HomeMy WebLinkAbout20112327.tiff RESOLUTION
RE: APPROVE THIRTY-SIX (36) 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 thirty-six(36) 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, 2011, and ending May 31,2012,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 thirty-six (36) 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 29th day of August, A.D., 2011, nunc pro tunc June 1, 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: '
:Barbara Kirkmey r� Chair •
Weld County Clerk to the :•�, , E llda
Sean P.P. Con a , ro-Tem
Deputy S1-rk to the Bo��:� ,��
tn, `' . Wi i G is
APPRO _' AS TO
vid E. Long
n ttorney' - Il-W\R
Douglaidema er
Date of signature: 9- s-aa
CL t.4-Sp 2011-2327
HR0082
MEMORANDUM EXHIBIT
861 - 2011 a A
a
= DATE: August 11, 2011
WEL u__eO NTY
TO: Barbara Kirkmeyer, Chair, Board of Commissioners
FROM: Judy A. Griego, Director, Human Services Department
SUBJECT: 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 presented at the Board's June 20,
2011, Work Session.
The major provisions of these Agreements are as follows:
Program Area/Funding
Provider Source PY11-12 Rate(s)
Barry R. Lindstrom, Ph.D., LLC Mental Health Services $325.00/Hr(MHA, Psych Eval,
Interactional)
06/01/11 - 05/31/12 Core $125.00/Hr(Ind. Therapy w/Ph.D.)
$65.00/Hr(Therapy w/M.S.)
$150.00/Hr(Fam. Therapy w/Ph.D.)
$75.00/Hr(Fam. Therapy w/M.S.)
$30.00/PP/Grp(Group Therapy)
$150.00/Hr(Court Facilitation/Staffing w/
Ph.D.)
$75.00/Hr(Court Facilitation/Staffing w/
M.S.)
Compliance Administrative Monitored Sobriety $13.00/Episode(Instant UA)
Services, LLC $25.00/Episode(Instant UA Confirmation)
CW Admin $16.00/Episode (Standard Lab Test)
06/01/11 -05/31/12 $48.50/Episode(Club Drug Panel)
$90.00/Episode (Hair Test)
$40.00/Episode (Ethyl Glucuronide Test-
EtG)
$2.00/Episode (BA)
$2.00/Episode (BA Confirmation)
$32.00/Episode(Instance Saliva Oral Swab
4-Panel Drug Screen)
$37.50/Episode (Swab/Saliva Test)
Consulting for Wellness Home Studies $1,050.00/Episode (Full Home Study)
$525.00/Episode(Updated Home Study)
06/01/11 -05/31/12 CW Admin $240.00/Episode (Partial Home Study after
3 hrs of service)
$80.00/Hr. (Partial Home Study hrly rate not
to exceed cost of full study or update)
$200.00/Person (Additional Adult)
2011-2327
Davies & Associates Domestic Violence/Anger $500.00/Episode (Adult Domestic Violence
Management Evaluation)
06/01/11 -05/31/12 $250.00/Episode(Polygraph if needed with
CW Admin evaluation.)
$85.00/Hr(Individual Counseling. Limited
availability.)
Davies & Associates Sex Abuse Treatment $1,200.00/Episode(Adult Parental Risk
Assessment)
06/01/11 -05/31/12 Core $950.00/Episode(Adult or Juvenile Offense
Specific Evaluations)
$250.00/Episode(Polygraph if needed with
evaluation.)
$85.00/Hr(Individual Counseling. Limited
availability.)
Dynamic Family Design, LLC Foster Parent Training $75.00/Hr(Minimum of two hours.)
$30.00/Episode(Round trip outside Weld
06/01/11 -05/31/12 CW Admin County)
Dynamic Family Design, LLC Home Study/ $995.00/Episode (Full HS)
Relinquishment $225.00/Each(Ea. Add. Adult)
06/01/11 -05/31/12 Counseling $485.00/Episode (Update HS)
$49.00/Hr(Hrly Rate after 4 hrs of service)
CW Admin $200.00/Episode (Cancelled HS/l-4 hrs of
service)
$75.00/Episode (Mileage charge per study
outside Weld County)
$75.00/Hr(Court Testimony - 1 hr min.)
$75.00/Hr(Relinquishment Counseling)
$25.00/Episode (Mileage per relinquishment
counseling referral outside Weld County)
Dynamic Family Design, LLC Home-Based Services $75.00/Hr(Transition Services)
$30.00/Episode (Flat rate for mileage for
06/01/11 -05/31/12 Core referrals outside Weld)
Lutheran Family Services of Home-Based Services $105.00/Hr(Option B, Therapeutic
Colorado Mentoring)
Core $500.00 (Pre-Adoption Assessment)
06/01/11 -05/31/12 $95.00/Hr(Ongoing Pre Adoption Support)
$75.00/Hr(Court Facilitation/Staffing)
Lutheran Family Services of Home Study $1,000.00 (English, 2 adults max, no more
Colorado than 4 interviewees total)
CW Admin $1,600.00 (Monolingual or Bilingual, 2
06/01/11 -05/31/12 adults max, no more than 4 interviewees
total)
$100.00 (Add. fee for more than 4
interviewees)
$75.00/Hr(Court Facilitation/Staff)
Lutheran Family Services of Life Skills $95.00/Hr (HBPC)
Colorado $105.00/Hr(Therapeutic Visitation, Level
Core 4)
06/01/11 -05/31/12 $95.00/Hr(Therapeutic Visitation, Levels 2
&3)
$75.00/Hr(Therapeutic Visitation, Level 1)
$75.00/Hr(Court Facilitation/Staffing)
Lutheran Family Services of Mediation Services $800.00/Episode(Initial TDM)
Colorado $500.00/Episode (Subsequent TDMs if
Core needed)
06/01/11 -05/31/12 $75.00/Hr(Follow up services)
Milestones Counseling Services, Foster Parent Consultation $90.00/Hr(Evaluation, Intervention,
LLC Feedback)
Core
06/01/11 -05/31/12
Milestones Counseling Services, Relinquishment $80.00/Hr(Relinquishment Counseling)
LLC Counseling
06/01/11 -05/31/12 CW Admin
Milestones Counseling Services, Mental Health Services $250.00/Episode (Mental Health
LLC Assessment)
Core $80.00/Hr(Family, Couples, Individual and
06/01/11 -05/31/12 Play Therapy)
North Range Behavioral Health Functional Family Therapy $650.00/Mth
06/01/11 -05/31/12 Core
North Range Behavioral Health Mental Health $200.00 (MHA)
$800.00 (Partial Psych Evaluation)
06/01/11 -05/31/12 Core $1,200.00 (Full Psych Evaluation)
$1,800.00 (Extend. Psych Evaluation)
$120.00/Hr(Court Facilitation/Staffing,
Partially Completed Evaluations)
North Range Behavioral Health Monitored Sobriety $20.00/Episode (UA - 5 Panel, UA - 7
Panel, InstaCheck- 1 Panel, Multi-panel
06/01/11 -05/31/12 CW Admin Instant UA, Instant Swab)
$35.00/Episode (Confirmation)
$5.00/Episode(BA)
$100.00/Episode (Hair Testing)
$35.00/Episode(Ethyl Glucuronide Test-
EtG)
$50.00/Episode(Patch)
North Range Behavioral Health Multi-Systemic Therapy $1,750.00/Mth
06/01/11 -05/31/12 Core
Poudre Valley Health Care, Inc., Home-Based Services $1,700.00/Mth
dba Poudre Valley Hospital $56.50/Day(Daily rate for partial month of
(Mountain Crest Behavioral Core service. Not too exceed monthly rate.)
Healthcare Center)
06/01/11 -05/31/12
Reflections for Youth, Inc. Day Treatment $109.06/Day(Regular DT)
$133.06/Day(Enhanced DT, One
06/01/11 -05/31/12 Core Enhancement)
$151.06/Day(Enhanced DT, Two
Enhancements)
$163.06/Day(Enhanced DT, Three
Enhancements)
Reflections for Youth, Inc. Sex Abuse Treatment $40.00/PP(1-4 people)
$25.00/PP(Additional people after 4)
06/01/11 -05/31/12 Core
Savio House Functional Family Therapy $780.00/Mth
06/01/11 -05/31/12 Core
Savio House Home-Based Services $1,814.00/Mth (CBS)
$1,600.00/Mth (CBS CP)
06/01/11 -05/31/12 Core
Savio House Home Studies/ $56.00/Hr(Full Study-Not to exceed
Relinquishment $864.00, Update-Not to exceed $448.00,
06/01/11 -05/31/12 Counseling Relinquishment Counseling)
CW Admin
Savio House Life Skills $48.00/Hr
06/01/11 -05/31/12 Core
Savio House Multi-Systemic Therapy $1,575.00/Mth (MST)
$2,537.00/Mth (MST-PSB)
06/01/11 -05/31/12 Core
Savio House Sex Abuse Treatment $1,833.00/Mth (SAI)
06/01/11 -05/31/12 Core
Sionnach Counseling Services, Foster Parent Consultation 90.00/Hr(Greeley Metro Area including La
LLC Salle, Eaton & Windsor)
Core $110.00/Hr(Outside Greeley Metro Area)
06/01/11 -05/31/12 $100.00/Hr(Court Staffing/Facilitation)
Sionnach Counseling Services, Foster Parent Training $90.00/Hr(Greeley Metro Area including
LLC La Salle, Eaton &Windsor)
CW Admin $110.00/Hr(Outside Greeley Metro Area)
06/01/11 -05/31/12 $100.00/Hr(Court Staffing/Facilitation)
Sionnach Counseling Services, Mental Health Services $90.00/Hr(Greeley Metro Area including
LLC La Salle, Eaton & Windsor)
Core $110.00/Hr(Outside Greeley Metro Area)
06/01/11 -05/31/12 $100.00/Hr(Court Staffing/Facilitation)
DSW Swan, Inc. Mental Health Services $120.00/Hr (Ind./Cpl./Fam. Therapy)
$150.00/1.5 Hrs(Ind./Cpl./Fain. Therapy)
06/01/11 -05/31/12 Core
Transitions Psychology Group, Life Skills $105.00/Hr(Visitation w/o Transportation)
LLC $1 25.00/Hr(Visitation w/Transportation,
Core Mentoring w/or w/o Transportation)
06/01/11 -05/31/12 $95.00/Hr(Court Facilitation/Staffing)
Transitions Psychology Group, Mental Health Services $95.00/Hr(Individual/Family/Couples
LLC Counseling, Play Therapy or EMDR w/o
Core Transportation)
06/01/11 -05/31/12 $110.00/Hr((Individual/Family/Couples
Counseling, Play Therapy or EMDR w/
Transportation, In-Home Counseling w/o
Transportation)
$125.00/Hr(In-Home Counseling w/
Transportation)
$180.00/Hr(Co-Therapy w/Transportation)
$165.00/hr(Co-Therapy w/o Transportation)
$95.00/Hr(Court Facilitation/Staffing)
Victor H. Cordero, PSY.D., P.C. Mental Health Services $1,200.00 (Psych or Interactional)
$300.00/Hr(Partial Psych or Interactional
06/01/11 -05/31/12 Core Services/Not to Exceed Full Cost)
$700.00 (MHA)
$250.00/Hr(Hrly rate for partial MHA
services/Not to Exceed Full Cost)
$100.00/Hr(Ind./Cpl/Fam. Therapy)
$100.00/Hr(Court Facilitation/Staffing)
Victor H. Cordero, PSY.D., P.C. Sex Abuse Treatment $1,200.00 (Psychosexual)
$300.00/Hr(Partial Psychosexual
06/01/11 -05/31/12 Core Services/Not to Exceed Full Cost)
$1,200.00 (Parental Risk Eval)
$300.00/hr(Partial Parental Risk Eval
Services/Not to Exceed Full Cost)
$100.00/Hr(Ind./Cpl./Fam. Counseling)
$100.00/Hr(Court Facilitation/Staffing)
$90.00/Session (Non-Offending Parent
Curriculum)
If you have any questions, give me a call at extension 6510.
PY-11-12-CORE-0141
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND BARRY R.LINDSTROM,PH.D.,LLC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Barry R.Lindstrom,Ph.D.,LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CORE-0141
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-12-CORE-0141
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-CORE-0141
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Trainin
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department. The
Contractor may be required to attend additional training at the request of the Department. The cost of such
training will be paid for by the Department. The Department will not compensate the Contractor for the
time spent attending the required trainings.
12. Subpoenas
The Provider 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 Provider receives a subpoena via facsimile but will only accept personal service,the Provider 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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0141
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Barry R.Lindstrom,Ph.D. Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Barry R.Lindstrom,Ph.D..LLC
P.O.Box A 3211 20th Street,Suite D
Greeley,CO 80632 Greeley,CO 80634
(970)352-1551 (970)356-3100
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors, and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-11-12-CORE-0141
20. 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.
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PY-11-12-CORE-0141
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
15)
I 4LD COUNTY BOARD OF COUNTY
1`)°!),,,
A RK TO TIIE BOARD COMMISSIONERS WELD
1861 ` � -� �I COUNTY, OLORADO
( S// IL 11'r e�
O p f Pj/erk bara Kirkmeyer, .hair 41 0 2 0 2011
D AS CONTRACTOR
•
Z--�, cc
BY
Co Attorney Co 417/12.0
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J p A.Grieg ,Directo
7
L9e)//23?7
PY-11-12-CORE-0141
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals,couples and/or families referred by the
Department,at 3211 20th Street,Suite D,in Greeley,CO,unless otherwise arranged. Services include the
following:
a. Mental Health Assessments/Psychological Evaluations—Assessments/Evaluations include an
individual clinical interview to obtain relevant psychosocial history and mental status evaluation with
each referred family members,conjoint clinical interviews with all family members(when applicable),
conjoint clinical interview with child and current caregiver(s)if child is in out-of-home placement at
the time of the referral,and psychological screening and testing.
For adults,screening and testing may include the Beck Depression Inventory,Beck Anxiety Inventory,
Penn Inventory for Post-Traumatic Stress Disorder(PTSD),Stressful Life Events Questionnaire,
Rotter Incomplete Sentences,Mood Disorder Questionnaire,Adult Self-Report Scale(for ADHD),and
other screening instruments as needed. These may include the Minnesota Multiphasic Personality
Inventory-2(MMPI-2),Million Clinical Multiaxial Inventory-III(MCMI-III),Wechsler Abbreviated
Scale of Intelligence(WASI),Bender Gestalt Visual Motor Test(BGVMT); Thematic Apperception
Test(TAT),Projective Drawings,and the Rorschach Test.
For children and adolescents,screening and testing may include the Behavioral Assessment System for
Children(BASC)standardized behavioral assessment for each child,completed by the child(as age
appropriate),parents,foster parents and teachers;Stressful Life Events Questionnaire;other non-
standardized behavioral assessment and developmental history forms completed by parents,foster
parents,and teachers as clinically indicated;Minnesota Multiphasic Personality Inventory for
Adolescents(MMPI-A);Millon Adolescent or Pre-Adolescent Clinical Inventory(MALI,M-PACI);
Thematic Apperception Test(TAT)or Children's Apperception Test(CAT);Projective Drawings;and
the Rorschach Test.
As clinically appropriate,evaluations will include consultation with collateral contacts,review of case
records,previous evaluations and treatment records.
b. Family(Interactional)Evaluations-Evaluate the child,the caregiver and the interaction between them
across two or more sessions. Family evaluations require an average of eight(8)hours of direct contact
and include the equivalent of an individual Mental Health Assessment of each family member and
assessment of interaction between family members. Evaluations will assess risk factors from the
Kempe Family Stress Inventory including: Parent Beaten or Deprived as a Child;Parent has a History
of a Criminal Record,Mental Illness or Substance Abuse;Parent Suspected of Abuse in the Past;
Parent with Isolation,Low Self Esteem or Depression;Multiple Stresses or Crises;Violent Temper
Outbursts;Rigid,Unrealistic Expectations of the Child's Behavior;Harsh Punishment of Child;Child
Difficult or Provocative or Perceived to be by Parent;and Child Unwanted or at Risk for Poor
Bonding/Attachment Difficulties. Family Evaluations can also assess level and intensity of visitation
and address issues related to visitation between children and incarcerated parents.
The evaluation will include some or all of the following depending on family composition,child's
placement and the caseworker's referral questions,and take from one to three months to complete:
i. Interviews:
1. Individual Clinical Interview(s)with each family member(1 to 2 hours for each
member);
2. Conjoint clinical interviews with all family members(including marital,parent-child,
and sibling subsystems as clinically indicated; 3 to 5 hours)
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PY-1 1-12-CORE-0141
3. Conjoint clinical interview/consultation with child and current caregivers(foster
parent,relative etc)if child is in out of home placement at the time of evaluation.
ii. Psychological Testing:
1. Adults:Millon Clinical Multiaxial Inventory-III(MCMI-III),Beck Depression
Inventory,Beck Anxiety Inventory,Penn Inventory for PTSD,and Stressful Life
Events Questionnaire(and others as clinically indicated)for each adult. [Additional
psychological testing(see complete list above)can be completed as needed to
address additional referral questions related to individual psychological functioning];
2. Children and Adolescents:Behavioral Assessment System for Children(BASC)
standardized behavioral assessment for each child,completed by the child(as age
appropriate),parents,foster parents,and teachers. Other non-standardized
behavioral assessment and developmental history forms completed by parents,foster
parents,and teachers as clinically indicated.
iii. Evaluation Reports:
A written report for all assessments/evaluations will be provided to the referring
caseworker within thirty(30)days of the completion of the evaluation. This report will
summarize the referral questions;brief case history;evaluation course;methods and
procedures(including psychological testing,records reviewed and collateral contacts);
findings;conclusions and recommendations. Evaluation reports will address both
strengths and protective factors and risk factors or problems.
