Welfare Contract and Services Coordinator.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$820.00/Month (Functional Family Therapy. Pro -rated for any partial month of service.)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
• CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
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Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
• CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
• CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
16
PY-13-14-CORE-0231
EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
17
PY-13-14-CORE-0231
4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Joceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
18
PY-13-14-CORE-0231
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR:
Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
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Core & Service Contract Coordinator Date
19
PY-13-14-CORE-0231
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PY-13-14-CORE-0150
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SAVIO HOUSE
69443 Lim-
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This Agreement, made and entered into the / — day of 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Savio House, hereinafter referred to as the "Contractor".
WITN ESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Home Based Intensive Services (Community Based Services -Adolescents, Child Protection); and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and
shall expire May 31, 2014 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
c97-02(Ca8
PY-13-14-CORE-0150
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.• and
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PY-13-14-CORE-0150
• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
• 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
H. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
Hi. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
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PY-13-14-CORE-0150
iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter into a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
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PY-13-14-CORE-0150
Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
• Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
• General Liability (PL and PD) (Minimum).
o Combined single limit -$500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
• Automobile Liability (Minimum) for. any CONTRACTOR transporting children or any party to
whom Department services are being provided.
Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any. Agreement.
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PY-13-14-CORE-0150
11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14, Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
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PY-13-14-CORE-0150
c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
William S. Hildenbrand
Name
17. Notice
Administrator
Title
Executive Director
Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
t970) 352-1551
18. Litigation
For Contractor:
William S. Hildenbrand, Executive Director
325 King Street
Denver, CO 80219
(303) 225-4014
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
7
PY-13-14-CORE-0150
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
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CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these
confidentiality requirements.
CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
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26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
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PY-13-14-CORE-0150
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
By:
ney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
B
CONTRACTOR:
11
BOARD OF COUNTY COMMISSIONERS
WELD COU TY C- LORADO
By:
Garcia, Chair
OCT 0 7 2013
Contractor
jXC-CMI,V6 D/2ECiO/Z
Title
ao%3 _a8.58
PY-13-14-CORE-0150
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide comprehensive programming, through their Community Based Services
program, to youth, ages 12 to 18, who are referred by the Department, are in need of transitional
services or family preservation services in order to prevent recidivism or placement, and prepare the
youth for a pro -social lifestyle.
a. Services include the following:
i. Skill Building for Youth — CONTRACTOR will provide individual counseling to the referred
youth as a means of maintaining the therapeutic relationship and teaching/modeling pro -
social attitudes and values. Skills will be demonstrated to the youth and the youth will be
given the opportunity to practice/role play new skills. All counseling sessions will
incorporate the principles of Cognitive Behavioral Therapy and Aggression Replacement
Therapy to address issues pertinent to the emancipating youth.
H. Budgeting and Managing Money —CONTRACTOR will teach youth to establish and maintain
a workable budget and pay bills in a timely manner. CONTRACTOR will accompany youth to
a local bank to establish banking services/accounts and will work with the youth to monitor
expenditures and adjust the budget as needed. Youth who have outstanding restitution,
the CONTRACTOR will ensure a portion of each paycheck is designated towards the youth's
legal obligations.
iii. Educational Support— CONTRACTOR will evaluate the referred youth's education needs
and interests through a review of educational services and plans, discussions and past
records during the pre -placement interview to determine what services are required. If the
youth is not enrolled in an educational program, CONTRACTOR will assist the youth in
identifying and enrolling in an educational/vocational program.
iv. Employment and Vocational Support —CONTRACTOR, in collaboration with the referred
youth and the caseworker, will determine employment interests, aptitudes and special
training completed. CONTRACTOR will assist the youth in finding employment, completing
applications, developing a resume and interviewing. Transportation services are available
to assist the client in accessing resources, applying for jobs, attending interviews, and
completing appropriate follow up. The youth also will be taught job maintenance skills.
Identified caretakers will be taught to monitor all aspects of the youth's employment
including hours worked, attitude, performance and income.
v. Finding and Securing Housing —CONTRACTOR will work with the referred youth to find
housing in an area that is appropriate for the youth. Transportation is available to assist
youth in completing the necessary processes to secure housing. CONTRACTOR will ensure
that the youth understands the application process, lease information, deposit
requirement, rental agreement, and setting up utilities/services, as well as other associated
factors such as moving, furnishing a home, and household budgeting/money management.
vi. Community Resources —CONTRACTOR will work with the referred youth to identify needs
and interests and will assist the youth in accessing appropriate community resources. This
will include completing a checklist that identifies the location of the nearest bank, grocery
store, post office and other neighborhood agencies. CONTRACTOR also will work with the
youth to identify appropriate social supports that will continue to be a part of the youth's
life in the future.
