HomeMy WebLinkAbout20102187 RESOLUTION
RE: APPROVE EIGHTEEN (18) CHILD PROTECTION AGREEMENTS FOR SERVICES
WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with eighteen (18) Child Protection Agreements
for Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and the providers
listed within Exhibit"A", commencing June 1, 2010, and ending May 31, 2011,with further terms and
conditions being as stated in said agreements, and
WHEREAS,after review,the Board deems it advisable to approve said agreements,copies
of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the eighteen (18) Child Protection Agreements for Services between the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Services, and the providers listed within 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 20th day of September, A.D., 2010, nunc pro tunc June 1, 2010.
• BOARD OF COUNTY COMMISSIONERS
ELD CO L TY, COLORADO
ATTEST: v `► . l_1
%Do.gl•s Rade .cher air
Weld County Clerk to the •('.•t". r
-!r _ 1:a •ara Kirkmeye , Pro-Tem
BY: .e . a �/�11;`.S .u`It°-'4.j ,
Deputy Clerk to the Boar: `F r
Sean P. C ay � —
AP O DAST M: (,If
4
Miriam . Ga
ounty A orney °LN,I C4 C .
David E. Long
Date of signature: 744"
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V I a C1 2010-2187
HR0081
MEMORANDUM
(170(\e 'aii DATE: September 14, 2010
' TO: Douglas Rademacher, Chair, Board of Common rs
Judy i A. Gr ego, Director, Human ices tepartm nt
COLORADO
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 May 10,
2010, Work Session.
The major provisions of these Agreements are as follows.
Program ArealFunding
Provider Source PY10-11 Proposed Rate(s)
Victor H. Cordero, PsyD, Mental Health Services $1,200.00 (Psych or Interactional)
PC $700.00 (MHA)
Core $300.00/Hr(Hrly rate for partial services
06/01/10-05/31/11 $100.00/Hr(Ind./Cpl/Fam. Therapy)
$100.00/Hr(Court Facilitation/Staffing/
Testimony)
Max. $25,000.00
Victor H. Cordero, PsyD, Sex Abuse Treatment $60.00/Hr
PC Max.$500.00
Core
06/01/10-05/31/11
Counseling Services of Anger/DV, Monitored $25.00/15 Contact Segments(Antabuse, Daily
Longmont, Inc. Sobriety, Substance Abuse Breathalyzers and Random Breathalyzers)
Treatment $20.00/15 Contact Segments (Twice Daily
06/01/10-05/31/11 Breathalyzers)
CW Admin $10.00/Episode (Urinalysis- 1 Drug Panel)
$11.00/Episode (Urinalysis-2 Drug Panel)
$12.00/Episode (Urinalysis- 3 Drug Panel)
$13.00/Episode (Poly Screen)
$25.00/Episode (Saliva Test-5 Drug Panel)
$15.00/Episode(Saliva Retest/Drug)
$3.00/Episode (Breath Test- One Time)
$150.00/Episode (Drug and Alcohol Evaluation)
$60.00/Episode (Domestic Violence Intake)
$150.00/Episode (Domestic Violence Intake
with Drug and Alcohol Evaluation)
$100.00/Episode (Anger Management
Assessment)
$60.00/Episode (Anger Management Intake)
$30.00/Episode (Anger/DV Session)
Max. $25,000.00 EXHIBIT
2010-2187
11
Dynamic Family Design, Home Study/ $970.00 (Full HS)
LLC Relinquishment Counseling $225.00 (Ea. Add. Adult)
$485.00 (Update HS)
06/01/10-05/31/11 CW Admin $48.50 (Hrly Rate after 4 hrs of service)
$200.00 (Cancelled HS/1-4 hrs of service)
$50.00 (Mileage- HS outside Weld)
$65.00/Hr(Relinq, HS- 1 hr)
$15.00/Episode (Mileage, Relinq outside Weld
$75.00 (Court Testimony- 1 hr)
Max. $35,000.00
Dynamic Family Design, Home-Based Services $300.00/Episode (FPFC Compatibility
LLC Evaluation)
Core $75.00/Hr(Hourly rate for service if cancelled
06/01/10-0531/11 before completed)
$75.00/Hr(Hourly rate for service—transitional
services)
$15.00/Episode (Flat rate for mileage for
referrals outside Weld)
$75.00/Hr(Court Testimony, 1 hr min.)