Recommendations will focus on how to maintain the child in his current placement,or
how a change in placement would help to move the child closer to his permanency goal.
If the child is legally free for adoption,recommendations will include whether the goal of
adoption is appropriate at that time and/or how to move toward getting the child into an
adoptive home,and what type of home would best meet the child's needs.
iv. Client Feedback:
Individuals and families will be offered a final diagnostic feedback session as part of the
evaluation process to discuss test results and the findings and recommendations of the
evaluation. Copies of the evaluation will be distributed to appropriate parties by the
caseworker or psychologist in keeping with privacy laws,client consent and legal and
professional standards.
a. Individual and Family Treatment Services—Services will be problem-focused and will assist in the
resolution of the issues that led to the Department's involvement with the family,as well as
supporting the treatment goals of safety,well being and maintenance of the child's placement.
Treatment will include development,cognitive-behavioral and family systems approaches with an
emphasis on a continuum of care and evidence-based practices.
2. Services will be provided by Barry R.Lindstrom,Ph.D.,and Bonnie S. Lindstrom,M.S,LPC. All Mental
Health Assessments and evaluations will only be conducted by Barry R. Lindstrom,Ph.D.
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.
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PY-1 1-12-CORE-0141
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 will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$325.00/Hour(Mental Health Assessment,Psychological Evaluation,Interactional Evaluation)
$125.00/Hour(Individual Therapy-Ph.D.)
$65.00/Hour(Individual Therapy-M.S.)
$150.00/Hour(Family,Siblings or Couples Therapy-Ph.D.)
$75.00/Hour(Family,Siblings or Couples Therapy-M.S.)
$30.00/Per Person/Group(Group Therapy)(Victim's Compensation will be utilized first when applicable.)
$150.00/Hour(Court Facilitation or Staffing-Ph.D.)
$75.00/Hour(Court Facilitation or Staffing-M.S.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`s day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101,et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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PY-11-12-CORE-0141
EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-1 1-12-CORE-0141
• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-HS-0049
CHILD PROTECTION AGREEMENT FOR SERVICES Cv/j
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES"i1:;,
AND CONSULTING FOR WELLNESS AND PREVENTION,LLC
This Agreement,made and entered into the day of 2011,by and between the Board o1',,((
Weld County Commissioners,sifting as the Board of Human Services,on behalf of the Weld County Department ofd
Human Services,hereinafter referred to as the"Department,"and Consulting for Wellness and Prevention,LLC, f/
hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Home Studies;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scone of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7t1 day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-115-0049
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 a seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-ll-12-HS-0049
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-HS-0049
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Traininv
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Evelin Gomez,Ph.D.,LPC,CACIII Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Evelin Gomez,Ph.D.,LPC,CACIII
P.O.Box A 12863 Birch Drive
Greeley,CO 80632 Thornton,CO 80241
(970)352-1551 (720)333-0032
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of finding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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.
114
44," OUNTY BOARD OF COUNTY
?* O THE BOARD COMMISSIONERS WELD /
1861 Prj COUNTY,COLORADO
kEaL-1
o. it. By: .�IL4,�� ,l. �i�.' .L—
i ' BaarbaraKirkmeyer, hair t:.Jc20 2011
V
APP AS TO M: CONTRACTOR:
BY
Co A ey ntractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: QI
u .Grie hector
7
,7P)//- '.3- 7
PY-I I-12-HS-0049
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide home study services primarily in the Denver and South County areas as
referred by the Department.
2. CONTRACTOR is able to accept a maximum of three(3)home study referrals per month.
3. CONTRACTOR utilizes the Structured Analysis Family Evaluation(SAFE)tool developed by the
Consortium of Children. CONTRACTOR is SAFE certified and on the State's approved home study
vendor list. CONTRACTOR also is certified as a SAFE supervisor.
4. Services will be provided by Evelin Gomez,Ph.D.,LPC,CACIII. Dr.Gomez is bilingual(Spanish).
5. CONTRACTOR will work with the applicant to complete a Department of Motor Vehicle background
check. All CBI,FBI and LexisNexis background check information will be completed by the Department.
6. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of
receipt of the home study referral. A complete home study will include the study in SAFE format,
background check information,SAFE questionnaires completed by the applicants,references and all other
original documents submitted by the home study applicant.
7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any
specific Weld County home. Areas of concern may include,but are not limited to,any physical,emotional,
educational or behavioral issues. Child abuse must be reported immediately per law.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,050.00/Episode(Full Home Study)
$525.00/Episode(Updated Home Study)
$240.00/Episode(Partial home study after three hours of service.)
$80.00/Hour(Partial home study hourly rate not to exceed cost of full study or update.)
$200.00/Person(Additional Adult)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently.Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101,et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COMPLIANCE ADMINISTRATIVE SERVICES,LLC
This Agreement,made and entered into the day of 2011, by and between the Board of
Weld County Commissioners,sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Compliance Administrative Services,LLC,
hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance, and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Monitored Sobriety Services;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on June 1, 2011, upon proper execution of this Agreement and shall
expire May 31,2012, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A "Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the Th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—I et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$I million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
12. Subpoenas
The Provider 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 Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and advise that the
subpoena must be personally served.
13. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
14. 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 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-1 1-12-CPS-0098
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.
IS. 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:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Marc Pham Controller
Name Title
16. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Marc Pham,Controller
P.O.Box A 7100 N. Broadway,Suite 5-N
Greeley,CO 80632 Denver,CO 80221
(970)352-1551 (303)428-3849
17. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
18. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
19. 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 13 herein.
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PY-I 1-12-CPS-0098
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: ►, -- - ��
ELD COUNT r, BOARD OF COUNTY
CLERK TO TH ;al"ry17 COMMISSIONERS WELD
„ � COUNTY,COLOR,D (/
By:
/ �
Deputy Cler -.. Barbara Kirkmeyer, hair 1 0 2 0 2011
APP VED AS TO • CONTRACTOR:
BY —
Cou Attorr Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju A.Grie ,Dir
6 J {
? '/- OC3�C 2
PY-I 1-12-CPS-0098
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide timely and quality random monitored sobriety services to clients referred
by the Department as follows:
a. CONTRACTOR will provide monitored sobriety services to Department clients at the
Department(315 A North 11d' Avenue), in Greeley.
b. CONTRACTOR will provide a qualified monitored sobriety collector on site Monday
through Friday at the Department,2-7 p.m.,and will conduct random weekend monitoring
two(2)Saturdays and two(2) Sundays per month, 10 a.m.to I p.m., or as modified by the
Department.
c. CONTRACTOR will only accept referrals when a client has been assigned a color and clients
will be required to call in seven(7)days per week.
d. CONTRACTOR will only provide monitoring services to referred clients who provide picture
identification. A caseworker may provide a client photo in lieu of a formal identification if
formal identification cannot be obtained.
e. CONTRACTOR will have male and female staff available on a regular basis.
CONTRACTOR will attempt to assign male clients on days when male staff members are
available. If a male staff member is not available the CONTRACTOR may opt to have the
client complete a urinalysis and an oral swab for validation purposes.
f CONTRACTOR may have a client complete a urinalysis and an oral swab if they suspect the
test may be compromised.
g. CONTRACTOR will not allow clients to make up missed monitoring unless prior approval
from the caseworker or supervisor is obtained.
h. CONTRACTOR will confirm any positive, negative or missed monitored sobriety within 24
hours through a phone call,test result,e-mail and/or fax to the referring caseworker.
i. CONTRACTOR will provide a report of the client's prior months monitoring within the first
week of the month following service.
j. CONTRACTOR will submit a copy of the valid Authorization for Service form, result and
client sign-in sheet(if applicable)with each monthly billing.
k. Results will be available online 24 hours per day, seven(7)days per week through the
Norchem website(www.norchemlab.coin).
PY-1 1-1 2-CP S-0098
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$13.00/Episode(Instant 5 Panel Drug Screen-Tests for THC,COC,AMP, OPI,PCP)
$25.00/Episode(Instant 5 Panel-Confirmation)
$16.00/Episode(Standard Laboratory Test-Tests for ALC,AMP/METH, BENZ,COC,OPI,PCP,THC)
$48.50/Episode(Club Drug Panel - Ecstasy,GHB, Ketamine,Oxycodone)
$90.00/Episode(Hair Test-Tests for THC,COC,OPI,PCP,AMP up to 90 days or more after use)
$40.00/Episode(EtG/Ethylglucuronide-Tests for alcohol up to 80 hours past consumption)
$2.00/Episode(Breathlyzer Screening)
$2.00/Episode(Breathalyzer Confirmation)
$32.00/Episode(Instance Saliva Oral Swab 4 Panel Drug Screen -Tests for THC,COC, METH,OPI)
$37.50/Episode(Swab/Saliva Test)
$75.00/Hour(Court Testimony)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety, proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph, sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-11-12-CPS-0098
10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall, during
business hours,have access to inspect any copy records, and shall be allowed to monitor and review
through on-site visits,all contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended, proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records, making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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PY-11-12-CPS-0098
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers, clients or affiliates,but does not include information (I) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, Contractor must confirm that any individual natural
person eighteen (IS) 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-I I-12-CPS-0098
• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND DAVIES&ASSOCIATES
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Davies&Associates,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific Evaluation and Limited Treatment Services);and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services funding to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
A.Mervyn Davies Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director A.Mervyn Davies,Director
P.O.Box A 824-B 9th Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)353-0422
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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:
ELD CO OF COUNTY
CLERK TO THE :O Mrl SSIONERS WELD
61 i t ,. ' JCOLORADO
t i
DeputyCler �J1 arbaraKirkmeye (hair Aim 9 20"
ED AS TO M: CONTRACTO
BY
Co Atton ey ntn for
WELD COUNTY DEPARTMENT
OF HUMAN SERVICE
By:
J A.Gri go,Direct
7
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Offense Specific Services to adult and juvenile,male and female,clients in
the Greeley area. Services include:
• Adult Offense Specific Evaluation: This evaluation will include a clinical interview,risk
assessment and recommendations. Assessments may include the following if applicable:
i. Millon Clinical Multiaxial Inventory-III(MCMI-III)
ii. Shipley Institute of Living Scale
iii. Substance Abuse subtle Screening Inventory(SASSI-III)
iv. Jesness Inventory Revised(JI-R)
v. State-Trait Anger Inventory(STAXI)
vi. Multiphasic Sexual Inventory(MSI)
vii. Hare Psychopathy Chec-List Revised,2n°Edition(PCL-R2)
viii. Wilson Sex Fantasy Questionnaire
ix. Sone Sexual History Form
x. Affinity Assessment of Sexual Interest,Version 2.5
xi. Domestic Violence Questionnaire
xii. Domestic Violence Risk Appraisal Guide(DVRAG)
xiii. Domestic Violence Risk and Needs Assessment(DVRNA)
xiv. Spousal Assault Risk Assessment(SARA)
xv. Minnesota Sex Offender Screening Tool Revised(MnSOST-R)
xvi. STATIC-99R
xvii. STABLE-2007
xviii. ACUTE-2007
xix. Colorado Sex Offender Risk Scale(SORS)
Evaluations are scheduled for six(6)-eight(8)hours and occur within one day.
Evaluations are usually 12-15 pages in length and will include recommendations,offender
strengths and offense pathways to assist in the establishment of appropriate treatment plans.
Evaluation reports will be sent to the Department within 14 days of meeting with the referred
client.
• Juvenile Offense Specific Evaluation: This evaluation is designed for juveniles,ages 12-17 years.
CONTRACTOR will meet with both the juvenile and the juvenile's care taker. Assessments may
include the following if applicable:
i. Millon Clinical Multiaxial Inventory-Ill(MCMI-III)
ii. Shipley Institute of Living Scale
iii. Substance Abuse subtle Screening Inventory(SASSI-Ill)
iv. Jesness Inventory Revised(JI-R)
v. Multiphasic Sexual Inventory(MSI-A)
vi. Juvenile Sex Offender Assessment Protocol-II(J-SOAP-B)
vii. Juvenile Sexual Offense Recidivism Risk Assessment Tool-II(JSORRAT-II)
Evaluations are scheduled for six(6)hours within one day or two 3-hour sessions after school.
The juvenile's care taker must be present for approximately two hours.
Evaluations are usually 10-14 pages in length and will include recommendations,offender
strengths,placement ideas(if applicable),and offender typologies to assist in the establishment of
appropriate treatment plans.
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Evaluation reports will be sent to the Department within 14 days of meeting with the referred
client.
• Adult Parental Risk Assessment: This evaluation will include a clinical interview,a battery of
psychological tests,questionnaires and interviews with support people. Tests and questionnaires
may include the following,if applicable:
i. Portions of the Ackerman-Schoendorf Scales for Parental Evaluation of Custody
(ASPECT)
ii. Stress Index for Parents of Adolescents(SIPA)
iii. Child Empathy Test—Version II
iv. Empathy for Children's Test(ECT)
v. Child Abuse Potential Inventory(CAPI)
vi. Relationship Questionnaire(RQ)
Clients must have completed an Adult Offense Specific Evaluation within the last six(6)months
through a S.O.M.B.provider and will be required to complete a polygraph as part of the Adult
Parental Risk Assessment.
Evaluations are scheduled for six(6)-eight(8)hours and occur within one day.
Evaluations are usually 12-15 pages in length and will include recommendations to assist in the
establishment of appropriate treatment plans.
Evaluation reports will be sent to the Department within seven(7)days of receiving the polygraph
report(additional cost).
• Polygraph: Polygraphs for both adults and juveniles are available in conjunction with an
evaluation if needed.
• Individual Therapy(Limited Availability): Individual therapy is available on a limited basis if
CONTRACTOR is able and willing to provide the services.
2. CONTRACTOR is a Adult and Juvenile Sex Offender Management Board(S.O.M.B.)Evaluator and
Treatment Provider,and will comply with the Colorado Sex Offender Management Board's Standards and
Guidelines.
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 of
a parent whom the CONTRACTOR is working with under an active referral. Areas of concern may
include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern
should be reported immediately AND on the required monthly report.
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.
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7. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,200.00/Episode(Adult Parental Risk Assessment)
$950.00/Episode(Adult or Juvenile Offense Specific Evaluation)
$250.00/Episode(Polygraph)
$85.00/Hour(Individual Session)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-11-12-CORE-0209
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with 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 Contract,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 contract with CONTRACTOR.
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PY-11-12-CORE-0209
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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's contracted providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-1 1-12-CPS-0123
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND DAVIES& ASSOCIATES
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Davies&Associates,hereinafter referred to as
"Contractor".
W ITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Domestic Violence Evaluation and Limited Treatment Services;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration funding to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CPS-0123
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 a seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-1 I-12-CPS-0123
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
A.Mervyn Davies Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director A.Mervyn Davies,Director
P.O.Box A 824-B 9'h Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)353-0422
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CPS-0123
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD COUN '+ . ns. ' OF COUNTY
CLERK TO T B� ' i � ISSIONERS WELD
61 i igi�fl• Y,COLORADO
DeputyCIeq. � ;' BatiaraKir eyer,Ch ir AUG 2011
APPROyErp AST R CONTRACT
BY
Co ttomey on for
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
u .Gri gc Director
7
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PY-11-12-CPS-0123
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Domestic Violence evaluation services to males and females, 18 years and
older,in the Greeley area. Services include:
• Adult Domestic Violence Evaluations: Evaluations will include a clinical interview,risk
assessment and recommendations. Assessments may include the following if applicable:
i. Millon Clinical Multiaxial Inventory-Ill(MCMI-III)
ii. Shipley Institute of Living Scale
iii. Substance Abuse subtle Screening Inventory(SASSI-III)
iv. Hare Psychopathy Chec-List Revised,2'°Edition(PCL-R2)
v. Domestic Violence Risk Appraisal Guide(DVRAG)
vi. Domestic Violence Risk and Needs Assessment(DVRNA)
vii. Spousal Assault Risk Assessment(SARA)
• Polygraph: Polygraphs are available in conjunction with an evaluation if needed.
• Individual Therapy(Limited Availability): Individual therapy is available on a limited basis if
CONTRACTOR is able and willing to provide the services.
2. CONTRACTOR is a Domestic Violence Treatment Supervisor and Provider(DVOMB),and will comply
with the Colorado Domestic Violence Offender Management Board's Standards and Guidelines.
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 of
a parent whom the CONTRACTOR is working with under an active referral. Areas of concern may
include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern
should be reported immediately AND on the required monthly report.
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
from 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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$500.00/Episode(Domestic Violence Evaluation)
$250.00/Episode(Polygraph)
$85.00/Hour(Individual Session)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`h day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-11-12-CPS-0123
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently.Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101,et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
12
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.'
The Department is requesting that provider 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's contracted providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND DYNAMIC FAMILY DESIGN, LLC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Dynamic Family Design, LLC,hereinafter referred
to as"Contractor".
WITNESSETH
WHEREAS,required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Home Studies and Relinquishment Counseling;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June I,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq. and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986, P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses, approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
The 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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-HS-0040
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Keith P. Wawrzyniak,Jr. Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Keith P. Wawrzyniak,Jr.