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vii. Leisure Time —CONTRACTOR will work with the referred youth to identify the youth's
recreational and social interests and assist the youth in accessing positive, age -appropriate
community activities that address those interests.
viii. Parenting Skills for Teen Parents —As applicable, CONTRACTOR will provide the referred
teen parent, or pregnant teen, with parenting skills training and support. CONTRACTOR will
determine the needs of the teen or expectant parent and address relevant topics and
ensure basic parenting skills are learned. Topics may include, but are not limited to,
newborn/infant/toddler development milestones, basic needs of children, age -appropriate
expectations, effective communication and decision -making, positive discipline strategies
and how to provide a nurturing, safe and consistent environment. The teen also may be
referred to a parenting support and education group.
ix. Crisis Intervention —CONTRACTOR will provide emergency response services 24 hours a
day/7 days a week to assist referred youth and families in crisis. Crisis intervention may be
provided by phone or through face-to-face contact dependent upon the nature of the crisis
and level of intervention needed.
b. Length of stay is usually four (4) to six (6) months based on the needs of the client.
c. CONTRACTOR does not currently have bilingual staff.
2. CONTRACTOR will provide family preservation or reunification services, through their Child Protection
Division, to families with children age birth to 12 years, as referred by the Department, and who are in
need of transitional services or family preservation services in order to prevent recidivism or placement.
a. Services will include:
i. Team Decision Making (TDM) — Family Group Conferences that involve extended family and
kin.
ii. Treatment Support Meetings— Family -centered, strength -based monthly staffing process to
include parents, extended family, CONTRACTOR, Department staff, GAL, and other involved
professionals. The process is anchored in the Colorado Assessment Continuum and the
focus is on protective concerns that need to be resolved to eliminate the need for
Department involvement. A work plan is established with the team outlining specific goals
to be accomplished, action steps, strengths, and time frames for completion.
iii. Therapeutic Supervised Visitation —CONTRACTOR will supervise visitation and work directly
with parents to improve parenting skills, eliminate safety concerns and reduce the time the
child is in out -of -home placement.
iv. Parenting Skills Development— Referred families will receive both group and individual
instruction with an emphasis on alternatives to physical discipline, household management,
consistent delivery of rules, consequences and rewards; and knowledge of developmental
milestones and nutrition.
b. Service Objectives:
i. Strengthen the family unit with in -home, family dictated services;
H. Reduce child abuse/neglect by teaching parenting skills, eliminating safety concerns and
reducing risk factors;
Hi. Establish permanency for children within reasonable and mandated time frames; and,
iv. Provide 24 -hour crisis intervention services.
c. It is the goal of services that upon completion, referred families will possess the skills necessary to:
Maintain their children in their home;
13
PY-13-14-CORE-0150
ii. Eliminate the need for Department or agency involvement;
iii. No longer abuse or neglect their children; and
iv. Improve the overall family functioning.
d. CONTRACTOR will provide 24 -hour crisis intervention services to referred families.
e. CONTRACTOR has staff proficient in Spanish and American Sign Language.
3. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts
the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service
Contract Coordinator immediately.
4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but
are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should
be reported immediately AND on the required monthly report.
6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless otherwise
directed by the Department.
7. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child
Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A change is defined as anything outside of the
approved documented service on the initial authorized referral form. This may include an increase or
decrease in services hours, change in frequency, change in location of services, transportation needs,
or any change to the initial referral or subsequent authorizations.
8. Proposed services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team
Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless
otherwise approved by the Child Welfare Contract and Services Coordinator.
14
PY-13-14-CORE-0150
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$1,600.00/Month (Child Protection. Pro -rated for any partial month of service.)
$1,814.00/Month (Community Based Services - Adolescent. Pro -rated for any partial month of
service.)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
15
PY-13-14-CORE-0150
EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
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PY-13-14-CORE-0150
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
• CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
• CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
17
PY-13-14-CORE-0150
EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
18
PY-13-14-CORE-0150
4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Joceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
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PY-13-14-CORE-0150
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR:
Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
/ _
Core & Service Contract Coordinator Date
20
PY-13-14-00RE-015O
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PY-13-14-CORE-0150
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PY-13-14-CORE-0211
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SAVIO HOUSE
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This Agreement, made and entered into the 'day of(*, 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Savio House, hereinafter referred to as the "Contractor".
