HomeMy WebLinkAbout20102015.tiff RESOLUTION
RE: APPROVE COLORADO WORKS PROGRAM AGREEMENT FOR SERVICES AND
AUTHORIZE CHAIR TO SIGN - NORTH RANGE BEHAVIORAL HEALTH
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 a Colorado Works Program Agreement 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 North Range
Behavioral Health, commencing July 1, 2010, and ending June 30, 2011, with further terms and
conditions being as stated in said agreement, and
WHEREAS,after review,the Board deems it advisable to approve said agreement,a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado,that the Colorado Works Program Agreement 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 North Range Behavioral Health be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 1st day of September, A.D., 2010, nunc pro tunc July 1, 2010.
BOARD OF COUNTY COMMISSIONERS
ELD COU' , _ OLORADO
ATTEST: �•� �. c� c.
� .o Rademac r, Ch •
Weld County Clerk to the : T:r•
QtaP e ara Kirkmeyer, Pro fem
Deputy Clerk to the Boar � (/—
�� Sean P. C
APP D AS L/ I C
William F. Garcia
C my Attorney EXCUSED
David E. Long
Date of signature: 9/9
0 T 0 N%� ( /�� 2010-2015
HR0081
'ot - 10 0"a C)
MEMORANDUM
if& DATE: August 30. 2010
wiriBe.TO: Douglas Rademacher. Chair,Board of County Co 'ssio rs
FROM: Judy A. Griego, Director, Human Servic pa t
(dt
COLORADO RE: Colorado Works Agreement for Services between the Weld County
Department of Human Services and North Range Behavioral Health
Enclosed for Board approval is a Colorado Works Agreement for Services between the Department and
North Range Behavioral Health. This Agreement was presented at the Board's August 30, 2010.Work
Session.
The major provisions of this Agreement are as follows:
No. Provider/Term Program Area/Funding Rates
1 North Range Behavioral Alcohol and Drug Max. $18,000 for Screening
Health Screening, Assessments, and Assessments
and Therapy Max. $5,100 for Alcohol and
July 1, 2010 —June 30, 2011 Drug Education Awareness
TANF ,
If you have any questions.give me a call at extension 6510.
2010-2015
Contract Number: TANF-10-11-0001
COLORADO WORKS 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 July 2010,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"Human Services,"and North
Range Behavioral Health,referred to as "North Range".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished
from and with appropriate agencies; and
WHEREAS,Human Services and North Range desire to enter into an agreement to
provide assistance to TANF families by offering alcohol and drug screening, assessments, and
therapy to those in need.
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and
agree as follows:
1. Term
This Agreement shall become effective on July 1, 2010, upon proper execution of this
Agreement and shall expire June 30, 2011.
2. Scope of Services
Services shall be provided by North Range to any person(s) eligible for Temporary
Assistance to Needy Families in compliance with Exhibit A"Scope of Services", a copy
of which is attached hereto and incorporated herein by reference.
3. Payment
a. Payment shall be made on the basis of Exhibit B, "Payment Schedule,"copies of
which are attached and incorporated by reference.
"Payment Schedule" shall establish the maximum reimbursement per month,
which will be paid from Temporary Assistance to Needy Families funds during
the duration of this Agreement.
b. North Range shall submit an itemized monthly bill to Human Services for all
costs incurred and services provided pursuant to Exhibit A of this Agreement in
accordance with criteria established by Human Services. The Contractor shall
submit all itemized monthly billings to Human Services no later than the
twentieth (20) day of the month following the month the cost was incurred.
Failure to submit monthly billings in accordance with the terms of this agreement
may result in North Range's forfeiture of all rights to be reimbursed for such
expenses. In the event of a forfeiture of reimbursement,North Range may
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Contract Number: TANF-10-11-0001
appeal such circumstance to the Director of Human Services. The decision of the
Director of Human Services shall be final.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent
upon the availability of Temporary Assistance to Needy Families funds.
d. Human Services shall not be billed for, and reimbursement shall not be made for
time involved in activities outside of those defined in Exhibit A. Work
performed prior to the execution of this Contract shall not be reimbursed or
considered part of this Agreement.
4. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. North Range shall provide proper monthly invoices and verification of services
performed for costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if North Range has failed to comply
with the Financial Management Requirements,program objectives, contractual
terms, or reporting requirements. In the event of a forfeiture of reimbursements,
North Range may appeal such circumstance to the Director of Human Services.
The decision of the Director of Human Services shall be final.
5. Assurances
North Range shall abide by all assurances as set forth in the attached Exhibit C, which is
attached hereto and incorporated herein by reference.
6. Compliance with Applicable Laws
At all times during the performance of this contract,North Range 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.
North Range 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
45C.F.R. (HIPAA)
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Contract Number: TANF-10-11-0001
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. 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.
7. Certifications
North Range 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.
8. Monitoring and Evaluation
North Range and Human Services agree that monitoring and evaluation of the
performance of this Agreement shall be conducted by North Range and Human Services.
The results of the monitoring and evaluation shall be provided to the Board of Weld
County Commissioners and North Range.
North Range shall permit Human Services, and any other duly authorized agent or
governmental agency, to monitor all activities conducted by the 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.
9. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
10. Remedies
The Director of Human Services or designee may exercise the following remedial actions
should s/he find North Range 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 North Range. These remedial actions are
as follows:
a. Withhold payment of North Range 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 North Range
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Contract Number: TANF-10-11-0001
cannot be performed or if performed would be of no value to the Human
Services. Denial of the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Human Services;
c. Incorrect payment to North Ranges 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 Human Services
and North Range, or by Human Services as a debt due to Human Services or
otherwise as provided by law.
11. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated
representatives of the respective parties. Either party may from time to time designate in
writing a new or substitute representative(s):
For Human Services:
John Kruse Public Assistance Administrator
Name Title
For North Range:
Wayne A. Maxwell Executive Director
Name Title
12. Notice
All notices required to be given by the parties hereunder shall be given by certified or
registered mail to the individuals at the addresses set forth below. Either party may from
time to time designate in writing a substitute person(s)or address to whom such notices
shall be sent:
To: Human Services To: North Range
Judy A. Griego, Director Wayne A. Maxwell,Executive Director
P.O. Box A 1300 North 17`"Avenue
Greeley, CO 80632 Greeley, CO 80631
13. Litigation
North Range shall promptly notify Human Services in the event that North Range learns
of any actual litigation in which it is a party defendant in a case which involves services
provided under this Agreement. North Range, 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.
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Contract Number: TANF-10-11-0001
14. 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.
15. 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 9 herein.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day,
month, and year first above written.
1E Z
ATTEST: ia
1S61 S4��
WELD COUNTY 4 BOARD OF COUNTY
CLERK TO THE BOA. ✓ CHI .`J COMMISSIONERS WELD
By: I I °!e,Si \ t BO CO O a�
Deputy Cler Do las demacher Chair
SEP 0 1 2010
APP ED AST • NORTH RANGE BEHAVIORAL
HEALTH
BY/Oct.,/U_ /1717,07
C ty Attomey Wayne A. axwell, Exec
utive utive Director
WELD COUNTY DEPARTMENT
OF HUMAN SERVICE
By:
Di for
Page 5 of 5
&r/r- ,wC/
Contract Number: TANF-10-11-0001
EXHIBIT A
SCOPE OF SERVICES:
• Screening& Scoring of Substance Abuse Subtle Screening Inventory—3 (SASSI—3) for
TANF applicants
• Level II Behavioral Health Assessment for TANF applicants
• Detoxification, Outpatient, and Residential Alcohol\Drug Treatment Options for TANF
recipients
Clients referred to treatment must meet ASAM eligibility requirements for that level of care.
Human Services' TANF Program will approve designated referrals and provide North Range with
a referral authorization.
REIMBURSEMENT:
A. Screening and assessment will be provided to Temporary Assistance to Needy Families
applicants or recipients as referred and identified by the Department of Human Services.
Payment will be a based on the following schedule:
Screenings *Assessments Rate per Month
Up to 50 per month 2 $700.00
51 to 75 per month 3 $975.00
76 to 100 5 $1300.00
* If the number of Assessments performed each month exceeds the indicated amount per these
rate groups then each additional assessment will be billed at$150.00 each.
B. Therapy options will be provided to TANF recipients as referred and identified by the
Department of Human Services.