P.O.Box A P.O.Box 208
Greeley,CO 80632 Eaton,CO 80615
(970)352-1551 (970)631-5092
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-II-12-HS-0040
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: A
WELD COUNT�Tl�'D OF COUNTY
CLERK TOTH:B• ' • 6tO 1` ISSIONERS WELD
/ �Vi t` Y.COLORADO
> R/
By: �%� ` :s.•1 C' ( !_
Deputy Clerk `:Q ` ,� � arbara Kirkmeyer,¢hair PJG 2 9
,PfaAST CONTRACTOR:
•
BY
Covet ttomey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J A. rieg Director
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PY-11-12-HS-0040
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide home study and relinquishment counseling services for families referred by
the Department.
2. CONTRACTOR will utilize the Structured Analysis Family Evaluation(SAFE)tool developed by the
Consortium of Children. CONTRACTOR is SAFE certified and on the State's approved home study
vendor list.
3. CONTRACTOR will complete a Department of Motor Vehicle background check. All CBI,FBI and
LexisNexis background check information will be completed by the Department,unless otherwise directed
by the Department.
4. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of
receipt of the home study referral. A complete home study will include the study in SAFE format,
background check information, SAFE questionnaires completed by the applicants,references and all other
original documents submitted by the home study applicant.
5. Relinquishment counseling services will be provided to all adult individuals referred by the Department,as
well as associated children 12 years of age and older,utilizing the required State format. CONTRACTOR
will submit a written report and the appropriate affidavits and interrogatories.
6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any
specific Weld County home. Areas of concern may include,but are not limited to,any physical,emotional,
educational or behavioral issues. Child abuse must be reported immediately per law.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$995.00/Episode(Full Home Study,no background check)
$485.00/Episode(Updated Home Study)
$225.00/Episode(Rate per additional adult)
$200.00/Episode(Cancelled home study, 1-4 hours of service)
$49.00/Hour(Cancelled home study after 4 hours of service)
$75.00/Episode(Mileage,Home Studies outside Weld County)
$65.00/Hour(Relinquishment Counseling,one(1)hour minimum)
$25.00/Episode(Mileage,Relinquishment Counseling outside Weld County)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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PY-11-12-HS-0040
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-11-12-HS-0040
• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND DYNAMIC FAMILY DESIGN, LLC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Dynamic Family Design, LLC, hereinafter referred
to as"Contractor".
WITNESSETH
WHEREAS,required approval, clearance, and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Foster Parent Training;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement, which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R. Part 80 a seq.;and
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 a seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986, P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex, religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that, at the time of entering into this Contract, it has currently in effect all
necessary licenses, approvals, insurance, etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
The Contractor will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attomey'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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 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,en-or,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:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Keith P. Wawrzyniak,Jr. Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A. Griego, Director Keith P. Wawrzyniak,Jr.
P.O.Box A P.O. Box 208
Greeley,CO 80632 Eaton,CO 80615
(970)352-1551 (970)631-5092
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR, within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of finding. CONTRACTOR reserves the right to suspend services to clients if
finding is no longer available.
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20. 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.
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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 COU RD OF COUNTY
CLERK TOT : sr �ii�j MISSIONERS WELD
�-Ate Ir TY,COLORADO //
By: � !. , ��i 7/�����1✓ t �'- .(
Deputy Cler ' j 1 g yy Barbara Kirkmeyer, air At
AP V A M: CONTRACTOR:
BY
Co mey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju .Griego irecto
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Foster Parent Training specific to transitioning a foster child into an
adoptive home.
2. Training will consist of a two(2)hour training that will include,but is not limited to an explanation of the
transition process,expectations for foster family and adoptive family,age-appropriate impacts and issues
surrounding transition,foster child preparedness,language to use and appropriate communication.
3. CONTRACTOR will provide a certificate of completion to the referred foster parent(s),with a copy to the
Department.
4. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
8. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Hour(Training)
$30.00/Episode(Mileage rate for referrals outside of Weld County)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-CORE-0187 Life
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND LUTHERAN FAMILY SERVICES OF COLORADO
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Lutheran Family Services of Colorado,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS, required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Home-Based Services(Pre-Adoption Services, Option B,Therapeutic Mentoring);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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
PY-11-12-CORE-0187
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
James Barclay President/Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director James Barclay,President/CEO
P.O.Box A 363 South Harlan Street,#200
Greeley,CO 80632 Lakewood,CO 80226
(970)352-1551 (303)217-5830
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CORE-0187
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: •
WELD CO OF
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7
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PY-11-12-CORE-0187
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Home Based Services as follows:
a. Pre-Adoption,Transition,Placement and In-home Support Services Program to families referred
by the Department.
i. The purpose of this program is to ensure that adoptive placements have the best chance to
flourish and succeed in maintaining a life-long commitment to the child(ren)placed in the
home.
ii. The goal of services is to reduce the risk of disruption in adoptive placement,either prior
to the finalization of the adoption or in the lifetime following the finalization.
iii. Services will be provided in a three step process:
1. Step One: CONTRACTOR will assess the child(ren)being considered for
adoption. The assessment will include a review of child-specific documentation,
as well as gathering information from the assigned caseworker(s), current foster
family and from other sources with knowledge of the child's history and unique
needs. If siblings are involved,each child will be assessed individually.
2. Step Two: CONTRACTOR will assess potential adoptive families submitted by
the assigned caseworker(s). This assessment will include a review of file
information, SAFE home studies,as well as face-to-face meetings with potential
adoptive placements. Once an adoptive placement is identified,
CONTRACTOR will present the child's information to the potential family.
CONTRACTOR also may arrange respite with the family for the child as part of
the presentation of the child. If all parties commit to the adoption,
CONTRACTOR will set up visitation as part of the transition of the child into
the final adoptive placement.
3. Step Three: CONTRACTOR will provide in-home support to the adopted child
and adoptive placement following finalization of the adoption if referred by the
Department. The frequency and duration of support services will be determined
through discussion with the assigned caseworker,with the final determination
resting with the Department.
b. Option B services to families referred by the Department.
i. The purpose of this program is to serve families who are either at risk of having children
placed out-of-home or whose children have recently been transitioned home.
ii. Services are provided utilizing flexible, individualized service modalities based upon the
family's strengths and needs with a goal of creating a safe,stable and nurturing family
environment;preventing,reducing or eliminating behaviors that may place a child or
family at risk;and preventing unnecessary out-of-home placements.
iii. CONTRACTOR will work with referred families,in a solution-focused manner,to
identify dysfunctional parent/child interactions; cross-generational trauma and family-of-
origin problems;triggers resulting in familial instability;family patterns,cycles and
hierarchies;and will assist family members in regulating emotions and improving family
communication patterns.
iv. Families appropriate for this program demonstrate generational family patterns embedded
in the family structure that negatively impact any parenting skills the parents may or may
not have learned. These patterns impede the ability of the parents to provide a safe and
stable environment for their children.
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c. Therapeutic Mentoring services to children and youth ages eight and older as referred by the
Department.
i. The purpose of this program is to prevent out-of-home and/or disrupted placements.
ii. Services are provided utilizing the Ansell Casey Life Skills Program,which utilizes an
assessment tool completed by both the child and the parent/caregiver to identify strengths
and weaknesses. The tool will assist in the development of a child-specific plan to meet
the needs of the referred child and/or youth at their socialemotional age rather than
chronological age.
iii. CONTRACTOR will work with referred child or youth,in a solution-focused manner,
using two to four blocks of time, once or twice per week.
iv. Services will primarily occur in the community or in office.
2. CONTRACTOR can provide bilingual services(Spanish).
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 and accepting 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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$500.00/Episode(Pre-Adoption Services:Assessment)
$105.00/Hour(Option B Services)
$95.00/Hour(In-Home Support/Transtion Services,Therapeutic Mentoring Services)
$75.00/Hour(Court Staffing and Court Facilitation)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7t°day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence, clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences, clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex, or national origin,be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of fmal payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall, during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements, or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents, and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain, or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers should continually assess family relationships(parent/child, sibling/sibling,extended
family/child, etc.)and should report any concerning relationship issues which may be a bather to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND DYNAMIC FAMILY DESIGN, LLC
This Agreement,made and entered into the day of 2011, by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services, on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Dynamic Family Design, LLC,hereinafter referred
to as"Contractor".
WITNESSETH
WHEREAS,required approval, clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Home-Based 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 I,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et. seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986, P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin, and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible, as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that, at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance, etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department unless the
Contractor has previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
The 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 retum 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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0191
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Keith P. Wawrzyniak,Jr. Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A. Griego,Director Keith P. Wawrzyniak,Jr.
P.O. Box A P.O. Box 208
Greeley,CO 80632 Eaton,CO 80615
(970)352-1551 (970)631-5092
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy, reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CORE-0191
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: .r� '
WELD CO R Y i i' RD OF COUNTY
CLERK TOT E ,6 1 MISSIONERS WELD
D
1861 ti KIS M1TY,
By
Deputy Clerk/ %! ltl _� arbara Kirkmeyer Chair PUG 2 011
APP RM: CONTRACTOR:
BY
Co A omey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
Jud .Griego, vector
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PY-11-12-CORE-0191
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide Foster Parent/Foster Child transitions services for foster and foster-adopt
families referred by the Department.
2. CONTRACTOR will provide transitional services to assist in the monitoring of initial visits between the
prospective foster/foster-adopt parent(s)and the child being considered for placement,in order to ensure
appropriateness and permanency of the placement. Transitional Services will include:
a. Education and training specific to the placed child and the respective placement.
b. One to two hour visits at a frequency determined by the Department.
c. Assessment of progress through observation and evaluation of interactions between the
foster/foster-adopt parent and the child(ren)being considered for placement.
d. Communication of all observations and concerns to the assigned caseworker verbally and through
written report. Each written report will include recommendations,if applicable,to ensure
permanency and appropriateness of placement.
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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PY-11-12-CORE-0191
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$75.00/Hour(Transitional Services)
$30.00/Episode(Flat Rate per Referral Outside Weld County)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101,et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-11-12-CORE-0191
• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-CORE-0202 I' 'afrI
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND LUTHERAN FAMILY SERVICES OF COLORADO
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sifting as the Board of Human Services, on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Lutheran Family Services of Colorado,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Lifeskills(Therapeutic Visitation); and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies, equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-CORE-0202
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract, a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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 defied to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
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PY-11-12-CORE-0202
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
James Barclay President/Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director James Barclay,President/CEO
P.O.Box A 363 South Harlan Street,#200
Greeley,CO 80632 Lakewood,CO 80226
(970)352-1551 (303)217-5830
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-11-12-CORE-0202
20. 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.
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PY-11-12-CORE-0202
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: a r _ _ . �e
LD CO yr •� ' OF COUNTY
CLERK TO TI-I B• �j ISSIONERS WELD
/61 �£ WtO TY,COLORADO
By: !,% ' � i �rl�lriii� /ay ; Alc L.,2L, .- /(,e/7,44,' ti
Deputy Cler ��fS)Tl p �it ' Barbara Kirkme}er,Chai AUG 2 9 20
ARNOO-a A Vn
CONTRACTOR:
BY
C mey Contras r
y
WELD COUNTY DEPARTMENAT G�
OF HUMAN ERVICES ( / ,,,--" as
By: Xrjr'/AV l/Ly/ ,y-via-5"are
Ju .Grieg irector
7
deg/,'-,- 39 7
PY-11-12-CORE-0202
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide the following Life Skills services as follows:
a. Parent Coach(in-home)services to families referred by the Department.
i. The purpose of this program is to serve families who are either at risk of having children
placed out-of-home or whose children have transitioned home.
ii. Services are provided utilizing flexible, individualized service modalities based upon the
family's strengths and needs.
iii. Services are designed to assist families in creating a safe,stable and nurturing family
environment;promote the safety and well-being of children and families; maintain and build
upon family connections and supportive resources;reduce isolation;assist parents in
developing appropriate parenting techniques;improve household management skills;prevent,
reduce or eliminate behaviors that may place a child or family at risk;and prevent
unnecessary out-of-home placements.
iv. Families appropriate for this program demonstrate a fundamental lack of knowledge of
parenting skills,basic life skills and community resources. This program is not intended to
address marital issues outside the parenting context,domestic violence,or chronic mental
health issues.
b. Therapeutic Visitation services to clients referred by the Department.
i. Services are available as follows:
1. Level 4(Family Therapy Level): Intensive services that utilize various techniques
from different therapy theories,including but not limited to,narrative and solution
focused,to assist family members in increasing emotional regulation,improving
family communication patterns and repairing parent/child relationships. Services
will assist the referred family to identify dysfunctional family relationships,cross-
generational patterns and trauma experiences that affect individual family members
and the family unit. Level 4 will also include all Level 3 services.
2. Level 3: Assessment of future intervention needs for continuing visitation and
providing protection,both emotionally and physically,for children and/or youth in
out-of-home placement.
3. Level 2: Step down from Level 3 if deemed appropriate to assist in the maintaining
stability and consistency within the family.
4. Level 1: Maintenance level that will be considered on a case-by-case basis if
CONTRACTOR has available staff.
ii. Services will occur at the Lutheran Family Services Therapy Center in Greeley or at the
Lutheran Family Services office in Fort Collins. Services may also occur in appropriate
community settings or in the family home if deemed appropriate, and approved by the
Department.
iii. All services will be provided by Master's,or higher,level therapists. CONTRACTOR has
bilingual(Spanish/English)staff.
2. CONTRACTOR can provide bilingual services(Spanish).
8
PY-11-12-CORE-0202
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 and accepting 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 will participate in team reviews of ongoing services as needed. These will primarily include
staffmgs and Utilization Review Team(URT)and are not considered billable hours.
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PY-11-12-CORE-0202
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$105.00/Hour(Face-to-Face Contact. Level 4(Family Therapy Level)and any)
$95.00/Hour(Face-to-Face Contact. Levels 2 and 3.)
$75.00/Hour(Face-to-Face Contact. Level 1.)
$75.00/Hour(Court Facilitation and Court Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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PY-11-12-CORE-0202
EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence, clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-11-12-CORE-0202
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall, during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 11(b)of
this certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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PY-11-12-CORE-0202
EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND LUTHERAN FAMILY SERVICES OF COLORADO
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Lutheran Family Services of Colorado,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Home Study 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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 71°day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CPS-0114
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be fmal.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended, cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-CPS-0114
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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 Attorneys Office immediately at 970-353-5215,ext. 6503, 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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CPS-0114
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
James Barclay President/Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director James Barclay,President/CEO
P.O.Box A 363 South Harlan Street,#200
Greeley,CO 80632 Lakewood,CO 80226
(970)352-1551 (303)217-5830
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-11-12-CPS-0114
20. 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.
6
PY-11-12-CPS-0114
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: /Jq�
�D CO N' ,i OF COUNTY
CLERK TO TH SSIONERS WELD
f; ' Y,COLORADO
1E61
By: �i. ,✓; t> .� � �1 ,4 (mss _ . 1.4.fc_/J‘ ,IG�2 9 2011
v
Deputy Cler., a , arbara Kir ye ,Chair `
APPROV#AS •
A CONTRACT
l7 � BY
o ttmey C t
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J A.Grie ,Due
7
PY-11-12-CPS-0114
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide home study services for families referred by the Department.
2. CONTRACTOR utilizes the Structured Analysis Family Evaluation(SAFE)tool developed by the
Consortium of Children. CONTRACTOR is SAFE certified and on the State's approved home study
vendor list.
3. CONTRACTOR will complete a Department of Motor Vehicle background check at no additional charge.
All CBI,FBI and LexisNexis background check information will be completed by the Department,unless
otherwise directed by the Department.
4. CONTRACTOR will notify the Department within three days of receipt of a referral if the referral will be
accepted and acted upon.
5. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of
receipt of the home study referral. A complete home study will include the study in SAFE format,
background check information, SAFE questionnaires completed by the applicants,references and all other
original documents submitted by the home study applicant.
6. CONTRACTOR can provide services in Spanish.
7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any
specific Weld County home. Areas of concern may include,but are not limited to,any physical,emotional,
educational or behavioral issues. Child abuse must be reported immediately per law.
PY-11-12-CPS-0114
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,000.00/Episode(Home Study-English)
$1,600.00/Episode(Home Study-Bilingual or Monolingual Spanish)
$250.00/Episode(Home Study-English,Partially Completed)
$400.00/Episode(Home Study-Bilingual or Monolingual Spanish,Partially Completed)
$100.00/Episode(Rate per additional person beyond primary applicant and four others)
$75.00/Hour(Court Staffing, Court Facilitation)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`s day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence, clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of, or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit fmdings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CON TRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible, or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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PY-11-12-CPS-0114
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties, (2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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PY-11-12-CPS-0114
EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-11-12-CPS-0114
• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical, emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-CORE-0189
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND MILESTONES COUNSELING SERVICES,LLC 2L7ll n,
This Agreement,made and entered into the day of 2011,by and between the Board of 1 Y
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Milestones Counseling Services,LLC,hereinafter
referred to as"Contractor".