Max. $3,000.00
Garson, Jon Mental Health Services $95.00/Episode (Individual and Family Therapy)
$50.00/Episode (Group Therapy)
06/01/10-05/31/11 Core Max.$20,000.00
Griffith Centers for Anger/DV $375.00/Episode (Anger/DV Eval)
Children -Chins Up $30.00/Hr/PP (Anger Group)
CW Admin $30.00/Episode/PP (Group, 1.5 hrs, =>6)
06/01/10-05/31/11 $30.00/Hr/PP (DV Group)
$45.00/Episode/PP (DV Group, 1.5 hrs, =>6)
Max.$15,000.00
Griffith Centers for Home-Based Services $48.00/Hr(Family Preservation Services)
Children -Chins Up Max. $5,000.00
Core
06/01/10-05/31/11
Griffith Centers for Lifeskills $36.00/Hr(Parenting Skills)
Children -Chins Up $30.00/Hr/Fam. (Parenting Skills Grp, >6)
Core $45.00/1.5 Hr/Fam. (Parenting Skills Grp., =/>
06/01/10-05/31/11 6)
Max.$20,000.00
Griffith Centers for Mental Health Services $52.00/Hr(Ind. Therapy)
Children -Chins Up $56.00/Hr(Fam. Therapy)
Core $75.00/Hr(EMDR)
06/01/10-05/31/11 $150.00 (MHA)
Max.$10,000.00
Griffith Centers for Sex Abuse Treatment $30.00/Hr/PP (SO TX Grp, <6)
Children - Chins Up $45.00/1.5 Hr/PP (SO TX Grp, =/> 6)
Core $50.00/Hr(SAI)
06/01/10-05/31/11 $30.00/Hr/Fam (Informed Supervision Grp, <6)
$60.00/Sess/Fam (Informed Supervision Grp,
>6)
$50.00/Hr/PP or
$100.00/Sess. (Informed Supervision - Ind.)
Max.$500.00
The Kempe Center of the Foster Parent Consultation, $125.00/Hr
University of Colorado Home Based Services, $165.00/Hr
Denver- School of Life Skills, and Therapeutic $121.00/Hr (Lifeskills, Therapeutic Visitation, In-
Medicine, AMC Campus Visitation office Therapeutic Services)
$110.00/Hr (Court Testimony)
06/01/10-05/31/11 Core $100.00/Hr (TDM/Staffing)
Milestones Counseling Foster Parent Consultation $540.00 (Evaluation, Intervention, Feedback)
Services, LLC $90.00/Hr (Add. Follow up)
Core Max. $1,000.00
06/01/10—05/31/11
Milestones Counseling Home Study $950.00 (Full HS)
Services, LLC $250.00 (Ea. Add. Adult)
CW Admin $550.00 (Update HS)
06/01/10—05/31/11 $250.00 (Cancelled HS/1-4 hrs of service)
$.30/Mile (Mileage- HS outside Weld)
$80.00/Hr (Relinquishment Counseling)
$100.00/Hr(Court Testimony)
Max. $10,000.00
Milestones Counseling Mental Health Services $250.00/Episode (Mental Health Assessment)
Services, LLC $80.00/Hr (Family, Couples, Individual and Play
Core Therapy)
06/01/10—05/31/11 Max.$5,000.00
Transitions Psychology Lifeskills $105.00/Hr(Visitation, Mentoring w/o
Group, LLC Transportation)
Core $125.00/Hr(Visitation, Mentoring w/
06/01/10—05/31/11 Transportation)
$95.00/Hr(Court Facilitation/Staffing)
$150.00/Hr(Court Testimony)
Max. $78,500.00
Transitions Psychology Mental Health Services $95.00/Hr (Individual/Family/Couples
Group, LLC Counseling, Play Therapy or EMDR w/o
Core Transportation)
06/01/10-05/31/11 $110.00/Hr((Individual/Family/Couples
Counseling, Play Therapy or EMDR w/
Transportation)
$180.00/Hr(Co-Therapy w/Transportation)
$165.00/hr (Co-Therapy w/o Transportation)
$95.00/Hr (Court Facilitation/Staffing)
$150.00/Hr(Court Testimony)
Max. $70,000.00
Walker, Stephanie Home Studies $925.00/Episode (Full Home Study)
$400.00/Episode (Update Home Study)
06/01/10—05/31/11 CW Admin $ .50/mile (per mile after 45 mile radius of
Loveland)
$75.00/Hr(Court Testimony)
Max. $10,000.00
If you have any questions, give me a call at extension 6510.