C. SASSI forms costs will also be charged to the Department of Human Services.
See attached fee schedule (Attachment A) for treatment services if approved.
MONTHLY BILLINGS: North Range will mail monthly billings no later than the 20`h day of
each month for services rendered the month before to:
John Kruse
Weld County Department of Human Services
315 N. 11 i Ave.
Greeley, CO 80631
Payment in full for services rendered is due within thirty (30) days of the billing date.
Page 1 of 1
Contract Number: TANF-10-11-0001
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse to North Range in consideration for the work and
Services performed, a total amount not to exceed Eighteen Thousand dollars ($18,000) as
outlined in Exhibit A for screening and assessments and a total amount not to exceed
Five Thousand One Hundred dollars ($5,100) for alcohol and drug education awareness.
Expenses incurred by North Range, in association with said project prior to the term of
this agreement, are not eligible Human Services expenditures and shall not be reimbursed
by Human Services.
Payment pursuant to this Contract, whether in whole or in part, is subject to and
contingent upon the continuing availability of Temporary Assistance to Needy Families
funds for the purposes hereof. In the event that said funds, or any part thereof,become
unavailable as determined by Human Services, Human Services may immediately
terminate this Contract or amend it accordingly.
2. Submittal of Vouchers
North Range 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.
Page 1 of 1
Contract Number: TANF-10-11-0001
EXHIBIT C
ASSURANCES
1. North Range 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 North Range or its employees, volunteers, or agents while performing
duties as described in this Agreement. North Range shall indemnify, defend, and hold
harmless Weld County, the Board of County Commissioners of Weld County, its
employees, volunteers, and agents. North Rangeshall provide adequate liability and
worker's compensation insurance for all its employees, volunteers, and agents engaged in
the performance of the Agreement upon request,North Range shall provide Human
Services with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any
immunities the parties or their officers or employees may possess,nor shall any
portion of this Agreement be deemed to have treated a duty of care with respect to
any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of
the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year.
5. If any section, subsections,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. North Range 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. North Range 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 North Range.
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Contract Number: TANF-10-11-0001
9. All such records, documents, communications, and other materials shall be the
property of Human Services and shall be maintained by North Range, in a central
location and custodian, in behalf of Human Services, for a period of three (3) 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 (3)year period, or if audit findings have not been resolved after a three (3)
year period,the materials shall be retained until the resolution of the audit finding.
10. North Range 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. North Range or Human Services may not assign
any of its rights or obligations hereunder without the prior written consent of both
parties.
12. North Range certifies that Federal appropriated funds have not been paid or will be paid,
by or on behalf of North Range, 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. North Range assures that it will fully comply with all other applicable federal and state
laws. North Range understands that the source of funds to be used under this Contract is:
Family Issues Cash Funds.
14. North Range assures and certifies that it is and it's principals:
a. Are not presently debarred, suspended,proposed for debarment, declared
ineligible, or voluntarily excluded from covered transaction by a federal
depai tment of agency.
b. Have not, within a three-year period of preceding this Agreement,been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (federal, state, or local)
transaction or contract under a public transaction; violation of federal or
state antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records,making false statements, or
receiving stolen property;
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Contract Number: TANF-10-11-0001
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 with a three-year period preceding this Contract,had one or
more public transactions(federal, state,and local)terminated for cause or
default.
15. The Appearance of Conflict of Interest applies to the relationship of a contractor
with Human Services when North Range 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,North Range 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,North Range
shall submit to Human Services, a full disclosure statement setting forth the details
that create the appearance of a conflict of interest. Failure to promptly submit a
disclosure statement required by this paragraph shall constitute grounds for Human
Services' termination, for cause, of its contract with North Range.
16. North Range 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 North Range shall be disclosed in a form
identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with
North Range written policies governing access to, duplication and dissemination of, all
such information. North Range shall advise its employees, agents, and subcontractors, if
any, that they are subject to these confidentiality requirements. North Range 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.
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 North Range in the course of providing services under this
Contract will be accorded at least the same precautions as are employed by
North Range for similar information in the course of its own business.
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Contract Number: TANF-10-11-0001
18. North Range certifies it will abide by Colorado Revised Statute(C.R.S.) 26-6-104,
requiring criminal background record checks for all employees, contractors, and sub-
contractors.