WITNESSETI I
WHEREAS,required approval,clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Foster Parent Consultation;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2011,upon proper execution of this Agreement and shall
expire May 31, 2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7(1 day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
:fie:/%-a?-'%
PY-11-12-CORE-0189
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services perforated for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et. seq. and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L. 99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary. CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-12-CORE-0189
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible, as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CF SR)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.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability (PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
I
PY-11-12-CORE-0189
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses, approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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
PY-11-12-CORE-0189
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Adelaida"Addie" Campbell Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A. Griego,Director Adelaida"Addie" Campbell,Owner
P.O. Box A 904 49th Avenue Court
Greeley,CO 80632 Greeley,CO 80634
(970)352-1551 (970)301-5833
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
finding is no longer available.
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PY-1 1-12-CORE-0189
20. 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.
PY-11-12-CORE-0189
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: ,
WELD COUNTY t s�� OF COUNTY
CLERK TOT ISSIONERS WELD
a''! _�,•.�tl�"Y,COLORADO
ISM ! " S■I
By: l . A et.i t,
Deputyi' ® ?'-'qq`p ' IarbaraKirkmeyer,C air AUG 2 9 2011
pp J"�
F �.. ♦aYJ 'ONTRA OR:
BY
Co . A ttomey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J A. Grieg ,Director
cQC// 9S 2 7
PY-1 1-1 2-CORE-0 1 89
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide foster parent/child evaluation and consultation for children and youth
residing in Weld County foster homes as referred by the Department.
2. CONTRACTOR will work collaboratively with children,foster parents,caseworkers,foster care
coordinators and other service providers to identify and address issues,in a solution-focused manner that
could potentially disrupt placements.
3. CONTRACTOR will provide services in three steps:
a. Step 1 —Engagement/Evaluation. CONTRACTOR will:
i. Meet with foster parent(s)of the referred child(ren)/youth to gather information
regarding their concerns and prior attempts to meet the needs of the child(ren)/youth.
ii. Administer the Parenting Relationship Questionnaire(PRQ). The PRQ will be used to
assess Relational Frustration(caregivers' level of stress or distress in parenting),
Parenting Confidence, Involvement,Discipline Practices and Communication of the
foster parent(s).
iii. Meet with the referred child(ren)/youth to gather information regarding their concerns
and perceived barriers to placement in the foster home.
b. Step 2—Intervention. CONTRACTOR will:
i. Observe the foster child(ren)/youth and foster parent(s)for the purpose of gathering
information on parenting style,bathers to relationship formation between the referred
child(ren)/youth and the foster parent(s),possible issues and plans for intervention.
ii. Meet with the foster parent(s)to provide feedback and intervention strategies to improve
foster parent/child interaction.
c. Step 3—Feedback. CONTRACTOR will:
i. Meet with foster child(ren)/youth and foster parent(s)following implementation of
interventions to assess progress. This will include observation of interaction with a
feedback session to highlight observed positive changes in the foster parent/child
interaction.
ii. Administer the PRQ to the foster parent(s)to assess changes made.
iii. Provide a written report to the Department regarding Evaluation,Intervention and
Feedback for referred child(ren)/youth. Intervention and Feedback will be reported on a
monthly basis for the duration of the referral.
4. 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.
5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to, any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
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PY-11-12-CORE-0189
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 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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT) and are not considered billable hours.
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PY-1 l-12-CORE-0189
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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, 2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$90.00/Hour(Evaluation,Intervention and Feedback-Six Hours)
$90.00/Hour(Additional Follow Up after 6 hours-If approved by Department)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the teens and
conditions of Exhibit A.
a. All billings are to be submitted by the 7i°day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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PY-11-12-CORE-0189
EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable, and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal, and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the 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 thc
audit finding.
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PY-11-12-CORE-0189
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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I6. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties, (2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors, and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-1 l-1 2-CORE-0189
• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CF SR 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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.
tc
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PY-11-12-CORE-0188
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND LUTHERAN FAMILY SERVICES OF COLORADO
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Lutheran Family Services of Colorado,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mediation Services(Team Decision Making);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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CORE-0188
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d-I a seq.and its implementing
regulation,45 C.F.R.Part 80 et. seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 a seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-12-CORE-0188
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorneys 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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0188
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
James Barclay President/Chief Executive Officer
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director James Barclay,President/CEO
P.O.Box A 363 South Harlan Street,#200
Greeley,CO 80632 Lakewood,CO 80226
(970)352-1551 (303)217-5830
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency, shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-11-12-CORE-0188
20. 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.
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PY-11-12-CORE-0188
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the thy,month,and year first
above written.
ATTEST: I • �; 4a
..ate .. ..
�ELDCOUNTYf OF COUNTY
CLERK TO THE : :`a '.SIONERS WELD
1661 � , ,COLORADO
BY a , ®, L ,C-1-.'r.,, 4A.--
Deputy Cler� � 1 I arbara Kirkmeyer C air A JG 9 20 ,
APP FO CONTRACTOR:
BY
o Attorney Contr
L./ s
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES Qe)��T G "ZOI
By:
J A.Grie o,Drrecto
7
PY-11-12-CORE-0188
EXHIBIT A
SCOPE OF SERVICES
CONTRACTOR will provide Team Decision Making(TDM)services to clients referred by the Department.
1. Services under this contract include:
a. Initial TDM Services
i. Consultation with referring caseworker to determine basic facts and parties to include in
initial TDM.
ii. Contact with all parties,scheduling and arranging meeting location.
iii. Travel time and mileage to meeting location.
iv. Materials needed for use at the meeting and preparation for the meeting.
v. Facilitation of the meeting.
vi. Summarization of decisions at the end of the meeting and determination of the need for a
subsequent meeting.
vii. Preparation and submission of report to the Department within 48 business hours of the
meeting.
b. Subsequent TDM Services(when approved by the Department):
i. Consultation with caseworker regarding goal of subsequent TDM meeting.
ii. Contact with all parties,explanation of meeting,scheduling and arrangement of meeting
location.
iii. Travel time and mileage to meeting location.
iv. Materials needed for use at the meeting and preparation for the meeting.
v. Facilitation of the meeting.
vi. Summarization of decisions at the end of the meeting.
vii. Preparation and submission of report to the Department within 48 business hours of the
meeting.
c. Follow-up Services(when approved by the Department):
i. Follow-up due to a lack of consensus in a TDM meeting.
ii. Additional gathering of information and sharing following a TDM.
iii. An"ice-breaker"meeting.
iv. Any other meetings/consultation needed at the request of the Department.
2. Goals,Values,Assumptions and Key Elements:
Core and Contracted Mediation- Team Decision Making
Service
Goals • To involve birth families,communities,resource families,service
providers and agency staff in all placement decisions
• To reduce the number of removals through team-designed safety plans
• Place children with kin and/or in their own neighborhood or community
• Place siblings together
• Place children in the least restrictive environment that addresses their
needs
• Reduce reliance on institutionalized care
• Connecting families to community supports that offer ongoing assistance
and ensure a network of support for the child and adults who care for
them
• Create a team approach among foster parents,birth parents,services
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PY-11-12-CORE-0188
provider and Department to promote reunification whenever possible
• Stabilize and preserve existing placements through caregiver support and
services to children to achieve the target of one placement per child
• Return the child home safely or provide permanency as soon as possible
• Decrease the frequency of children re-entering foster care
• These are suggested goals that the Department may modify for their
purposes. The goals stated are designed towards CFSR compliance
Values • Every child deserves a family
• Every family needs the support of the community
• Public child welfare agencies need community partners
Assumptions • A group can be more effective in decision making than an individual
• Families are the experts on themselves
• When families are respectfully included in the decision making process,
they are capable of identifying and participating in addressing their
needs
• Members of the family's own community add value to the process by
serving as natural allies to the family and experts on the community's
resources
Key Elements 1. A TDM meeting, including birth parents and youth,is held for
ALL decisions involving child removal,change of placement,
and reunification/other permanency plan
2. The TDM meeting is held BEFORE the child's move occurs,or
in cases of imminent risk,by the next working day,and always
before the initial court hearing in cases of removal.
3. Neighborhood-based community representatives are defined by
Department and invited to participate in all TDM meetings
especially those regarding possible child removal
4. The meeting is led by a facilitator employed by the Contractor
who has been trained in TDM facilitation,has the appropriate
clinical skill level and is immediately accessible.
5. Information about each meeting, including participant,location
and recommendations is collected by the Contractor and given
to the Department so the Department may enter data on child
and family outcomes in order to ensure continuing program
evaluation of the TDM process and its effectiveness
6. (Optional)If so desired by the Department,a TDM meeting
resulting in a child's removal may serve as a springboard for the
planning of an"icebreaker"family team meeting, ideally to be
held in conjunction with the first family visit, so that the birth-
foster parent relationship can be initiated
7. Each TDM meeting will last approximately 1—2 hours
8. Unless the Department directs otherwise,the list of suggested
participants will be supplied by the Department and the
Contractor will contact participants with time and location of
meeting.
9. A thorough discussion of risk and safety concerns,as well as
family's strengths and needs is a part of every TDM meeting.
3. TDM Meeting Process and Structure:
a. Types of TDM Meetings
For every family involved with the Department the Contractor suggests the following as required
points at which a TDM meeting will be held:
• Prior to removing a child,whether emergency or considered;
• Prior to any change of placement for a child already in care;
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PY-11-12-CORE-0188
• Prior to making a permanent plan,including reunification,termination of parental rights,
guardianship,emancipation,or long term foster care
b. Triggers for a meeting
Emergency or Considered Removal
Scheduled when the Department caseworker assesses child(ren)at high risk for abuse/neglect,
or within one working day after emergency removal/placement of child or before first court
hearing. TDM team determines whether agency should file for custody and facilitate
placement;or child can return safely home with services;or voluntary placement by parents
with provision of services and safety plan,etc.
Placement Preservation/Change of Placement
Requested before child(ren)move from one placement to another. Meeting is scheduled
when potential disruption of placement is recognized,safety issues exist or move from current
placement is believed necessary to benefit child.
Permanency Planning
Reunification—Scheduled when risk level is reduced and parental progress in family's
ability to protect and provide safety for child is recognized. Team determines if
child(ren)can safely return to own family,and is held before overnight visits begin.
Other Permanent Plan(Permanent custody/adoption, Guardianship,Long-term Foster
Care)- Meeting scheduled when lack of progress by parents in reducing risk suggest
need for permanent placement plan/legal filing.
Emancipation
4. Suggested Participants and Preferred Role:
The Department may mod O,any and all of the following:
Birth Parents • Recognized as the expert on their family's needs and strengths. Presence
and involvement integral to meeting,however with the exception of TDM
for reunification,absence or non-participation would not preclude or
postpone scheduled TDM meeting.
Child(ren) • Children are encouraged to participate whenever determined appropriate
by Department and all children 12 and older are strongly recommended to
participate.
Extended family and non- invited by parents as support/to assist/be resource.
relative supports
Current caregivers—kin, Key team member;assists in providing information regarding child(ren)'s
foster adjustment,progress,needs;and in developing ideas and reaching decision.
Caseworker/supervisor Convener of meeting;content expert;with facilitator,leads discussion.
Responsible for making decision if absence of consensus.
Community Partners Defined by their identity as a member of the family's community,whether
based on neighborhood,ethnicity,religion or other connection. They are
invited by agency,based on existing partnership,to provide support,
resource expertise,and external perspective to decision-making. Their
presence in meeting should be agreed to by parents.
Service Providers Currently or previously involved with family.
Guardian ad litem(e.g. Court appointed representative responsible for representing child's best
CASA or Attorney GAL) interest.
Other public agency staff May include home finding,therapist, independent living,family
preservation staff,or others able to provide expertise/information. As
agency personnel,they share responsibility for high quality decision;and
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may seek review of caseworker's decision in situations where consensus
not reached, if unable to support the decision due to belief that it puts child
at risk of serious harm or violates law or Department policy.
Facilitator Contractor trained process expert who works with Department caseworker
to lead group through solution-focused process. Assigned to family's case
throughout involvement with agency. Provides summary report to
participants outlining decision and action steps.Collects mutually agreed
upon data for Department for ongoing program evaluation. Expected to
seek review of caseworker's decision in situations where consensus not
reached,if unable to support the decision due to belief that it puts child at
risk or serious harm or violates law or policy.
5. CONTRACTOR Agenda Responsibilities as Facilitator:
Introduction:
The facilitator welcomes everyone and describes the purpose and the goals of the meeting. The Facilitator explains
the team decision-making process, establishes a safe climate and sets a tone of inclusion. The Facilitator states that
all opinions and ideas are considered,and clarifies that if group consensus cannot be achieved,the agency will need
to exercise its responsibility to make the final decision. The Facilitator invites participants to introduce themselves
and to state their connection to the child and family. After introduction,the Facilitator explains the"Ground Rules"
and asks participants if they wish to enact any additional rules. Once the"Ground Rules"are determined,the
Facilitator seeks the agreement of all participants to uphold them throughout the meeting
Identify the Situation
The facilitator invites the parents to initiate the discussion by sharing information about their family, situation and/or
needs. The Department caseworker and/or supervisor follow by clearly defining their concerns.
Assess the Situation
It is important that family strengths, safety risks and safety needs are thoroughly examined. For this reason,the
assessment stage should not be rushed. All participants are advised to remain receptive to receiving new information
that might alter their previous understandings and recommendations. During this stage,the Facilitator elicits specific
and behaviorally descriptive information from participants,encouraging"straight talk"and full disclosure of
strengths and concerns. The Facilitator summarizes the key points of the assessment and may choose to list strengths
and needs on an easel for easy reference by the group. The Facilitator separates facts from opinions, and identifies
differences as well as areas of common ground.
Develop Ideas
During this stage,all participants brainstorm through a free,non-judgmental sharing of ideas. In order to maximize
participation,the Facilitator may describe the concept of brainstorming,thus promoting creative thinking and active
listening. The Facilitator also assists in clarifying thoughts,summarizing,listing and visualizing ideas.
Reach a Decision
The Facilitator sets an expectation that the team is capable of reaching consensus. The Facilitator encourages the
team to consider the merit of each idea,by reality testing possible consequences and the ease or difficulty of
implementation. The Facilitator encourages dialogue,checks for agreement,and remains attentive to the feelings
and responses of family members. If it appears that reaching consensus is unlikely,the Facilitator reminds the team
that the agency may need to make the final decision. Reasons for the decision are discussed. Whether made by
consensus or by the agency alone,the decision shall reflect the least intrusive,least restrictive option that provides
safety and protection for the child. Criteria for measuring success should be identifiable and the parties to the safety
or action plan should be clear about their respective responsibilities. The decision then becomes the agency's
official position,binding upon all staff.
Recap/Closing
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The Facilitator reviews the safety or action plan with the team,checks for understanding and solicits any further
questions. Particularly at this time,the Facilitator acknowledges and addresses participants' emotions and responses
through empathic understanding. The Department may wish to make the option of a follow up meeting available in
which case the Facilitator would determine at this time if the family is interested in convening a follow-up voluntary
Family Conference. If the family expresses interest,the Facilitator shall notify the designated source. The
Facilitator ends the meeting by thanking the participants for their contributions.
Ground Rules:
The following ground rules will be posted at the meeting site for easy reference:
1.Right to privacy(to be distinguished from confidentiality).
2.Mandated reporting requirements.
3.All participants will be treated with respect.
4.Only one person will speak at a time.
5.Everyone will have an opportunity to speak and to ask questions.
6.No caucusing,passing notes or otherwise communicating in a way that excludes others.
7.Time framed of approximately 2 hours.
Other Expectations of CONTRACTOR TDM Facilitator:
1. Facilitator will be expected to focus the groups' energy on a common task—to reach a decision about
placement issues that protects and provides safety for the child in the least restrictive/intrusive manner
possible.
2. Facilitator will assure that the purpose of the TDM meeting is understood and all participants have an
opportunity to be involved. With the Weld County Department caseworker,they lead the group
discussion that determines the placement/custody recommendation for the child.
3. Facilitator will protect ideas and individuals from attack or being ignored. They will provide a safe,
supportive environment to permit communication.
4. Facilitator will be sensitive and responsive to nonverbal cues. They will have the ability to manage
conflict and emotions.
5. Facilitator will periodically summarize,clarify,reframe and identify areas of agreement to assist the
group.
6. Facilitator will assure that the situation is thoroughly examined,risks stated,family strengths
recognized,goals verbalized, ideas brainstormed,quality decision made with safety and action plans
developed.
7. Facilitator will be an information resource for the group. They will be knowledgeable of laws, agency
policies/procedures,services,best practice,etc.and monitor compliance with standards alongside
Department caseworker and/or supervisor
8. CONTRACTOR Facilitator will move the group through the problem-solving/decision-making process,
maintaining reasonable time frames.
9. Facilitator will manage the process and structure of the meeting,recognizing the family and
Department caseworker are the content experts. They are responsible to ensure that a high quality
decision results form the meeting, intervening if necessary,as an experience/knowledgeable participant.
10. Facilitator will strive to develop consensus decision with ALL participants but always with agency and
Department staff in attendance.
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11. Facilitator will accurately record information and decisions. They will provide a copy of the
safety/actions plan steps at the completion of the staffing to all participants.
12. Facilitator will model supportive,non-threatening,and respectful behavior.
6. Summary of Safety and Risk issues for Different Types of TDM Meetings:
Contractor is aware that safety and risk must be addressed thoroughly at each meeting. For this reason, Contractor
will include a brief summary of safety and risk issues specific to the different types of TDM meetings and the
Facilitator's role and responsibilities pertaining to the safety and risk discussion.