ifse-017P--))
PY-10-11-CORE-0136 �•
CHILD PROTECTION AGREEMENT FOR SERVICESv
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
•AND VICTOR H.CORDERO,PSY.D.,P.C. .3
AND
This Agreement,made and entered into the day of 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 the"Department,"and Victor H.Cordero,Psy.D.,P.C.,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 TI IEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1 Term
This Agreement shall become effective on June 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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-I0-I 1-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.
h. 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 he 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,douments,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 Pav 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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P Y-10-11-CORE-0136
Included is 45 C.P.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 tile a complaint either with
the Colorado Department of Human Services or with the U.S. Department of IIealth and Human Services,
Office for Civil Rights.
R_ 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.
h. General Liability(PL&PD)(Minimum).
L 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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PY-1 0-11-CORE-0136
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.
I. 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 training&
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 he 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 he defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
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PY-10-11-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 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.
I6- 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. 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 'I'o: 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-10-I 1-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 0-1 l-CORE-0I36
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written
ATTEST:
WELD �lT f'f h, OARD OF COUNTY
�. ��.
CLER I1/42 OMMISSIONERS WELD
OUN COLO
By: l/may /i i *:_rJ�/-1'llr�j , Bv: 1
Deputy Cle �� � Chair Dougla Rademacher
AP :D AS T CONTRAC OIZ: '�}��g�p.e-.. \/
BY � \ ' Q
Co -Attorney Contractor
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
J v .Griego, hector
7
PY-10-1I-CORE 0136
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals,couples and/or families in Weld
County referred by the Department. Services include the following:
a. Psychological/Psychosexual Evaluations—Evaluations include a comprehensive evaluation of the
client utilizing various assessment tools including standardized,objective,projective and otherwise
named 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-III 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-Ill(MCMI-III),
Millon Adolescent Clinical Inventory(MAO),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 Evaluations—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 front three(3)to five(5)hours,plus scoring,
collateral contacts and report generation.
d. Individual,Couples and Family Counseling—Services to assist in identifying barriers to
appropriate 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.
2. Services will be provided by Victor H. Cordero,Psy.D. Dr. Cordero is Sex Offender Management Board
certified at the Associate Level.
3. CONTRACTOR is bi-lingual(Spanish/English).
4. CONTRACTOR will submit a report on a monthly basis for each active ongoing referral. Reports will be
submitted per the online fonnat required by the Department unless otherwise directed by the Department.
For evaluation services,the CONTRACTOR will submit a portion of the evaluation,and submit a full,
original copy to the referring caseworker.
5. CONTRACTOR will participate in team reviews of ongoing services as needed.
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PY-10-11-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 Core Services funding,not to exceed$25,000.00.
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,if Core Services funds,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/Psychosexual Evaluation)
$1,200.00/Episode(Interactional Evaluation-Regardless of number of participants if one report is
produced.)