19. North Range certifies that it shall comply with the provisions of Colorado Revised
Statutes (C.R.S.) 8-17.5-101, et seq. North Range shall not knowingly employ or
contract with an illegal alien to perform work under this Contract or enter into a contract
with a sub-contractor that fails to certify to North Range that the sub-contractors shall not
knowingly employ or contract with an illegal alien to perform work under this Contract.
North Range 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 Human 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). North Range shall comply with all reasonable requests made
in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Depaittuent of
Labor and Employment. If North Range fails to comply with any requirement of this
provision or C.R.S. 8-17.5-101, et seq., Human Services may terminate this Contract for
breach and North Range shall be liable for actual and consequential damages to Human
Services.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3),
if North Range receives federal or state funds under this Contract, North Range 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 North Range 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.
Page 4 of 4
Contract Number: TANF-10-11-0001
ATTACHMENT A
Fee Schedule
2010-2011
Assessments
Level II Behavioral Health Assessment $150.00
Off-site Level II Behavioral Health Assessment $250.00
Treatment Options
Co-Occurring Alcohol and Drug with Domestic Violence $ 25.00/hour
Group Therapy($50 per group)
Family Therapy($80 session maximum) $ 80.00/hour
Intensive Family Therapy ($80 session maximum) $ 80.00/hour
Individual Counseling $ 70.00/hour
Substance Abuse Group Therapy($50 per group) $ 25.00/hour
Adult Intensive Outpatient Group ($60 per group) $ 30.00/hour
Women's Services
Level II Behavioral Health Assessment $150.00
Individual Counseling $ 70.00/hour
Group Counseling ($50 per group) $ 25.00/hour
Special Connections-Treatment for pregnant women and postpartum
women (Medicaid reimbursement eligible)
• If on Medicaid,North Range will bill Medicaid directly.
• If not on Medicaid, fees are as stated above in Women's
Services.
Youth Services
Adolescent Detox $185.00/day
Adolescent lOP ($60/Group) $ 30.00/hour
Level II Behavioral Health Assessment $150.00
Family Counseling $ 80.00/hour
Individual Counseling $ 70.00/hour
Outpatient Group Counseling($50 per group) $ 25.00/hour
Miscellaneous Services
Case Aide/Case Management Services $ 35.00/hour
Expert Court Testimony(Non-Medical) $ 70.00/hour
Case Consultation(Interdisciplinary Assessment Process) $ 35.00/hour
Enhanced Services Negotiated on a case
by case basis.
Substance Abuse Residential Services
Adult Residential Services(North Range) $132.00/day
Out-of-Area Adolescent and Adult Residential Services Negotiated on
individual basis.
Methadone Negotiated on
individual basis.
Other Services
Breathalyzer Testing $ 5.00/test
Urinalysis Testing(7-Panel) $ 15.00/test
Urinalysis Testing(5-Panel) $ 12.00/test
Contract Number: TANF-10-11-0001
UA Confirmation -GCMS. $ 35.00
Monitored Antabuse (If client is currently enrolled in weekly counseling No Charge
program(s) of North Range Center.)