SAFETY ISSUES RISK ISSUES
Initial Removal TDM
Determine: Present serious harm and/or High probability of future serious abuse/neglect
dangerous condition based upon present situation and past history
Focus: Child—What needs to be done now? Parent(s)—what must change for the future?
Decide: Immediate response to present situation and Priority services to address risk/needs and
Reduce future risk of abuse/neglect
Reunification TDM
Determine: Significant positive impact on No/low probability of future serious abuse/neglect
on concerns by services or otherwise that
resulted in placement and home presently safe
Focus: Child—safe return to parent(s)home Parents(s)-have successfully addressed all issues that
Harmed and put child at risk of A/N
Decide: Parents(s)able to provide safe home and Positive prediction of parent(s)ability to maintain
for child at this time safe,nurturing, stable environment long term
Other Permanency Plan
Determine: Little or no change by parents High probability of future serious abuse/neglect
Regarding concerns that resulted in placement
And safety issues remain
Focus: Child—unsafe to be in parents' care Parent(s)—traits,behaviors,conditions remain that
As issues that endanger child persist that indicate likelihood of additional serious risk of
Harm if child is in their care
Decide: Long term protection plan in nurturing, stable
environment
Facilitator Responsibilities Regarding Safety and Risk at the TDM:
1) Ensure all safety issues and risk concerns are shared and thoroughly examined
2) Ensure all discussion of risks and safety issues is understandable
3) Ensure impact of risk behaviors upon child is clear,especially to parents: "connect the dots"
4) Ensure specific and behaviorally descriptive explanations of concerns and expectations
5) Ensure all views regarding safety and risks are heard,clarifications provided and questions answered
6) Ensure family strengths,particularly those that address safety and risk issues are recognized
7) Ensure through discussion of history remains strengths-based and solution-focused
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8) Ensure all adults in home and having child access are assessed and discussed
9) Ensure"reality test"of ideas to address both immediate safety needs and future risks
10) Ensure TDM decision provides safety in least restrictive/intrusive manner for child:always raise the
question of balance between safety and emotional trauma of separation
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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
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$800.00/Episode(Initial Team Decision Making(TDM)Conferences)
$500.00/Episode(Subsequent Team Decision Making(TDM)Conferences)
$75.00/Hour(Follow up Services)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed, color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period, or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal, and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits, all contract activities,supported with fluids under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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PY-11-12-CORE-0188
EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers maybe impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-I 1-12-CORE-0204
CHILD PROTECTION AGREEMENT FOR SERVICES 11��,,
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERV*Qf s,% ,
AND MILESTONES COUNSELING SERVICES,LLC h �Fj 9 31
`• t
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Milestones Counseling Services,LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
o?67/- 2
PY-11-12-CORE-0204
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be fmal.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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.seut and its implementing
regulation,45 C.F.R.Part 80 et.seq.•and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-12-CORE-0204
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-CORE-0204
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0204
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Adelaida"Addie"Campbell Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego.Director Adelaida"Addie"Campbell,Owner
P.O.Box A 904 496 Avenue Court
Greeley.CO 80632 Greeley,CO 80634
(970)352-1551 (970)301-5833
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
PY-11-12-CORE-0204
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: : / L
LD COUN I , �./S V� OF COUNTY
CLERK TO THE ' O SSIONERS WELD j
,a6t
t t LORADO
l � � �.� wy ,�"
Deputy Clerk arbors Kirlmteyer, ' hair r J 2 0 2011
APP AS TO CONTRACT
BY `A -
Co Attorney Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju A.Gri g hector
(-?l//-L?327
PY-11-12-CORE-0204
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals,couples and families referred by the
Department. Services include:
a. Mental Health Assessments(Two hour appointment. A written report will be provided to the
Department.)
b. Therapy(Individual,Couples,Family,and Play Therapy;Eye Movement Desensitization
Reprocessing(EMDR)and Cognitive Behavioral Interventions.)
2. CONTRACTOR is bilingual(Spanish).
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$250.00(Mental Health Assessment)
$80.00/Hour(Therapy)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit fmdings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR
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PY-11-12-CORE-0204
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-11-I2-CORE-0204
• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-HS-0115 e/. .b 'p
CHILD PROTECTION AGREEMENT FOR SERVICES i Jr
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND MILESTONES COUNSELING SERVICES,LLC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Milestones Counseling Services,LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Relinquishment Counseling;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scone of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-HS-0115
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 a seq. and its implementing
regulation,45 C.F.R.Part 80 et. seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 a seq. and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin, and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-12-HS-O115
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
PY-ll-12-HS-0115
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses, approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503, 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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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
PY-11-12-HS-0115
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law,
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Adelaida"Addie" Campbell Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A. Griego,Director Adelaida"Addie" Campbell,Owner
P.O. Box A 904 49th Avenue Court
Greeley,CO 80632 Greeley,CO 80634
(970)352-1551 (970)301-5833
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-11-12-HS-0115
20. 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.
PY-I1-12-HS-0115
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
9 `
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WELD CO ' Y 1 _>. ' I OF COUNTY
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CLERK TO n ,:� � .�.�i ISSIONERS WELD
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.
By: ii /' /_ a� _`D19� ;�f/�]�; y► y: ' wC - , 1:lAt4'< _LA._
Deputy Cler. �....r arbara Kihkiueyer, hair Al 2 9 2011
O AST CONTRA :
BY :7.w`( 1
Co Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju A. Gneo, irector
1
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PY-11-12-HS-0115
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide relinquishment counseling services for families referred by the Department,
2. 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.
3. Relinquishment counseling services will be provided to all adult individuals referred by the Department, as
well as associated children 12 years of age and older,utilizing the required State format. CONTRACTOR
will submit a written report and the appropriate affidavits and interrogatories.
0
PY-11-12-HS-0115
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$80.00/Hour(Relinquishment Counseling)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7i°day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
PY-11-12-HS-0115
EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient, auditable, and otherwise adequate records that will provide
accurate,current,separate, and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors, and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the 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.
to
PY-1 I-12-HS-0115
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records, and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
I I. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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PY-ll-12-HS-0115
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees, agents, and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
rn
PY-1 l-12-1-IS-0115
EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CF SR)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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 CF SR in the areas of safety,permanency and well-being,followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CF SR 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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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•
PY-11-12-HS-0115
• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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.
1A
PY-11-12-CORE-0120
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and North Range Behavioral Health,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding 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, 2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule," of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services finding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-I I-12-CORE-0120
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
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 a seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions, covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-I 1-12-CORE-0120
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review, a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum). •
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum) for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage maybe required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that, at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0120
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Larry D.Pottorff Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Larry D.Pottorff,Executive Director
P.O.Box A 1300 N. 17th Avenue
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)347-2373
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of finding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CORE-0120
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
•r?
75
ATTEST: ,y
WELD COUNTr. OF COUNTY
CLERK TO THE t O r?, :t I.SIONERS WELD
f teat Ct`^��� ,9LORADO
By: g <.t C II!%Li
Deputy CIe j � �" C, air
r.Jc 2 s 2011
O D CONTRACTOR:
my Attorney ontractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J d A.Grieg ,Director
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L /� a3‘,22-
PY-I 1-12-CORE-0120
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Functional Family Therapy(FFT)services to male and female youth within
the approximate age range of 11-17 years of age, and their families,within Weld County referred by the
Department. CONTRACTOR has offices in Greeley and Fort Lupton,CO.
2. CONTRACTOR will provide services in accordance with the National Functional Family Therapy(FFT)
model and its standards and guidelines.
3. FFT is an intensive in-home,evidenced-based therapeutic service that empowers youth and families with
the skills and resources needed to independently address the difficulties they are having raising their
children. Youth are empowered to cope with family,peer, school and neighborhood problems;build
community and natural support systems; decrease negativity and blame among family members; and
decrease anti-social behaviors. Primary interventions include,as clinically appropriate: Family,
cognitive/behavioral, family therapy,and school and/or community-based.
4. Length of treatment is approximately 2-6 months, 1-2 hours per week.
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.
7. CONTRACTOR will document in detail any and all observed or verbalized concems 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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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, 2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$650.00/client/month(Pro-rated for any partial month of service.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County, the Board of County Commissioners of Weld County,its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause, or phase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall, on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current, separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal, and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a govemment entity
(federal,state, or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees, agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional, educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and North Range Behavioral Health,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
ail £517
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
S. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Larry D.Pottor f Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Grieco,Director Larry D.Pottorff,Executive Director
P.O.Box A 1300 North 17th Avenue
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (979)347-2373
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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.
C ..( _
ATTEST: ♦II���- •,•
WELD COUN B�ARIOFCOUNTY
CLERK TO TH. L I ' - rr •M I.SIGNERS WELD
d Y cr:"3 ,COLORADO / %
B �,��, t 72
Deputy Cle
p y � �" , � f-Barbara Kirkmeyer,G air /J9 2 9 2011
RO D A.�` � CONTRACTOR:
BY •
Co /f . ey ontractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By: L
Ju .Grie o, irector
ac//- _2
PY-11-12-CORE-0142
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR is the community mental health center serving Weld County.
2. CONTRACTOR will provide the following services under this contract:
a. Level 1 —Mental Health Evaluation
-3-6 service hours
-Review of applicable Human Services and CONTRACTOR records.
-Clinical interview and diagnostic evaluation.
-Possible administration of brief screening inventories(e.g.,Beck Inventories, State-Trait
Inventories,Personality Assessment Screener).
-Client feedback.
-Written report addressing relevant psychosocial history,diagnostic formulation,and treatment
recommendations.
b. Level 2- Partial Psychological Evaluation
-8-14 service hours
-Review of applicable Human Services and CONTRACTOR records.
-Clinical interview and diagnostic evaluation.
-Administration of partial test battery,such as cognitive or personality testing(e.g., Wechsler IQ
tests, MMPI,MCMI,PAI).
-Consultation with collateral sources.
-Client feedback.
-Written report addressing relevant psychosocial history,diagnostic formulation,and treatment
recommendations.
c. Level 3—Full Psychological Evaluation
-8-14 service hours
-Review of applicable Human Services and Contractor records,including prior evaluation and
mental health treatment records,police reports,medical records,and records from other agencies
involved in case.
-Extensive clinical evaluation.
-Administration of formal test battery to assess personality,emotional,and/or cognitive
functioning,and/or parenting issues(e.g.,Wechsler IQ tests, MMPI,MCMI,PAI, STAXI,STAI,
Beck screens,TSI,PSI).
-Consultation with collateral sources.
-Client feedback.
-Written report addressing psychosocial history,personality issues,emotional functioning and
regulation abilities,and/or intellectual functioning and/or parenting/family issues,and diagnostic
formulation,as well as treatment recommendations and prognosis.
d. Level 4—Extended Psychological Evaluation
(To be utilized when impairment in cognitive functioning is suspected/known,when the client is
unable to read or write,when there are major memory deficits,when resistance leads to invalid
measures and instruments need to be re-administered,and/or when other significant barriers to
testing are present.)
-20 service hours
-Review of applicable Human Services and Contractor records,including prior evaluation and
mental health treatment records,police reports,medical records,and records from other agencies
involved in case.
-Extensive clinical evaluation.
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-Administration of formal test battery to assess personality,emotional,and/or cognitive
functioning,and/or parenting issues(e.g.,Wechsler IQ tests,MMPI,MCMI,PAI, STAXI, STAI,
Beck screens,TSI, PSI).
-Consultation with collateral sources.
-Client feedback.
-Written report addressing psychosocial history,personality issues,emotional functioning and
regulation abilities,and/or intellectual functioning and/or parenting/family issues,and diagnostic
formulation,as well as treatment recommendations and prognosis.
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 participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$200.00/Episode(Level 1 -Mental Health Evaluation)
$800.00/Episode(Level 2 -Partial Psychological Evaluation)
$1,200.00/Episode(Full Psychological Evaluation)
$1,800.00/Episode(Extended Psychological Evaluation)
$120.00/Hour(Partially Completed Evaluation)
$120.00/Hour(Court Facilitation or Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees, volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs, sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state govemment has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will hilly comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Arc not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and North Range Behavioral Health,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Monitored Sobriety Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
L As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CPS-0109
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Larry D.Pottorff Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Larry D.Pottorff,Executive Director
P.O.Box A 1300 North 17th Avenue
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)347-2373
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement maybe terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CPS-0109
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: - e
WELD CO Y a ' O�.' I OF COUNTY
CLERK TOT E :F' % • ISSIONERS WELD /
1b61 a(11/42
� ! �i�TYyCOLORADO iy
By l,��/ / �. ►1�I'�IJ? +4JIi •Jr� .�t�(�F(�s( '1 '`!�1��--
Deputy erk' � 1 arbara Kirkmeyer,Chair /LUG 2 9 2011
APP ED AS TO • CONTRACTOR:
BY
Co y Attomey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
d A.Gde , irec
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide timely and quality monitored sobriety services to male and female
clients referred by the Department as follows:
a. Services will be provided at the North Range Behavioral Health Detox facility in Greeley,
CO,at 1140 M Street,and in Fort Lupton,CO,at 145 1st Street.
b. CONTRACTOR will provide a qualified monitored sobriety collector 24 hours a day/seven
days a week at the Greeley site. At the Fort Lupton site,the CONTRACTOR will provide a
qualified monitored sobriety collector 12:30-7:00 p.m.,Monday thru Thursday and 12:30-
6:00 p.m.on Friday.
c. CONTRACTOR will confirm all positive and negative monitored sobriety results within 24
hours through a phone call,test result,e-mail and/or fax to the referring caseworker.
d. CONTRACTOR will confirm all positive and negative monitored sobriety results for lab
UA's once processing has been completed through Redwood,typically within 3 days.
CONTRACTOR will report all positive and negative Instant UA results within 24 hours. If
the result is positive,it will be sent to Redwood for final confirmation.
e. CONTRACTOR will submit a copy of the valid Authorization for Services form,result and
client sign-in sheet(if applicable)with each monthly billing.
f. Results will be available online 24 hours per day,seven(7)days per week online at Redwood
Toxicology(6 WV,Nocbtoxicologv.com).
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contractor amend it accordingly.
2. Fees for Services
$20.00/Episode(Urinalysis Test-5 Panel:THC,Cocaine,Amphetamines,Benzodiazepines,Opiates)
$20.00/Episode(Urinalysis Test-7 Panel:THC,Cocaine,Amphetamines,Opiates,Benzodiazepines,
Barbiturates,Alcohol)
$20.00/Episode(InstaCheck 1 Panel)
$20.00/Episode(Multi-panel Instant UA)
$20.00/Episode(Instant Swab)
$35.00/Episode(GCMS-Confirmation of Positive Result)
$5.00/Episode(Breathalyzer)
$100.00/Episode(Hair Testing. MUST BE PRE-APPROVED BY DEPARTMENT.)
$50.00/Episode(Patch Monitoring. MUST BE PRE-APPROVED BY DEPARTMENT.)
$35.00/Episode(Ethyl Glucuronide/EtG Test. MUST BE PRE-APPROVED BY DEPARTMENT.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-1 I-12-CPS-0109
• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH RANGE BEHAVIORAL HEALTH
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and North Range Behavioral Health,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Multi-Systemic Therapy(MST);and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the Th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$I million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorneys 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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Larry D.Pottorff Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Larry D.Pottorff,Executive Director
P.O.Box A 1300 N. 17th Avenue
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)347-2373
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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:
LD COUNTY Its OUNTY
CLERK TO THE B ' ; S NERS WELD
Ii U LORADO /
By:
Deputy Clerli arbara Kirlaneyer,Chair LUG 9 2011
APP V CONTRACTOR: LLC
BY NIT J
ou orney Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J A.Gil gc hector
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Multi-Systemic Therapy(MST)services to male and female youth ages 12-
17,and their families,within Weld County as referred by Human Services. CONTRACTOR has offices in
Greeley and Fort Lupton,CO.
2. CONTRACTOR will provide MST services in accordance with the National MST model and it's standards
and guidelines.
3. 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 prosocial peers,improve youth school or vocational performance,
engage youth in prosocial 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.
4. CONTRACTOR will provide 3-5 hours of service per week for approximately 2-5 months for each family
referred by Human Services.
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.
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,750.00/client/month(Pro-rated for any partial month of service)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 711 day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES �l ' //G',
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES 0 _7 .
AND POUDRE VALLEY HEALTH CARE,INC.dba POUDRE VALLEY HOSPITAL fi:
This Agreement,made and entered into the iday of 2011,by and between the Board of J cS
Weld County Commissioners,sitting as the Board of Human Services,. n behalf of the Weld County Department of
Human Services,hereinafter referred to as the`Department,"and Poudre Valley Health Care,Inc.dba Poudre
Valley Hospital,hereinafter referred to as"Contractor".
Contractor operations Mountain Crest Behavioral Healthcare Center,a licensed behavioral health care
facility located at 4601 Corbett Drive,Fort Collins,CO 80528. Mountain Crest offers Residential Wraparound
Services.
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided funding to the Department for
Wraparound Aftercare Services(Home-Based 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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses, approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0174
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Shari Simmons,LCSW Residential Coordinator
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Shari Simmons.LCSW
P.O. Box A 4601 Corbett Drive
Greeley,CO 80632 Fort Collins,CO
(970)352-1551 (970)207-4867
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CORE-0174
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
SJ
F COUNTY
CLSIGNERS WELn ,rCOLODO
By:
Deputy Cler :'v• Barbara K rkmeyer, hair p y 2 Q q n 11
AP AS CONTRACTORS f LJ i
BY
Co ti y Contractor
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
rv(4
By:
u y .Grieg ,Direct
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PY-11-12-CORE-0174
EXHIBIT A
SCOPE OF SERVICES
1. 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"Wraparound Aftercare 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.