$300.00/Hour(Partial Psychological,Psychosexual or Mental Health Evaluations)
$700.00/Episode(Mental Health Evaluation)
$100.00/Hour(Individual,Couples and Family Counseling-Face-to-Face Contact)
$100.00/Hour(Court Facilitation, Staffing and Testimony)
Department referrals will not he sent to collections by Contractor for default of co-pay/fees. Services will
he 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_ Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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-10-11-CORE-0136
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,
he denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
S. 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 he
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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FY-l 0-1 I-CORE-0136
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 he 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 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-10-1 l-CORE:0136
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 infomtation 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 (h) 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-
765-103(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, (h) 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 fonns 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 contact 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 he 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 arc 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.
PY-10-I I-CORE-0136
• Providers should continually provide recommendations about whether any out-of-home placement
continues to he appropriate and should make recommendations regarding when changes in this area should
he 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 bathers 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-10-11-CORE.-0159
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES' ,
AND VICTOR H.CORDERO,PSY.D.,P.C.
This Agreement,made and entered into the day of 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 the"Department,"and Victor H.Cordero,Psy.D.,P.C.,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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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-10-11-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 inured 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 he 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 aclstowledges 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.I .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 1975,421I.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-10-I 1-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 I Inman Services or with the U.S.Department of Health and Human Services,
ORice 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.
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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PY-10-11-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 completer!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. Try
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 perthrmed 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-10-1 I-CORE-0 1 59
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance arc
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,ernr,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the I)epartment and CONTRACTOR,or by the Department as a debt due
to the Department or othemise 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,Psv.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 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.
5
PY-10-I I-CORE-0159
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-I0-11-CORE-0159
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
UNTY BOARD OF COUNTY
O �.-.� tO THE BOARD COMMISSIONERS WELD
I�t %',; ` •.r� COUNT , IOLORADO
��Yj/�
By: 15�hg
hair Vonglas (Rademacher
SEP 2 2010
APY. D AS CONTRA OR:
4-R Qa&-tA9CV
Co ey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By 2'
J A.Grieg ,Director
7
aG/D-9a7
PY-I 0-11-CORE-0159
EXHIBIT A
SCOPE OF SERVICES
t. CONTRACTOR will provide Informed Supervision services to non-offending parents in Weld County as
referred by the Department.
2. CONTRACTOR will provide non-offending parents with 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.
3. Services will be provided in eight(S)to 12 sessions(hours).
4. Services will be provided by Victor H.Cordero, Psy.D.
5. CONTRACTOR is hi-lingual(Spanish/English).
6. CONTRACTOR will submit a report detailing the outcome of ongoing services per the online format
required by the Department.
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FY-10-11-CORE-0159
EXHIBIT B
PAYMENT SCHEDULE
l. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services perfonned
from Core Services funding,not to exceed$500.00.
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,if Core Services funds,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
inunexiiately terminate this Contract or amend it accordingly.
2. Fees for Services
$60.00/Hour(Informed Supervision for Non-offending Parent)
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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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-10-I 1-CORE-0159
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 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 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 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 nc,ossary to resolve any matters which may he 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 he retained until the resolution of the
audit finding.
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PY-1 0-11-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 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. 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 fix 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
minors 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 intonation 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 tails 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)(9). 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.K.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-
765-103(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 O-I 1-CORE-0159
• 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
he 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 banter to achieving
permanency. Providers should document ongoing efbrts 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 he 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-10-II-CPS-0119
I-CPS-01 19
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COUNSELING SERVICES OF LONGMONT,INC.
D- , 26
This Agreement,made and entered into the day of��4 . 2010, by and between the Board of
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 Counseling Services of Longmont,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 Child Welfare Administration
funding to the Department for Anger/Domestic Violence Evaluation and Treatment; Monitored Sobriety Services;
and Substance Abuse Evaluation and Treatment;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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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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PY-10-11-CPS-0119
Included is 45 C.F.R. Pan 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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PY-10-11-CPS-0119
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 a0
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 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 retum 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-10-11-CPS-0119
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:
Yolanda Cavazos-Pond, MA,CAC III 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 Yolanda Cavazos-Pond,MA,CAC III
P.O. Box A 1129 Francis Street
Greeley,CO 80632 Longmont,CO 80501
(970)352-1551 (303)772-3853
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 10 herein.