Patch Monitoring(includes confirmation) $ 50.00/patch
SWAB $ 15.00/test
SWAB Confirmation—GCMS $ 35.00/each
�� 41
DATE(AIM/DDIYYYY)
coRDCERTIFICATE OF LIABILITY INSURANCE NPORTH 2 06/23110
PRODUCER ' _ _-- � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rich & Cartmill Ins of CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
of Colorado LLC HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
8213 W. 20th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Greeley CO 80634 _ -W~ '
Phone: 970-356-8030 Fax:970-356-8032 ,INSURERS AFFORDING COVERAGE NAIC#
INSURED i INSURER A: ACE American Ins Co ! 22667
INSURFRR- Pinnacol Assurance '
North Range Behavioral Health i INSURER C__. AC@ Property & Casualty
1300 N. 17th Avenue !INSURER D'
Greeley CO 80631 I
�... ----............ .. ------._ __._
'INSURER F I
COVERAGES
THE POLICIES or INSURANCE LISTED BELOW HAVE SEEN ISSUED ro iiiE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONritAc1 OH OTHER DOCUMENT WITI•I RL'SPEC T TO WHICH THIS CERTIEICATE MAY RE ISSUED OR
MAY PERTAIN.THE INSURANCE Arr onoED BY runt'POLICIES DESCRIBED I IL'-REIN IS SUBJECT 10 O ALL'1HE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LMFTS SHOWN MAY ILAVE BEEN REDUCED BY PAID CLAIMS
INSR IAOD'V' .----' ._....------ I POLICY EFFECTIVE:POLICY•EXPIRATION! •
LTR INSRQ TYPE OF INSURANCE . POLICY NUMBER IDATE(MMIDDIYYYYj _DATE(MMIDD/YYYY)! LIMITS
' =GENERAL LIABILITY • I I• -EACHOCCURRENC( i s 1,000,000
UAMAGE'10 RENTED "-
A - X •X ••COMMR.HCIA:.GENLRALLIARIIITY •1 SVRA37799361001 07/01/10 07/01/11 !PREMISESI[aocalrwltey s 250,000
• i : :(Amos MAOF i X •OCCUR. ! I MED EXP(Any one pnmon)_.. .S 10,000--•_
I I ' PERSONAL ILADV INJURY S 1,000,000
l !GENERAL AGGREGATE $3,000,000
GENT.AGGREGATE LIMI1 APPLIES PER' PRODUCTS•COMP/OP AGO^i 3,000,000
EX POLICY I I iFCOT I 1 Loc I ! Emp Ben. 1,000,000
I AUTOMOBILE LIABILITY COMBINED! I r
i SMIGLE LIMIT $1,000,000
A 'X ANY AUTO CALH08614611001 07/01/10 07/01/11 �(E" widens)
ALL OWNED AUTOS :BODILY INJURY I
'E
(Per person)
SCHEDULED AUTOS I
i
HIRED AUTOS BODILY INJURY
. . . I Is
• •NONCANNY.D AUTOS i {(Poi aaldenq
i ( !PROPERTY DAMACL
.. . ...._ . _.. .. ...._.... S
IPM!BrJ.'I0YnI)
�J GARAGE LIABILITY ----------- -_—� AVID ONLY•r:A ACCIDENT $ _--
(A.NY AU 1 LJ OTHER IRAN
I A ACC
____..._..._...... .... i...._..._. .......
mot''$
_.)
EXCESS i UMBRELLA LIABILITY i • ' I'Hi:H Ih.CLIRREN:A I$2,000,000
C 'X occult 1 CLAIM.`.MADE I XOOG25503740001 07/01/10 07/01/11 !AGGREGATE $2,000,000
s
. !!)EOIXC1 IDLE. '. •
i
iX RF_FENTION $10,00v i •s
IrV('otAliJ•'-ZTfiT—_�_
WORKERS COMPENSATION X I TORY LNITS; ? ER
•AND EMPLOYERS'LIABILITY Y/N - -- - - 1
+
B ANY I.LHM ICTCrn•ARiN1,UXI•+1!iilvl'i ( 4044331 i 07/01/10 07/01/11 I:L [A:;II i.ICiINI .., 1100000
Ot.i10ERR.L•MUE t XCI.UDr.lr- I;
•
(Man i___
(Mandatory in NH) ,: I. DISEASE.-FA EMPLOYEE $100000 ,.
11 vns.•Yrsrr.bc n:�.l.r f
11 ves.U.c+'ItU,,,,i NS Deno,, i..i. DISEASE. POLICY I IMIT !$500000
i OTHER •
•
A ' Professional Liab ' OGLG2550382A001 07/01/101 07/01/11 : Aggregate $`_,000,000
I
I
— — : Ea incide $3,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSE_MENT I SPECIAL PROVISIONS -
State of Colorado is listed as additional insured where their interest may
appear. 10 day cancellation provision still applies for non-payment.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
WELDHS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 60 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHAI_I.
Weld County Department of IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Human Services REPRESENTATIVES.
315 N 11th Ave AUTHORIZED REPRESENTATIVE
Greeley CO 80631 Michael J Schmitt CIC
I
ACORD 25(2009/01) )T 1988.2009 ACORD CORPORATION. All rights reserved.
The ACC RD name and logo are registered marks of ACORD
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