2. The CONTRACTOR will provide the following in the home/community to those clients referred by the
Department:
a. Team development—Support team for the family consisting of both professional and non-professional
members.
b. Monthly team meetings.
c. Practice of the Crisis/Safety Plan.
d. Facilitation of both formal and informal resources to address the family's unique needs.
e. On-call availability.
f. Weekly face-to-face contact with the family by the Wraparound Facilitator.
g. Individual and family therapy if needed by the same therapist the family worked with in residential
placement.
h. Attendance at court appointments and staffings as needed.
i. Required documentation for High Fidelity Wraparound,the Department and the court.
3. Timeline for Wraparound Services:
a. Upon Intake: Preliminary Intake Assessment
b. Within 24-72 Hours: Evaluation and Comprehensive Assessment; Initial Risk Assessment;Psychiatric
Assessment;and Health/Physical Assessment
c. Within One Week: First Family Interview, First Individual Interview; Basic Strengths,Needs, Cultural
Discovery(SNCD); Basic Functional Assessment(FA); Safety/Crisis Plan(CP);Basic Wrap Team
Development;and Psychosocial
d. Within 10 Days: Initial Team Meeting-Care Plan Development;Case manager begins working with
youth on goals
e. Within 30 Days: Comprehensive Team Meeting
f Within 30-45 Days: Decision on Wraparound Aftercare made by team(Intensive Wrap or Basic
Wrap).
4. Under Intensive Wrap,CONTRACTOR will provide the following:
a. Comprehensive SNCD
b. Comprehensive FA
c. Comprehensive CP
d. Monthly Team Meetings
e. Identified needs coming out of assessments/recommendations are;new techniques are practiced and
strengths built upon.
f. Wrap Facilitator works with the family building team development in their community.
g. Wrap Facilitator teaches the family how to build natural supports in their community.
h. Wrap team meetings are held in the family's community to assist the team in practicing treatment plan
recommendations.
i, Pass check-ins.
j. Wrap will go to the home and practice in-home techniques that are being identified in therapy.
k. Available via telephone for crisis assistance.
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5. Under Basic Wrap,CONTRACTOR will provide the following:
a. Monthly team meetings
b. Assessments and recommendations are given to the caseworker for community referrals.
c. Wrap will make recommendations to assist the family in developing a team of natural supports.
d. Pass check-ins once every two weeks.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,700.00/Month(Flat Base Rate)
$56.50/Day(Daily fee for partial months of service. Not to exceed flat monthly base rate.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause, and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their goveming bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment, declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery,falsification or destruction of records, making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that maybe required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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C71fl�ifi •
PY-11-12-CORE-0112
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND REFLECTIONS FOR YOUTH,INC.
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services, hereinafter referred to as the"Department,"and Reflections for Youth, Inc.,hereinafter referred to
as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Day Treatment Services;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services," a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
_9C/A-_3077
PY-11-12-CORE-0112
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986, P.L.99-603;
- 42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-12-CORE-0112
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$I million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-CORE-0112
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals, insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
I1. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
4
PY-1 I-12-CORE-0112
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Jeffrey J.Johnson,MA,LPC Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Jeffrey J.Johnson,MA,LPC
P.O.Box A P.O.Box 1860
Greeley,CO 80632 Berthoud,CO 80513
(970)352-1551 (970)344-1380,x202
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-1 I-12-CORE-0112
20. 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.
6
PY-11-12-CORE-0112
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
Ilia
ATTEST: •
WELD COUNTY r G, : ►Ti1 OUNTY
CLERK TO THE BOA r 1 1 f • v ERS WELD
LORADO
♦cr 1
By:
DeputyCleq: r►�^�:y ' ¢arbaraKirkmey-r,Chair LUG 2 9 2011
APP AS CONTRACTOR:•
�1
BY
Cou n ey Co ac r
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
lu y .Grieg Director
7
,?&'//, 137
PY-11-12-CORE-0112
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide comprehensive,highly structured Day Treatment services to female and male
youth,ages 11-18,as referred by the Department. Youth,age 18-21,which are considered special education
and eligible for educational services,any youth with an extensive history of aggression to self and/or others,
adjudicated sexual offenders,youth will a full-scale IQ below 70 and youth requiring routine medical assistance
(diabetes,seizure disorders,etc.)will be assessed on a case-by-case basis for admittance into the program.
2. CONTRACTOR will provide Day Treatment services with the option of one(I),two(2)or three(3)additional
enhancements at the rates noted in Exhibit B.
3. CONTRACTOR is a Medicaid provider as of February 2011.
4. CONTRACTOR will provide Day Treatment services at 1000 S.Lincoln Avenue,#190-200,Loveland,CO
80537.
5. CONTRACTOR is licensed by the Colorado Department of Human Services State Child Care Licensing.
6. Services include,but are not limited to,assessment and evaluation,development and implementation of a
treatment plan,therapy,daily information to parent and/or caretaker regarding homework and treatment goal
progress,staffings as needed(at least monthly),a discharge plan and aftercare. Parents and/or caretakers are
expected to participate in the above progression of services and will be provided detailed information at the
time of discharge.
7. CONTRACTOR will provide individual,group and family therapy to all referred youth unless otherwise
directed by the Department.
8. CONTRACTOR will provide interpretive services and transportation on a case-by-case basis as needed at no
additional cost to the Department.
9. Testing and psychiatric medication evaluations and appointments will be conducted as needed to aid in case
planning and ensure the appropriate treatment is utilized for the referred youth's maximum growth and benefit.
10. Services will be provided by Masters' level therapists who have specific training in one or more of the
following areas: Eye Movement Desensitization and Reprocessing(EMDR),Dialectic Behavioral therapy,
Cognitive Behavioral Therapy and/or Reactive Attachment Disorder.
1 I. Referred youth will receive services for approximately four(4)to six(6)months. Length of services is
dependent upon the referred youth's daily/weekly progress, individual/family needs and availability of funding.
12. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
13. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
14. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
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PY-1 I-12-CORE-0l 12
15. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
16. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
9
PY-11-12-CORE-0112
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$109.06/Day(Regular Day Treatment)
$133.06/Day(Regular Day Treatment with One Enhancement)
$I51.06/Day(Regular Day Treatment with Two Enhancements)
163.06/Day(Regular Day Treatment with Three Enhancements)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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PY-11-12-CORE-0l 12
EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND REFLECTIONS FOR YOUTH,INC.
This Agreement,made and entered into the day of 2011, by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Reflections for Youth, Inc., hereinafter referred to
as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Informed Supervision Only);and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
PY-11-12-CORE-0161
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-I 1-12-CORE-0161
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Jeffrey J.Johnson,MA,LPC Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Jeffrey J.Johnson,MA,LPC
P.O.Box A P.O.Box 1860
Greeley,CO 80632 Berthoud,CO 80513
(970)352-1551 (970)344-1380,x202
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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 COUNT OF COUNTY
CLERK TO THE O Crjt.SIONERS WELD
,COLORADO
By:
e u < ". Barbara Kirkme r,Chair
Pty Cler � I � r:0.,� zszot1
AP V AS • CONTRACTOR:
BY
Cou t Co ra t
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J .Grieg ,Direct
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide informed supervision services to individuals,parents,family members and
caretakers,who supervise juvenile sex offenders at 1000 S.Lincoln Avenue,in Loveland,CO,as referred by
the Department. Provider will consider providing services in home or in a community setting on a case-by-case
basis.
2. Services will be provided by Carol Johnson,MA,who is certified through the Kempe Center,as an informed
supervision trainer,per the requirements set forth by the Colorado Sex Offender Management Board on
Juvenile Standards.
3. CONTRACTOR will ensure that the all referred parties meet the informed supervision requirements for the care
and supervision of a youth who has committed a sex offense. This will include the primary goals of community
safety and the safety of the youth being supervised and will be addressed through the following: Safety
planning, increased awareness/understanding of the definitions of abusive behaviors,recognition and
confrontation of thinking errors, increased accountability and responsibility on the part of the supervised youth
and supervising parent(s)or caretaker(s),recognition of and intervention in the cycle of abuse,definition of
healthy and age appropriate sexuality,and increasing the supervised youth's coping skills.
4. Services will be provided over three(3)hours,occurring in the same day,and will include an exit exam to
ensure a full understanding of the material.
5. CONTRACTOR will provide interpretive services as needed.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services.If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports
will be submitted per the online format required by the Department,unless otherwise directed by the
Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$40.00/Person/Class(Up to Four Participants)
$25.00/Person/Class(Additional Participant After Four Participants)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers, and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin, be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(I) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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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 2011,by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Savio House,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding 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 1,2011, upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A "Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,'Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CORE-121
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L. 99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended, cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit- $500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-1 1-12-CORE-121
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-121
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
William S. Hildenbrand Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Grieco,Director William S. Hildenbrand,Executive Director
P.O.Box A 325 King Street
Greeley,CO 80632 Denver,CO 80219
j970)352-1551 (303)225-4014
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-1 1-12-CORE-121
20. 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.
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PY-11-12-CORE-121
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ag,a
ATTEST:
ELD COUNT ,t, . 4N OF COUNTY
CLERK TOTHE O pr _';;-, SIONERS WELD
C COLORADO
By: L
� L LOLL- r _i
Deputy Cle / I5 IA ' Barbara Kirkmeyer, hair NG 2 9 2011
AP D AS M• CONTRAC/T���O//R::// O/
` BY LN
Co A mey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
u .Grieg , hector
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PY-11-12-CORE-121
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Functional Family Therapy(FFT)services to male and female youth within
the approximate age range of 12-21 years, and their families,as referred by the Department. Services are
based in the Longmont area but serve Weld,Larimer, Boulder and northern Adams counties.
2. CONTRACTOR will provide services in accordance with the National Functional Family Therapy(FFT)
model and its standards and guidelines.
3. FFT is an intensive short-term, in-home,evidenced-based therapeutic service that empowers youth and
families with the skills and resources needed to independently address the difficulties they are having
raising their children. Youth are empowered to cope with family,peer,school and neighborhood problems;
build community and natural support systems;decrease negativity and blame among family members; and
decrease anti-social behaviors. Primary interventions include,as clinically appropriate: Family,
Cognitive/Behavioral,family therapy, and school and/or community-based.
4. Length of treatment is four(4)hours per week per family over approximately three(3)months.
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.
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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, 2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$780.00/client/month(pro-rated for any partial month of service)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees, volunteers, or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall he deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs, sentences, clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications, and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.) 26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
•
also document what barriers may be impeding progress.
Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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
families unless otherwise noted.
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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 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Savio House,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Home Based Intensive Serivces(Community Based Services-Adolescent and 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, 2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference,
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for, and reimbursement shall not he made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
- 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 eL seq.and
its implementation regulations,45 C.F.R. Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race, color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
1l. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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, ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
William S. Hildenbrand Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director William S. Hildenbrand,Executive Director
P.O. Box A 325 King Street
Greeley,CO 80632 Denver,CO 80219
(970)352-1551 (303)225-4014
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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 • •+ COUNTY
CLERK TO THE BIARr "'i ,� �� 1 NERS WELD
1861 �i��t. Y OLORADO
By
Deputy Cleo, `�, p p yv ° t� arbara Kirkmeyer,Chair ,IJG 2 9 2011
AP" gtDASTar•-ter. _ li•��6 ONTRACTOR:
BY
Co -�s ey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J A.are , Direc
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide comprehensive programming,through their Community Based Services
program,to youth referred by the Department who do not qualify for Chafee services,and 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. Services include the following:
a. Mentoring—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.
b. 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.
c. 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.
d. 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.
e. 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.
f. 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.
g. 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.
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h. 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 dependant upon the nature of the crisis and level of intervention
needed.
i. Aftercare Support—CONTRACTOR will work with the referred youth to develop an individualized
network of community services to maintain the youth after program involvement has terminated. This
will include neighborhood agencies that will assist the youth in maintaining contact with positive
influences that will provide the youth with support after discharge from the program.
CONTRACTOR also will assist the youth in identifying a significant other,role model or mentor
within the youth's social network who will continue to be a positive influence in the future.
2. CONTRACTOR will provide family preservation or reunification services,through their Community
Based Services-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 concems 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. Goals and Objectives:
i. Prevent child abuse and neglect by teaching parenting skills,eliminating safety concems and
reducing risk factors;
ii. Strengthen families so they may remain intact;
iii. Strengthen the family unit with in-home,family dictated services.
c. It is the goal of services that upon completion,referred families will possess the skills necessary to:
i. Maintain their children in their home;
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 6.5 hours of service per week/referral; 1.5 hours of administration and
5.0 hours of direct face-to-face service to the referred family.
e. CONTRACTOR will provide 24-hour crisis intervention services to referred families.
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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 will participate in team reviews of ongoing services as needed. These will
primarily include staffings and Utilization Review Team(URT)and are not considered billable
hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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, 2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,814.00/Month(Community Based Services-Adolescents. Pro-rated for any partial month of service.)
$1,600.00/Month(Community Based Services-Child Protection. Pro-rated for any partial month of
services.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs, sentences, clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex, or national origin, be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate, current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not, within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(I)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104, requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to he appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical, emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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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 2011,by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the-Department,"and Savio House,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Home Studies and Relinquishment Counseling;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1, 2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7i°day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements, CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et. seq. and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L. 99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment, construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503, 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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 he performed in a manner that will not unduly interfere with agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
William S. Hildenbrand Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A. Griego,Director William S. Hildenbrand,Executive Director
P.O. Box A 325 King Street
Greeley,CO 80632 Denver,CO 80219
(970)352-1551 (303)225-4014
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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: / 1
WELD COUNTY COUNTY
fi CLERK TO THE B AR NERS WELD
7R T OLORADO
By: / �� -, l Jo_
Deputy Clerk Barbara Kirkme r,Chair LUG 2 9 2011
AP O "(O' - : CONTRACTOR:
BY a•l
Cou ' •ttomey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICE
By:
J y A. Gri ,Dvec o
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide home study and relinquishment counseling services for families referred by
the Department.
2. CONTRACTOR can conduct foster and kinship home studies.
3. CONTRACTOR will utilize the Structured Analysis Family Evaluation(SAFE)tool developed by the
Consortium of Children. CONTRACTOR is SAFE certified and on the State's approved home study
vendor list.
4. CONTRACTOR will complete a Department of Motor Vehicle background check. All CBI,FBI and
LexisNexis background check information will be completed by the Department.
5. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of
receipt of the home study referral. A complete home study will include the study in SAFE format,
background check information, SAFE questionnaires completed by the applicants,references and all other
original documents submitted by the home study applicant.
6. Relinquishment counseling services will be provided to all adult individuals referred by the Department,as
well as associated children 12 years of age and older,utilizing the required State format. CONTRACTOR
will submit a written report and the appropriate affidavits and interrogatories.
7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any
specific Weld County home. Areas of concern may include,but are not limited to,any physical,emotional,
educational or behavioral issues. Child abuse must be reported immediately per law.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$56.00/Hour(Home Study Services and Relinquishment Counseling. Full home study not to exceed
$864.00. Home study update not to exceed$448.00.)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 715 day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate, current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven (7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible, or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, CONTRACTOR shall not enter any
third party relationship that gives the appearance of creating a conflict of interest. Upon leaming 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties, (2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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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 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Savio House,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding 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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services."a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—I et seq. and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
- its implementing regulations,45 C.F.R. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et seq. and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986, P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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, ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
William S. Hildenbrand Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Grieco,Director William S. Hildenbrand,Executive Director
P.O.Box A 325 King Street
Greeley,CO 80632 Denver,CO 80219
(970)352-1551 (303)225-4014
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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 COUNT B Ro •F COUNTY
CLERK TO THE O ` r"4 M SIONERS WELD
C.q�.��'`/COLORADO
By. itli -//Iii ��_�.�%� ` hl Z cc./
ClerkBarbara Kirkmeyr,Chair /.'JU 2 9 2011
•.r
AP ED AS CONTRACTORLe
:
BY
Co y Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju .Griego irecto
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide lower level Life Skills services to clients 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 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 concem 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 will participate in team reviews of ongoing services as needed. These will
primarily include staffings and Utilization Review Team(URT)and are not considered billable
hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract, 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
this Contract or amend it accordingly.
2. Fees for Services
$48.00/Hour(Life Skills)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees, volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their goveming bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex, or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate, and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven (7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours, have access to inspect any copy records, and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment, declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104, requiring criminal
background record checks for all employees,contractors, and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concems.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-CORE-0147
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 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Savio House,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Multi-Systemic Therapy(MST)and Multi-Systemic 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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-1 1-12-CORE-0147
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133,
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
- 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. Part2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex, religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-1 I-12-CORE-0147
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-I 1-12-CORE-0147
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses, approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
1 L Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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, ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0147
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
William S. Hildenbrand Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director William S. Hildenbrand,Executive Director
P.O. Box A 325 King Street
Greeley,CO 80632 Denver,CO 80219
(970)352-1551 (303)225-4014
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term'litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CORE-0147
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: ✓/a..—L•It• S`
W DCOUNTY t & �,- "`:+ • •D ; COUNTY
CLERK TO THE !ee, • IONERS WELD
COLORADO /
By:
Deputy Clerks ♦��� ' :arbara Kirkmeyer,C :ir !/II 2 0 2011
/ u
AP ED AST CONTRACTOR:
��
BY 77/17/414 '�
Cou omey Contractor ll
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
J y .Gri g ,Direc o
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PY-11-12-CORE-0147
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide Multi-Systemic Therapy(MST)or Multi-Systemic Therapy for Problem
Sexual Behaviors(MST-PSB)services to youth ages 12-21,and their families,as referred by the
Department.