WITN ESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Life Skills; and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and
shall expire May 31, 2014 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
1
MI5 -c fcRg
PY-13-14-CORE-0211
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
• Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
2
PY-13-14-CORE-0211
• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
• 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
Colorado Revised Statute (C.R.5.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
iii. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
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iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter in to a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
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Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
• Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
• General Liability (PL and PD) (Minimum).
o Combined single limit - $500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
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11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
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c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
William S. Hildenbrand
Name
17. Notice
Administrator
Title
Executive Director
Title
AU notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
William S. Hildenbrand, Executive Director
325 King Street
Denver, CO 80219
(303) 225-4014
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
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appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
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CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these
confidentiality requirements.
CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
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26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
By:
APO
uit""orney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD C OLORADO
F. Garcia, Chair
CONTRACTOR:
By:
OCT 0 7 2013
Contractor
7-<E.CU7/ve ba-te YOt2-
Title
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PY-13-14-CORE-0211
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide lower level Life Skills services to families with children, age birth to 18,
as referred by the Department.
2. Services will include hands-on teaching of basic skills including, but not limited to, effectively
accessing community resources, parenting skills, household management, and basic family
conflict management.
3. CONTRACTOR will provide services in the family home and/or in the community, as appropriate.
4. Average length of services is four (4) to six (6) months.
5. CONTRACTOR has staff proficient in Spanish and American Sign Language.
6. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The
first attempt will occur within 24 hours of receiving the referral (excluding weekends and
holidays). CONTRACTOR will document efforts to engage client in referred services. If after three
(3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the
Child Welfare Contract and Services Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to
the Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any
child whom the CONTRACTOR is working with under an active referral. Areas of concern may
include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas
of concern should be reported immediately AND on the required monthly report.
9, CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department, unless otherwise
directed by the Department.
10. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child
Welfare Contract and Services Coordinator, a Department -facilitated Team Decision Making
(TDM) or Family Team Meeting (FTM), or by court order. A change is defined as anything outside
of the approved documented service on the initial authorized referral form. This may include an
increase or decrease in services hours, change in frequency, change in location of services,
transportation needs, or any change to the initial referral or subsequent authorizations.
11. CONTRACTOR may bill for participation in Team Decision Making (TDM) meetings and Family
Team Meetings (FTM), when approved by the Department prior to the TDM or FTM occurring,
and when the TDM or FTM is a minimum of one (1) hour in length. All other staffings and/or
meetings with Department staff are not considered billable hours unless otherwise approved by
the Child Welfare Contract and Services Coordinator.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$50.00/Hour (Life Skills)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
• CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
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Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
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EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
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4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Joceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
17
PY-13-14-CORE-0211
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR:
Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMMAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
/ _
Core & Service Contract Coordinator Date
18
PY-13-14-CORE-0211
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-13-14-CORE-0211
CONTRACTED SERVICES CLIENT VERIFICATION FORM
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
a)
Section I: (To be completed by the CONTRACTOR)
Primary Client billed:
Your Agency's Contact Person:
Household Number:
SECTION II (To be completed by client)
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PY-13-14-CORE-0147
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SAVIO HOUSE
0979-/, j1'G--
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This Agreement, made and entered into the / day ofe!} 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Savio House, hereinafter referred to as the "Contractor".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Multisystemic Therapy (MST) or Multisystemic Therapy -Problem Sexual Behavior (MST-PSB); and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and
shall expire May 31, 2014 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
1
aa3 - 628078
PY-13-14-CORE-0147
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.; and
2
PY-13-14-CORE-0147
• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
• 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
iii. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
3
PY-13-14-CORE-0147
iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter into a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
4
PY-13-14-CORE-0147
Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
• General Liability (PL and PD) (Minimum).
o Combined single limit -$500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
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PY-13-14-CORE-0147
11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
6
PY-13-14-CORE-0147
c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
William S. Hildenbrand
Name
17. Notice
Administrator
Title
Executive Director
Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
William S. Hildenbrand, Executive Director
325 King Street
Denver, CO 80219
1303)225-4014
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
7
PY-13-14-CORE-0147
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23, Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
8
PY-13-14-CORE-0147
CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these
confidentiality requirements.
CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
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PY-13-14-CORE-0147
26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
10
PY-13-14-CORE-0147
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY ,COLORADO
am F. Garcia, Chair
CONTRACTOR:
By:
Contractor
OCT 0 7 2013
z/
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Title
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PY-13-14-CORE-0147
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Multisystemic Therapy (MST) or Multisystemic Therapy -Problem Sexual
Behavior (MST-PSB) services to youth ages 11-18, and their families, with chronic violence or substance
abuse issues, as referred by the Department.
2. CONTRACTOR will provide MST and MST-PSB in accordance with the National Multisystemic model and
will comply with its standards and guidelines.
3. Services usually occur in the family home or in the community, as appropriate. CONTRACTOR also has an
office in Longmont, CO.
4. The nine (9) core principles of MST are:
a. The primary purpose of assessment is to understand the fit between the identified problems and
their broader systemic context (how problems "make sense" in a given context).
b. Therapeutic contacts emphasize the positive and use systemic strengths as levers for change.
c. Interventions are designed to promote responsible behavior and decrease irresponsible behavior
among family members.
d. Interventions are present -focused and action -oriented, targeting specific and well-defined
problems.
e. Interventions target sequences of behavior within and between multiple systems that maintain
identified problems.
f. Interventions are developmentally appropriate and fit the developmental needs of the youth.
g. Interventions are designed to require daily or weekly effort by family members.
h. Intervention effectiveness is evaluated continuously from multiple perspectives, with providers
assuming accountability for overcoming barriers to successful outcomes.
i. Interventions are designed to promote treatment generalization and long-term maintenance of
therapeutic change by empowering caregivers to address family members' needs across multiple
systemic contexts.
5. MST is a short-term and goal -oriented treatment that specifically targets those factors in each youth's
social network that are contributing to his or her antisocial behavior. MST interventions typically aim to
improve caregiver discipline practices, enhance family affective relations, decrease youth association with
deviant peers, increase youth association with pro -social peers, improve youth school or vocational
performance, engage youth in pro -social recreational outlets, and develop an indigenous support network
of extended family, neighbors, and friends to help caregivers achieve and maintain such changes. Specific
treatment techniques used to facilitate these gains are integrated from those therapies that have the
most empirical support including cognitive behavioral, behavioral, and the pragmatic family therapies.
Each family referred for MST will receive 6.5 to 10 hours of service per week for approximately three (3)
to five (5) months.
6. MST-PSB is a specialized, comprehensive MST program designed to meet the needs of juvenile sex
offenders reintegrating into the community. Emphasis is placed on aspects of the youth's ecology that
specifically relate to the youth's sexual delinquency and on the youth's peer relations so as to encourage
age appropriate and normative sexual experiences. Each family referred for MST-PSB will receive three
(3) to four (4) hours of service per week for approximately six (6) to eight (8) months, with a focus on
caregiver participation. MST-PSB does not utilize group therapy. It is approved by the Sex Offender
Management Board (SOMB) as a treatment modality.
7. CONTRACTOR has one (1) bilingual (Spanish) MST therapist.
12
PV -13 -14 -CORE -0147
8. CONTRACTOR will be available to referred families 24 hours per day/7 days per week via emergency pager
or cell phone.
9. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Child Welfare Contract and
Services Coordinator immediately.
10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
12. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department, unless otherwise directed by the
Department.
13. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare
Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team
Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented
service on the initial authorized referral form. This may include an increase or decrease in services hours,
change in frequency, change in location of services, transportation needs, or any change to the initial
referral or subsequent authorizations.
14. Proposed services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team
Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless
otherwise approved by the Child Welfare Contract and Services Coordinator.
13
PY-13-14-CORE-0147
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$1,670.00/Month (Mutlisystemic Therapy. Pro -rated for any partial month of service.)
$2,537.00/Month (Multisystemic Therapy -Problem Sexual Behavior. Pro -rated for any partial month
of service.)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
14
PY-13-14-CORE-0147
EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
• CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
15
PY-13-14-CORE-0147
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
• CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
16
PY-13-14-CORE-0147
EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
17
PY-13-14-CORE-0147
4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Joceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
18
PY-13-14-CORE-0147
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR:
Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month/Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
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FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
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19
PY-13-14-CORE-0147
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PY-13-14-CORE-0232
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SAVIO HOUSE
This Agreement, made and entered into the / day of 2013, by and between the Board of
Weld County Commissioners, on behalf of the Weld County Department of Human Services, hereinafter referred
to as the "Department" and Savio House, hereinafter referred to as the "Contractor".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Core Services to the Department for
Sexual Abuse Treatment (Sexual Abuse Intervention, Sexual Abuse Intervention -Child Protection); and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2013 upon proper execution of this Agreement and
shall expire May 31, 2014 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from Core Services
funding during the duration of this Agreement.