2. CONTRACTOR will provide MST and MST-PSB services in accordance with the National MST model
and it's standards and guidelines.
3. 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 prosocial peers,improve youth school or vocational performance,
engage youth in prosocial 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 3-5 months.
4. MST-PSB is a specialized,comprehensive MST program designed to meet the needs ofjuvenile sex
offenders reintegrating into the community. Emphasis is placed on aspects of the youth's ecology that
specifically relate to the youth's sexual delinquuency and on the youth's peer relations so as to encourage
age appropriate and normative sexual experiences. Each referred family referred for MST-PSB will receive
3-4 hours of service per week for approximately 6-8 months,with a focus on caregiver participation. MST-
PSB does not utilzie group therapy.
5. CONTRACTOR will be available to referred families 24 hours per day/7 days per week via emergency
pager or cell phone.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral (excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,575.00/client/month(MST)(Pro-rated for any partial month of service)
$2,537.00/client/month(MST-PSB) (Pro-rated for any partial month of service)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7`"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph, sentence,clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current, separate, and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
1I. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery, falsification or destruction of records, making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not, within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties, (2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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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 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Savio House,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Sexual Abuse Intervention Program-SAI);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 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-1 1-12-CORE-0162
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. 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
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 a seq. and
its implementation regulations,45 C.F.R. Part 91;and
- Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973, as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan (PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum) for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
Il. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-1 I-12-CORE-0162
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall he
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
William S. Hildenbrand Executive Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director William S. Hildenbrand,Executive Director
P.O. Box A 325 King Street
Greeley,CO 80632 Denver,CO 80219
(970)352-1551 1303)225-4014
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization andior foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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PY-11-12-CORE-0162
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
D CO 1\, OF COUNTY
CLERK TOT Bt , ,' tISSIONERSWELD
4 Y,cOLORADO
By:
Deputy Clef' /�fr Q' - y arbar�yer, hair
t.JG 2 0 2011
AP V AS CONTRACTOR:
BY al76/ (e
my Atto cy Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Jud . riego,Director
7
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PY-11-12-CORE-0162
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide individual offense specific therapy, family therapy and informed
supervision training(if needed)to adolescent males and females,ages 14-20,who have committed a
sexual offense,both adjudicated and non-adjudicated sexually reactive youth and youth with boundary
issues and/or harassment behaviors,as referred by the Department.
2. CONTRACTOR targets youth who have identified caretakers who are willing to participate in the
program and provide the necessary monitoring and supervision.
3. CONTRACTOR can also serve emancipating youth with problem sexual behaviors focusing on
identifying high-risk situations,safety planning and relapse prevention,community and family support
as youth reintegrate into the community and develop independent living skills.
4. The Sex Abuse Intervention(SAI)program works with youth with problem sexual behaviors in their
homes and/or community to stop sexual abuse behavior and prevent its recurrence through monitoring,
education and therapeutic intervention provided in the community. The program utilizes a high level of
supervision and involvement and emphasizes community safety and client accountability at all times
which assists in shortening placement stays and helps youth successfully and safely transition to their
homes and families. Services include 7-8 hours of face-to-face contact per week,either in-home or in-
community services, including Offense Specific Group Treatment time. This also includes one family
session,one direct contact session,and community/school/employment checks,meetings,collateral
activities,and administrative activities.
5. All SA1 therapists receive training and supervision according to the Colorado Sex Offender
Management Board(SOMB)Standards and all staff follow SOMB training and supervision guidelines.
6. CONTRACTOR can provide polygraph services when necessary and appropriate. The Department
will pay for one(1)polygraph per year.
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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, 2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract, 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
this Contract or amend it accordingly.
2. Fees for Services
$1,833.00/Month(Pro-rated for any partial month of service)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 71°day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees, volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections,paragraphs, sentences,clauses,or phrases might he declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate, and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery,bribery, falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-1 1-12-CORE-0162
• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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PY-11-12-CORE-0178
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMANI RV 1 h, A ro SS
AND SIONNACH COUNSELING SERVICES,LLC tiff
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Sionnach Counseling Services,LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7'"day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
John Gray,M.A.,LPC Sole Proprietor
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director John Gray,M.A.,LPC
P.O.Box A 1136 E.Stuart Bldg.2,Ste.2240
Greeley,CO 80632 Fort Collins,CO 80521
(970)352-1551 (970)215-5563
I8. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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20. 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.
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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:
ELD COUNTY / B�,4%SFCOUNTY
CLERK TO THE B IA 'motge2N, IONERS WELD
- CO /COLORADO
By BY: ti, �, . �.�..�%•• ,� � r�;
Deputy Cler � �l • :arb irkmeydr,Chair
,,, ,:�•� /,JG 2 9 2011
APP ED AST CONTRACTOR-
BY
Co- o•ney Co
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
I A.Grieg ,Direct
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EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide mental health services to individual children residing in Weld County
homes as referred by the Department. Services will occur in the child's current foster home.
2. CONTRACTOR is certified in Eye Movement Desensitization and Reprocessing(EMDR).
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$90.00/Hour(Face-to-face contact in Greeley Metro Area including La Salle,Eaton and Windsor.)
$110.00/Hour(Face-to-face contact outside Greeley Metro Area including Lochbuie,Frederick and
Hudson.)
$100.00/Hour(Court Facilitation and Court Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees, agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs, internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.'
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a bather to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND SIONNACH COUNSELING SERVICES,LLC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Sionnach Counseling Services,LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Foster Parent Consultation;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7`"day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, 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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—I et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.-and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 a seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 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 sourc svpitlielscpquirset, onstruction
and services. This assurance is given in consideration of and for the ph5r or.—PntalMnilinDkid all
federal and/or state financial assistance.
My person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. My aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoena
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
John Gray,M.A.,LPC Sole Proprietor
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director John Gray,M.A.,LPC
P.O.Box A 1136 E.Stuart Bldg.2,Ste.2240
Greeley,CO 80632 Fort Collins,CO 80521
(970)352-1551 (970)215-5563
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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1N WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: r ArJ :
WELD COUN 7 t' �� OF COUNTY
CLERK TO THE :O ar 4f .. 0 SSIONERS WELD
C ' ,COLORADO
By: I.�.u t �,r►►l"•.�i.� ; Y. lC k L
Deputy Cler III ��i � � Barbara Kirkmeyer,Chair 60 2 9 2011
APPROV F CONTRACTOR:
BY
0 o y ContrP
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Judy Griego,D ctor
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide consultation services for foster children and youth residing in Weld
County foster homes. 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 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.
3. Interventions will be clinical and/or psychoeducational in nature and will aim to target issues including,
but not limited to,the following:
a. Fine tune solutions: Solution-focused in working with challenging situations
b. Developmental appropriateness of expectations
c. Social skills education
d. Power struggles
e. Collaborative work with difficult teens
f. What to do when consequences don't work
g. De-escalation of anger
h. Facilitating structure/respect
i. Behavior modification
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 will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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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
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$90.00/Hour(Face-to-face contact in Greeley Metro Area including La Salle,Eaton and Windsor.)
$110.00/Hour(Face-to-face contact outside Greeley Metro Area including Lochbuie,Frederick and
Hudson.)
$100.00/Hour(Court Facilitation and Court Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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I0. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery, bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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-I02(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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUINUNAKattgEA le: 5b
AND SIONNACH COUNSELING SERVICES,LLC
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Sionnach Counseling Services,LLC,hereinafter
referred to as"Contractor".
W ITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Foster Parent Training;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June I,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
John Gray,M.A.,LPC Sole Proprietor
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director John Gray,M.A.,LPC
P.O.Box A 1136 E.Stuart Bldg.2,Ste.2240
Greeley,CO 80632 Fort Collins,CO 80521
(970)352-1551 (970)215-5563
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-1 l-12-CPS-01 10
20. 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.
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PY-11-12-CPS-0110
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: WELD COUNTY F COUNTY
CLERK TO THE : r`!; i M TONERS WELD
r%61 v jC C• ,COLORADO
By:
Deputy Clerk r �� Barbara Kirkm er,Chair AUG 2 9 2011
r.r
APP D AS O • CONTRACTOR: ,
BY
Co y A y Con c�
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
/ I
By: ,I��.�..� /� 1_. ♦1
J A.Grie=.,Director '
7
PY-11-12-CPS-0110
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will coordinate and facilitate individualized and group training,as well as follow up
supervision/training for Weld County foster and group home parents. 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 work collaboratively with foster and group home parents,caseworkers,foster
care coordinators and other service providers to identify and address training needs.
3. CONTRACTOR will work with Department staff to identify topics to be addressed based on the
current needs of the foster and group home parents and the needs of the children in those homes.
Potential topics may include,but are not limited to,the following:
a. Reactive Attachment issues
b. Gang involvement
c. Soiling
d. Issues with authority
e. Teaching family skills
f. Effective praise
g. De-escalation of anger
h. Pre-escalation assessment
i. Behavior modification
4. CONTRACTOR will follow up with individualized supervision/training in each referred home to allow
foster and group home parents to ask additional questions pertinent to the application of the conference
information in their specific home.
5. All trainings will incorporate handouts,assessment tools,quizzes,etc.,tailored to the identified needs of
the foster and group home parents.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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PY-11-12-CPS-0110
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$90.00/Hour(Face-to-face contact in Greeley Metro Area including La Salle,Eaton and Windsor.)
$110.00/Hour(Face-to-face contact outside Greeley Metro Area including Lochbuie,Frederick and
Hudson.)
$100.00/Hour(Court Facilitation and Court Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7h day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-1 I-12-CPS-0110
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is
Child Welfare Administration funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment, declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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PY-11-12-CPS-0110
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1) lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
busi ness.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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PY-ll-12-CPS-0110
• Providers 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 providers'opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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.
14
tai
' ,_.<-4:7'
18// 1,
PY-11-12-CORE-0210 L c
CHILD PROTECTION AGREEMENT FOR SERVICES ',' f,
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES `f 1 f
AND DSW SWAN,INC.
This Agreement,made and entered into the f17-day of 2011,by and between the Board of
Weld County Commissioners,sitting as the Board o f Human Services n behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and DSW Swan,Inc.,hereinafter referred to as
"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7t°day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services funding to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CORE-0210
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Aonlicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d--I et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et. seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963; and
the Education Amendments of 1972:and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-11-I2-CORE-0210
Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD) (Minimum).
1. Combined single limit-5500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
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PY-11-12-CORE-0210
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals, insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11.
Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Cynthia Swan,MA,CMFT,LPC Owner
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Grieco,Director Cynthia Swan,Owner
P.O.Box A P.O. Box 724
Greeley,CO 80632 Niwot,CO 80544
(970)352-1551 (303)437-7505
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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20. 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.
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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: •
ELD COUNTY r . ,1* F COUNTY
CLERKTOTHE ce 1 �. .rr,9p v� IONERS WELD ,
i �. ,` �.> S ,"N�N .COL/ORADO
By: i !i/ //' i . _ w� '•Y �J~��I '"y %►'! iliWC�U Vue,//J'L;;� t
Deputy Clerk �.�r•�/► arbara Kirkmeye ,Chair //BO 2 9 nu
APP AS TO CONTRACTOR: •
Coun A � "ntractor 94 1� C 44_) //[ r./4WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
.Griego Director
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals and families(all ages)referred by the
Department.
2. Services will be provided at 685 Briggs Street,in Erie,CO.
3. Services include individual and family therapy.
4. CONTRACTOR will help referred clients assess and improve communication,functioning and relationships
with others through a solution focused,acceptance/commitment,and traditional talk therapy,combined with
experiential enactments to reveal and change faulty links between events and beliefs,which influence
behavior and communication.
5. The goal of services includes:
• Support
• Improved communication
• Improved family functioning and relationships
• Increased awareness of self and others
• Decreased anxiety
• Increased sense of safety
• Promotion of successful identification and communication of needs
6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services,
7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
8. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services.If after three (3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
9. CONTRACTOR will 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 will participate in team reviews of ongoing services as needed. These will primarily
include stuffings and Utilization Review Team(URT)and are not considered billable hours.
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10
EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,'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
this Contract or amend it accordingly.
2. Fees for Services
$120.00/Hour(Individual and Family Therapy)
$150.00/1.5 Hours(Individual and Family Therapy)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7th day of the month following the month of service.
If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
1. 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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall he deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph, sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current, separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local, federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification:and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal, state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
CHILI)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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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
wilt 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's contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TRANSITIONS PSYCHOLOGY GROUP, LLC
This Agreement, made and entered into the day of 2011, by and between the Board of
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services, hereinafter referred to as the"Department,"and Transitions Psychology Group, LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Lifeskills(Therapeutic Visitation,Coaching);and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June I,2011, upon proper execution of this Agreement and shall
expire May 31,2012.unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from
Core Services fundine during the duration of this Agreement.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7"day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, 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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to ail applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—I et.seq.and its implementing
regulation,45 C.F.R. Part 80 a seq.•and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than $I million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext.6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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. Thcsc remedial actions are as follows:
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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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Gregory Creed, Ph.D., LPC Co-Director
Name Title
Jami Moe-Hartman,MA,LPC Co-Director
Name Title
Norma A. Alkire, MA,LPC Co-Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Gregory S.Creed,Ph.D.,LPC
P.O. Box A Jami Moe-Hartman,MA,LPC
Greeley,CO 80632 Norma A.Alkire,MA,LPC
(970)352-1551 7251 West 20's Street,Unit M-2
Greeley,CO 80634
(970)336-1123
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18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
20. 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.
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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:
ELDCOV Y ��' RDOFCOUNTY
CLERK TO HE '!x? �i=4ns �1�� MISSIONERS WELD
COLORADO �
1961 NTY
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By: JJJe/ /. �..�i61 Lk_ 11, 7.'; �
Deputy Cler ' I.�1 �J Barbara KirkmeyerjCh� /
� FJG292011
AP D AS O M: CONTRACTOR: /
BY 4ir
C Attorney Co tractor
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C ractor , 1( —
WELD COUNTY DEPARTMENT ontractor
OF HUMAN SERVICES
By:
J d A.Gri go,Dir c or
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EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide Lifeskills services to clients referred by the Department,primarily in the Greeley
area. Referrals outside a 25-mile radius of Greeley,CO, will incur an additional mileage cost per Exhibit B.
Services include:
a. Therapeutic Visitation—An enhanced supervised visitation program that incorporates concepts from a
variety of therapeutic disciplines such as individual,couples and family therapy,play therapy,music
therapy,parent-child interactional therapy and parenting skills education. This blended approach is
utilized to develop individualized interventions for the family.
All contact between the parent and the child is structured to provide for the safety and well-being of
the children while maintaining the continuity of family relationships. Parents are given the opportunity
to learn and practice positive parenting.
Parents are continually assessed regarding their capacity to appropriately care for their children.
Services are available both in-office and in-home to address the continuum of care issues as the client
progresses to a less restrictive setting.
b. Intensive Lifeskills Coaching(Mentoring)—Services are designed to address family needs to prevent
placement of children or facilitate the reunification process when children return home,and enhance
the parent's capacity to provide for their children's needs. Services occur in the client's home.
2. All services will be provided by Master's,or higher, level therapists. CONTRACTOR has two bilingual
(Spanish/English)staff members.
3. CONTRACTOR will utilize a team approach to link mental health services with existing services,such as
Lifeskills or other community services to ensure a continuum of care.
4. All staffings outside Court staffings/facilitations require pre-approval from the Department's Core and Service
Contract Coordinator.
5. CONTRACTOR will provide transportation at an additional charge as approved by the Department.
CONTRACTOR will only bill for travel from the pick up location to the visit and back. Travel time to or from
the office,or other location,to the pick up or drop off location is not an allowable charge.
6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt
will occur within 24 hours of receiving the referral (excluding weekends and holidays). CONTRACTOR will
document efforts to engage client in referred services. If after three(3)attempts the client does not respond the
CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom
the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited
to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately
AND on the required monthly report.
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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 will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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, 2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$105.00/Hour(Therapeutic Visitation, Face-to-Face Contact,without Transportation)
$125.00/Hour(Therapeutic Visitation w/Transportation or Intensive Home-Based Lifeskills Coaching,
with or without Transportation, Face-to-Face Contact)
$95.00/Hour(Court Facilitation or Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7"'day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection, paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local, Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven (7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities, supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract 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 written consent of both panics.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft, forgery, bribery,falsification or destruction of records, making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any, with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TRANSITIONS PSYCHOLOGY GROUP, LLC
This Agreement,made and entered into the day of 201 I,by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Transitions Psychology Group, LLC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS, required approval, clearance,and coordination have been accomplished from and with
appropriate agencies: and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Mental Health Services(Therapy):and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 3I,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 71h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
- Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary.CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
II. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
I5. 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:
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PY-I1-12-CORE-0144
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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Gregory Creed,Ph.D.,LPC Co-Director
Name Title
Jami Moe-Hartman,MA, LPC Co-Director
Name Title
Norma A. Alkire,MA,LPC Co-Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Gregory S.Creed,Ph.D.,LPC
P.O. Box A Jami Moe-Hartman,MA,LPC
Greeley,CO 80632 Norma A.Alkire,MA, LPC
(970)352-1551 7251 West 20'"Street,Unit M-2
Greeley,CO 80634
1970)336-1123
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18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy.reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
20. 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.