1
0,20/8 -,a47,27P P
PY-13-14-CORE-0232
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
5. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.• and
2
PY-13-14-CORE-0232
• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
• 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
• Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is Core Services
funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
iii. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
3
PY-13-14-CORE-0232
iv. Have not, within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause or default.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter in to a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents , warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(6). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17,5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
4
PY-13-14-CORE-0232
Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
• Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
General Liability (PL and PD) (Minimum).
o Combined single limit - $500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
5
PY-13-14-CORE-0232
11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12, Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
Contractor substantially failed to satisfy the scope of work found in this Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by the Contractor cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
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c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
William S. Hildenbrand
Name
17. Notice
Administrator
Title
Executive Director
Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
(970) 352-1551
18. Litigation
For Contractor:
William S. Hildenbrand, Executive Director
325 King Street
Denver, CO 80219
1303)225-4014
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading
which has been filed in any Federal or State court or administrative agency, shall deliver copies of such
document(s) to the Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 17. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
7
PY-13-14-CORE-0232
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the
undersigned parties and nothing in this Agreement shall give or allow any claim or right of action
whatsoever by any other person not included in this Agreement. It is the express intention of the
undersigned parties that any entity other than the undersigned parties receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict
of interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph
shall constitute grounds for the Department's termination, for cause, of its Agreement with
CONTRACTOR.
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CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period,
or if audit findings have not been resolved after a seven (7) period, the materials shall be retained until
the resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information, in any form, including social networks.
CONTRACTOR shall advise its employees, agents, and sub -contractor, if any, that they are subject to these
confidentiality requirements.
CONTRACTOR shall provide its employees, agents, and sub -contractors, if any, with a copy or written
explanation of these confidentiality requirements before access to confidential data is permitted.
CONTRACTOR shall have its employees, agents, and subcontractors, if any, sign a written confidentiality
agreement and shall provide a copy of such agreement to the Department, if requested.
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26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Cou r'"y Attorney
11
BOARD OF COUNTCOMMISSIONERS
WELD COUNT �O ORADO
illiam F. Garcia, Chair
CONTRACTOR:
By:
OCT 0 7 2013
adeZZ
Contractor
XECU>iYe hl(W rot
Title
02,9/3
PY-13-14-CORE-0232
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Sexual Abuse Intervention (SAI) services to youth, ages 12-18, who have
committed sexual offenses, both adjudicated and non -adjudicated, or youth displaying boundary for
harassment issues, as referred by the Department. Caregivers for referred youth must be willing to
participate in the program and provide the necessary monitoring and supervision.
a. Services occur in the client's home and/or community
b. Services will focus on the following:
i. Identifying high -risk situations;
ii. Safety planning;
Hi, Relapse prevention;
iv. Community and family support as youth reintegrates into the community; and,
v. Independent living skills.
c. CONTRACTOR utilizes a high level of supervision and involvement and emphasizes community
safe and client accountability at all times. Services are comprehensive, providing individual
offense specific therapy, family therapy, offenses specific group therapy, facilitation of polygraph
testing, informed supervision training as needed, assistance with independent living skills for
emancipating youth, school containment planning and home and community checks to ensure
safety and supervision plans are followed.
d. Key program concepts include:
i. Community safety is the primary concern.
ii. Assessment of clients with sexual offenses is an ongoing process; therefore, level of risk
is not constant overtime.
Hi. Victims have a right to safety and self-determination.
iv. Remorse and empathy should be expressed through accountability to victims.
v. Youth who are sexually abusive have often been victims of abuse and neglect
themselves; it is important that they experience empathy and support from others while
being challenged to develop this capacity themselves.
vi. Treatment of clients with sexual offenses requires a coordinated team response.
vii. Effective treatment focuses both on extinguishing deviant and abusive behaviors and on
addressing healthy, age -appropriate development and sexuality. Treatment should also
address improving social and emotional skills and development.
viii. Successful treatment and supervision of clients with sexual offenses is enhance by the
positive cooperation of family, friends, employers and members of the community who
have influence in their lives.
ix. Treatment of clients with sexual offenses should seek, whenever possible, to strengthen
clients' emotional ties to family, friends and community.
e. Duration of services is six (6) to eight (8) months.
f. CONTRACTOR does not provide bilingual (Spanish) services.
2. CONTRACTOR will provide Sexual Abuse Intervention -Child Protection (SAI-CP) services to children, ages
4-12, who are sexually acting out inside or outside of the family system.
a. Services occur in the client's home and/or community.