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PY-11-12-CORE-0144
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: /, -_ --•
ELD COON I: ��)�a ARD OF COUNTY
CLERK TO MISSIONERS WELD
.` yNTY,COLORADO
BY By. L CK C,t J/,,. 41€ (=-
Deputy hark ) Barbara Kirkmeyer,Chair / I JG 2 9 2011
APP D AS J ) CONTRACTO(RR:�,/y/J�� /
By /ten' G��LO-Li�l►2°C
/I??
o orney Contractor
141)ThigthIlf (4) h
Contractor
WELD COUNTY DEPARTMENT ntractor
OF HUMAN SERVICES
By:
Ju .Griego,Director
7
//- a'
•
•
PY-11-1 2-CORE-0144
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide mental health services to clients referred by the Department,primarily in the
Greeley area. Referrals outside a 25-mile radius of Greeley,CO,will incur an additional mileage cost per
Exhibit B. Services include:
a. Individual Counseling—Services are available for adults and adolescents and are designed to address a
wide variety of issues that impact the individual and family. The goal of the service is to remove any
barriers to safety and well being in the home which may include, but are not limited to,behavior
problems,depression,anxiety,stress,trauma,grief and loss,health,self-image,character and treatment
compliance.
b. Couples Counseling—Services are available to couples to address existing issues in order to facilitate
long-lasting systemic change within the family. Services build upon the strengths and resiliency of the
couple in order to correct deficit areas that undermine the family's foundation.
c. Family Counseling—Services are available to families to address communication,togetherness,
flexibility,family structure, family lifecycle,and multi-generational issues. Family interactions and
resiliencies also are assessed and treated.
d. Co-Therapy—Services are provided by two Master's,or higher, level family systems therapists to
bridge services between programs and promote change in referred families in complex cases. Services
are limited to one(I)to three(3)sessions per referred family and require pre-approval from the
Department's Core and Service Contract Coordinator.
e. Play Therapy—Services are available for children two(2)and older.
f. Eye Movement Desensitization and Reprocessing(EMDR)Counseling
2. All services will be provided by Master's,or higher. level therapists. CONTRACTOR has two bilingual
(Spanish/English)staff members.
3. CONTRACTOR utilizes a team approach to link mental health services with existing services,such as Lifeskills
or other community services to ensure a continuum of care.
4. CONTRACTOR can provide transportation at an additional charge as approved by the Department.
CONTRACTOR will only bill for travel from the pick up location to the visit and back. Travel time to or from
the office,or other location,to the pick up or drop off location is not an allowable charge.
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.
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.
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PY-I I-12-CORE-0144
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 will participate in team reviews of ongoing services as needed. These will primarily include
staffings and Utilization Review Team(URT)and are not considered billable hours.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
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 31,2012.
Expenses incurred by CONTRACTOR, in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$95.00/Hour(Individual/Couples/Family Counseling, Play Therapy,EMDR without Transportation, Face-
to-Face Contact)
$1 10.00/Hour(Individual/Couples/Family Counseling,Play Therapy,EMDR with Transportation,or In-
Home Counseling without Transportation, Face-to-Face Contact)
$125.00/Hour(1n-Home Counseling with Transportation, Face-to-Face Contact)
$165.00/Hour(Co-Therapy without Transportation, Face-to-Face Contact)
$180.00/Hour(Co-Therapy with Transportation, Face-to-Face Contact)
$95.00/Hour(Court Facilitation or Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the Th day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
I. 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.
2. Weld County,the Board of County Commissioners of Weld County, its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees, volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color, sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-1 I-12-CORE-0144
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
I I. This Contract 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 written consent of both parties.
I2. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery, bribery, falsification or destruction of records,making false
statements, or receiving stolen property:
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification; and
d. Have not,within a three-year period preceding this Contract, had one or more public transactions
(federal, state, and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract, 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 contract with CONTRACTOR.
I6. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
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PY-I I-12-CORE-0144
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor, if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors, if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets, business affairs, internal operations and management procedures and those of its
customers,clients or affiliates, but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, Contractor must confirm that any individual natural
person eighteen (IS) 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States 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 Contract.
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EXHIBIT D
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 providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider 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 providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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.
a 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I 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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate, providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND VICTOR H.CORDERO,PSY.D.,P.C. 2011 This Agreement,made and entered into the day of 2011,by and between the Board of
AUG 1 8 P 2 3
Weld County Commissioners,sitting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Victor H.Cordero,Psy.D.,P.C.,hereinafter
referred to as"Contractor".
WITNF,SSETII
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of human Services has provided Core Services funding to the
Department for Mental Health Services;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows
1. Tenn
This Agreement shall become effective on June 1,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A 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. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-11-12-CORE-0136
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terns,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall he final.
6_ Assurances
CONTRACTOR shill abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. ibis includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—I et. sect and its implementing
regulation,45 C.F.R.Part 80 eL seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. S etion 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.Par 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
S. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4_ State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must he attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department nil]not compensate the Contractor for the time spent attending the required trainings.
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 nill contact the Weld County Attorney's Office immediately at 970-353-5215,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 perfonned in a manner that will not unduly interfere with agreement work.
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:
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PY-11-12-CORE-0136
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 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 he
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:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Victor H.Cordero,Psy.D. Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Victor H.Cordero,Psy.D.
P.O.Box A 2870 N. Speer Boulevard,Unit 240
Greeley,CO 80632 Denver CO 80211
(970)352-1551 (303)455-9480
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
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PY-11-12-CORE-0136
20. 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.
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PY-I 1-12-CORE-0136
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: '. 1 Ud,+
ID COUNTY ! ,r ' � ���tJNTY
CLERK TO THE BO ' P i �l S t O '!'S WELD
l8 •d� ' O RAIX)
�tf
Deputy Clerk • • Kirkmeye',Chair t,'JG 2 9 2011
APP ED AST • : ' C R:
\ QI.J49--ACTC-—
BY
Co o ey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
13y:
J .Griego, eater
PY-1 I-12-CORE:0136
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals and/or families in Weld County
referred by the Department. Services include the following:
a. Psychological Evaluation--Evaluation includes a comprehensive evaluation of the client utilizing
various assessment tools including standardized,objective,projective and otherwise normed
instructions,as well as questionnaires,mental status examination and clinical interview. Testing
and screening may include,but are not limited to,any of the following instruments;Wechsler
Intelligence Scale-Ill or subtests,Universal Nonverbal Intelligence Test,other tests of
cognitive/intellectual ability,Wechsler Abbreviated Scale of Intelligence,various informal
cognitive/neuropsychological tasks,Minnesota Multiphasic Personality Inventory-II(MMPI-II),
Personality Assessment Inventory(PAI),Milton Clinical Multiaxial Inventory-III(MCMI-III),
Milton Adolescent Clinical Inventory(MACI),Parenting Stress Index,Child Abuse Potential
Inventory,Beck Scales of Depression and Anxiety,State Trait Anger Expression Inventory,
'Trauma Symptom Checklist for Children,and other screening/testing assessments.
Face-to-face interview and testing time will range from five(5)to seven(7)hours,plus scoring,
interpretation,collateral contacts and report generation.
b. Interactional Evaluation—Evaluation of parent-child dynamics,family dynamics,capacity to
parent and overall parent ability as determined by,but not limited to,in-person observation of the
parent or family during visitation with the children,interview with the parent,parenting related
questionnaires and collateral contacts.
"These evaluations can occur at scheduled visitation time at supervising agencies,the evaluator's
office,or in the client's home.
c. Mental Health Evaluation- Specific evaluation utilized to assess for the presence of specific
mental,emotional,behavioral or psychological process. It is not a comprehensive evaluation of
personality,global functioning or intellectual capacity. Assessment is completed utilizing
screening instruments,symptom checklists,formal mental status examination,and clinical
interview,as well as psychological evaluation tools as appropriate.
Face-to-face interview and testing will range from three(3)to five(5)hours,plus scoring,
collateral contacts and report generation.
d. Individual and Family Counseling—Services to assist in identifying barriers to appropriate
parenting. Interventions arc designed to improve safety of children in the home,assist in
stabilizing the home environment and adult/caregiver behaviors,and intervene in order to affect
more positive,healthy family dynamics and functioning.
2. Services will be provided by Victor H.Cordero,Psy.D.
3. CONTRACTOR is bi-lingual(Spanish/English).
4. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
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5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
8. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include stuffings and Utilization Review Team(URT)and are not considered billable hours.
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PY-11-12-CORE-0136
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,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
this Contract or amend it accordingly.
2. Fees for Services
$1,200.00/Episode(Psychological Evaluation)
$1,200.00/Episode(Interactional Evaluation-Regardless of number of participants if one report is
produced.)
$700.00/Episode(Mental Health Evaluation)
$300.00/Hour(Partial Psychological or Interactional Evaluation. Not too exceed cost of full evaluation.)
$250.00/Hour(Partial Mental Health Evaluation. Not too exceed cost of full evaluation)
$100.00/hour(Individual,Couples and Family Counseling-Face-to-Face Contact)
$100.00/Hour(Court Facilitation or Statfmng)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify'that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7s'day of the month following the month of
service_ If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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EXHIBIT C
ASSURANCES
l. 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.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not he
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall he maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall he 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. t lave not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with 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 Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(I)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. My proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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.5. 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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States 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 Contract.
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EXHIBIT])
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 providers to comply with a standard assessment and reporting
system which will address these three areas..
The Department is requesting that provider 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 providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers' opinion.
• Providers 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. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND VICTOR IL CORDERO,PSY.D.,P.C.
This Agreement,made and entered into the day of 2011,by and between the Board of
Weld County Commissioners,sifting as the Board of Human Services,on behalf of the Weld County Department of
Human Services,hereinafter referred to as the"Department,"and Victor H.Cordero,Psy.D.,P.C.,hereinafter
referred to as"Contractor".
WITNESSETII
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific);and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Tenn
This Agreement shall become effective on June I,2011,upon proper execution of this Agreement and shall
expire May 31,2012,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by CONTRACTOR to any person(s)eligible for child protection services in
compliance with Exhibit A"Scope of Services,"a copy of which is attached by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B,"Payment Schedule,"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.
h. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred
and services provided pursuant to Exhibit A of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to
the Department by the 7a'day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service,it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. 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. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-I 1-I2-CORE-0159
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,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 Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the 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 event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,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 that have been or may hereafter be established which
relate to the Contract. 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
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.FR. Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C,Sections 6101 et.seq.and
its implementation regulations,45 C.N.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
- the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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PY-I I-12-CORE-0159
Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
S. Compliance with Child and Family Services Review
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 monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
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 provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PI,1@.PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to he provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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PY-11-12-CORE-0159
c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
1L Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings
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,ext. 6503,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 CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
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 agreement work.
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:
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PY-11-12-CORE-0159
a. Withhold payment to CONTRACTOR until the necessary cervices 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 CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Victor H.Cordero,Psy.D. Director
Name Title
17. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego,Director Victor H.Cordero,Psy.D.
P.O.Box A 2870 N.Speer Boulevard,Unit 240
Greeley,CO 80632 Denver.CO 80211
(970)352-1551 (303)455-9480
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of fimding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
5
PY-I 1-12-CORE;0b9
20. 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.
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PY-11-12-CORE-0159
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written. RQ
... ,. `
'LDCOUNT _ ,�, vt'4F COUNTY
CLERK TO THE '• r�' �� :f.IONERS WELD
86I �ti�ey� • COLORADO
4/
By: s►"„g� ! -, , L/r�
Deputy Cle ' • ` I 'I --Barbara Kirlaney: ,Chair /JO 2 9 2011
iD AS T _ CONTRAC OR:•
BY .CM5V9-4° S4eCS)1
Co mey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
J . Grie Director
7
9O//a7S%
PY-11-12-CORE-0159
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide Sex Abuse Treatment(Offense Specific)services to individuals,couples
and/or families in Weld County referred by the Department. Services include the following:
a. Psychosexual Evaluation-Evaluation includes a comprehensive evaluation of the client utilizing
various assessment tools including standardized,objective,projective and otherwise nonned
instructions,as well as questionnaires,mental status examination,psychosexual history interview
and clinical interview. All evaluations strictly adhere to the Standards and Guidelines as dictated
by the Colorado Sex Offender Management Board_ Testing and screening may include,but are not
limited to,any of the following instruments;Wechsler Intelligence Scale-III or subtests,Universal
Nonverbal Intelligence Test,Milton Clinical Multiaxial Inventory-III(MCMI-III),Parenting Stress
Index,Child Abuse Potential Inventory,Beck Scales of Depression and Anxiety,State Trait Anger
Expression Inventory,various psychosexual specific tests,various family/couples/relationship
questionnaires,Abel Assessment for Sexual Interest,Collateral Polygraph Evaluation
Consultation,and miscellaneous sexuality,beliefs/behavioral questionnaires and inventories.
Face-to-face interview and testing time will range from six(6)to nine(9)hours,plus scoring,
interpretation,collateral contacts and report generation.
b. Individual and Family Counseling—Services to assist in identifying barriers to appropriate
sexuality,healthy family sexual behaviors,family boundaries,and parenting. Interventions are
designed to improve safety of children in the home,assist in stabilizing the home environment and
adult/caregiver behaviors,and intervene in order to affect more positive,healthy family dynamics
and functioning in the day-to-day and sexual arena. This includes addressing issues specific to
sexual abuse dynamics,victim's issues,family safety,sexual behavior health,and family
accountability as a means of supporting and holding the offender accountable_
c. Non-offending Parent Curriculum- A time limited,psycho-educational understanding of
perpetrator dynamics,victim dynamics,impact of abuse on victims,and assist non-offending
parents in the development of a safety plan and safety mentality within the home to minimize
potential for future abuse of children
Services will be provided in eight(8)to 12 sessions(hours).
2. Services will be provided by Victor II.Cordero,Psy.D.
3. CONTRACTOR is bi-lingual(Spanish/English)and all services can be provided in Spanish.
4. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first
attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays).
CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the
client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract
Coordinator immediately.
5. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of services and/or the need for additional services.
6. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
S
•
PY-I 1-12-CORE-0159
7. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services.
Reports will be submitted per the online format required by the Department,unless otherwise directed by
the Department.
8. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily
include staffings and Utilization Review Team(URT)and are not considered billable hours.
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PY-1 1-12-CORE-0159
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from 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 31,2012.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Contract,whether in whole or in part,is subject to and contingent upon the
continuing availability of said finds 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
this Contract or amend it accordingly.
2. Fees for Services
$1,200.00/Episode(Psychosexual Evaluation or Parental Risk Evaluation)
$300.00/Hour(Partial Psychosexual Evaluation. Not too exceed cost oftull evaluation.)
$100.00/Hour(Individual and Family Counseling-Face-to-Face Contact)
$90.00/Hour(Non-offending Parent Curriculum)
$100.00/Hour(Court Facilitation or Staffmng)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRAC'T'OR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7"'day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service,it may result in forfeiture of payment.
b. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs
incurred and services provided pursuant to Exhibit A of this Agreement in accordance
with criteria established by the Department.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
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FY-1 I-l2-CORI3-0159
EXHIBIT C
ASSURANCES
I. CONTRACTOR agrees it is an independent contractor and that its ofticers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as 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. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request,CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall he deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or he otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR,in a central location and shall be made available to Social
Services upon its request,for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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PY-11-12-CORE-0159
10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have access to inspect any copy records,and shall be allowed to monitor and review
through on-site visits,all contract activities,supported with funds under this Contract to ensure compliance
with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the
performance of the Agreement shall be conducted by appropriate funding sources. The results of the
monitoring and evaluation activities shall be provided to the appropriate and interested parties.
11. This Contract shall he 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 written consent of both parties.
12. 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.
13. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws.
CONTRACTOR understands that the source of funds to be used under this Contract is Core Services funds.
14. CONTRACTOR assures and certifies that it and its principals:
a. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily
excluded from covered transaction by a federal department of agency.
b. I lave 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 statutes or commission of
embezzlement,theft,forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal,state,or local)with commission of any of the offenses enumerated in paragraph 12 of this
certification;and
d. Have not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships arc in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the
two relationships are in opposition.During the term of the Contract,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 contract with CONTRACTOR.
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16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. 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.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. 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 Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (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 requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract 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 Contract, 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 Contract. If Contractor
operates as a sole proprietor, it hereby swears or atfums under penalty of perjury that it(a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the fonns 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.K.S.24-76.5-103 prior to the effective date of this Contract.
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EXHIBIT I)
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 providers to comply with a standard assessment and reporting
system which will address these three areas.'
The Department is requesting that provider 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 providers.
Safety Outcomes
CFSR Outcome Measures
Safety I 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 providers
• Providers 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 arc 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 provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
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 providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider 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.
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• Providers 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 providers'opinion.
• Providers should continually assess family relationships(parenUchild,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a bather to achieving
pennanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers 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 I 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 providers:
• Providers 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.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers 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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