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b. Assessments include the following:
i. Child exposure to adult sexual activity;
ii. Abuse history (sexual, verbal, physical);
iii. Lack of appropriate information or education;
iv. Cognitive/developmental functioning;
v. Mental health and medication needs of child and family;
vi. History of trauma including parental history of trauma;
vii. General parenting skills and knowledge;
viii. Presence of other risk factors; and,
ix. Resource and support available to the family.
c. Services include the following:
i. Family therapy;
ii. Child -focused skill building (boundaries, touching rules, personal safety, refusal skills);
iii. In -home supervision and safety plans;
iv. School containment plans;
v. Psycho -education regarding consistent and appropriate supervision of children and
enforcement of safety plans;
vi. Psycho -education regarding healthy sexual development and age -appropriate
behaviors;
vii. Case management integrating all family, social system and resources;
viii. Role modeling of teamwork to families through co -therapy;
ix. Address parents' own trauma and identify appropriate resources; and,
x. Help parents repair hard their actions or inaction may have cause their children.
d. CONTRACTOR utilizes a high level of supervision and involvement and emphasizes community
safe and client accountability at all times. Services are comprehensive, providing individual
offense specific therapy, family therapy, offenses specific group therapy, facilitation of polygraph
testing, informed supervision training as needed, assistance with independent living skills for
emancipating youth, school containment planning and home and community checks to ensure
safety and supervision plans are followed.
e. Key program concepts include:
i. Parenting Skills Development - Families receive instruction with an emphasis on
alternatives to physical discipline, household management, consistent delivery of rules,
consequences and rewards, knowledge of development milestones and nutrition;
ii. Informed Supervision - Adapted for families with younger children;
iii. Victim dynamics and Problem Sexual Behavior dynamics; and,
iv. Healthy boundaries for all family members.
f. Duration of services is an average of six (6) to eight (8) months. The length of services is dictated
by the needs and safety of victim and children with the home, the needs of the family, client
functioning, the objectives of the referral source and the recommendation involved parties and
multi -disciplinary team.
g. CONTRACTOR can provide bilingual services (Spanish, American Sign Language).
3. CONTRACTOR will make at least three (3) attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three (3) attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Child Welfare Contract and
Services Coordinator immediately.
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PY-13-14-CORE-0232
4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are
not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department, unless otherwise directed by the
Department.
7. CONTRACTOR agrees any change to an existing referral must be pre -approved through the Child Welfare
Contract and Services Coordinator, a Department -facilitated Team Decision Making (TDM) or Family Team
Meeting (FTM), or by court order. A change is defined as anything outside of the approved documented
service on the initial authorized referral form. This may include an increase or decrease in services hours,
change in frequency, change in location of services, transportation needs, or any change to the initial
referral or subsequent authorizations.
S. Proposed services are inclusive of attendance at staffings, Family Team Meetings (FTM) and/or Team
Decision Making (TDM) meetings. Staffings and/or meetings are not considered billable hours unless
otherwise approved by the Child Welfare Contract and Services Coordinator.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2014.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$1,833.00/Month (Sexual Abuse Intervention, Sexual Abuse Intervention -Child Protection. Pro -rated
for any partial month of service.)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
15
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EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
• CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
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PY-13-14-CORE-0232
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
• CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
17
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EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all contractors regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to contractors via e-mail.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Child Welfare Contract and Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department periodically. Contractors are asked to provide input regarding client
status/progress. You will be notified in advance via e-mail if you have case up for review.
Contractors may attend in person or via phone if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Child
Welfare Contract and Services Coordinator, through a Team Decision Making (TDM) or
Family Team Meeting (FTM), or by court order. A verbal or written authorization from a
caseworker or supervisor does not constitute authorization to modify a referral. If
contacted by a caseworker or supervisor to modify a referral please contact the Child
Welfare Contract and Services Coordinator for a referral.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy) each member should
sign the same form at the time of service.
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
18
PY-13-14-CORE-0232
4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures, and 4) a monthly progress report if applicable submitted per the online
format required by the Department unless otherwise directed by the Department. A
contractor also may include their own invoice or other documents they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
loceyln Florez, Fiscal Clerk
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
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PY-13-14-CORE-0232
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
(SAMPLE ONLY. ACTUAL FORM WILL BE SENT TO CONTRACTOR)
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR: Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMAAAAAAAAAMA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
20
PY-13-14-CORE-0232
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