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PY-10-11-CPS-0119
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: ✓
WELD C . BOARD OF COUNTY
CLERK T• H � , OMMISSIONERS WELD
i0 ', `OUNY,COLORADO
By: �i bat ;i�,'��`J. �`' + y c cL4 &2 Ako c
Deputy Cler �� ® \ Chair�Douglas Rademacher
//JJ `� SEP 2 0 2010
APPRkk) D AS • CONTRACTOR•
// /
BY /6;141--/fir WGrr
Co ty Att ey ontractor
WELD COUNTY DEPARTMENT
OF HUMA SERVIC
By:
y A. G ego, Di ct r
7
PY-10-II-CPS-0119
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Anger/Domestic Violence Evaluation and Treatment; Substance Abuse
Evaluation and Treatment;and Monitored Sobriety Services to clients referred by the Department.
2. CONTRACTOR can currently serve adult clients for Anger/Domestic Violence and Substance Abuse
issues, and both adults and adolescents for Monitored Sobriety Services. CONTRACTOR is seeking
certification through ADAD to provide adolescent Substance Abuse services in the future.
3. CONTRACTOR will provide services primarily at 1129 Francis Street, in Longmont,CO.
CONTRACTOR also has a small satellite office at 555 alter St., #19D, in Broomfield,CO.
4. Monitored sobriety results will be reported through Norchem and will be available within 48 hours. Both
positive and negative results will be faxed to the Department at(970)346-7667 since results cannot be
accessed directly online. Additionally, the referring caseworker will be notified immediately by phone call,
e-mail or fax if results are positive.
5. Minors receiving monitored sobriety services must attend their first monitoring session with a legal
guardian. The legal guardian must sign consent forms.
6. CONTRACTOR will submit a monthly report for each client participating in ongoing services (Anger
Management or Substance Abuse treatment). Reports should be submitted with monthly billing and will be
distributed to the referring caseworker.
7. CONTRACTOR will participate in reviews of ongoing services as requested.
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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 Child Welfare Administration funding,not to exceed $25,000.00.
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, if Child Welfare Administration funds,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
$25.00/15 Contact Segments(Antabuse, Daily Breathalyzers and Random Breathalyzer)
$20.00/15 Contact Segments(Twice Daily Breathalyzers)
$10.00/Episode(Urinalysis- I Drug Panel)
$11.00/Episode(Urinalysis-2 Drug Panel)
$12.00/Episode(Urinalysis-3 Drug Panel)
$13.00/Episode(Poly Screen)
$25.00/Episode(Saliva Test-5 Drug Panel)
$15.00/Episode(Saliva Retest/Per Drug)
$3.00/Episode(Breath Test-One Time)
$150.00/Episode(Drug and Alcohol Evaluation)(Includes intake when necessary and requested.)
$60.00/Episode(Domestic Violence Intake)
$150.00/Episode(Domestic Violence Intake with Drug and Alcohol Evaluation)
$100.00/Episode(Anger Management Assessment)(Includes intake when necessary and requested.)
$60.00/Episode(Anger Management Intake)
$30.00/Episode(Anger Management/Domestic Violence 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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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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.
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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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.
I8. 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 DYNAMIC FAMILY DESIGN,LLC
This Agreement,made and entered into the day of 2010,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 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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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 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 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-10-lI-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 36376 Mason View Road
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 13 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 COQ' r rPc ARD OF COUNTY
CLERK T ,. , `tMMISSIONERS WELD
`1181 t� /:` `i$UN Y,COLORADO
,�.�:� , . it ` n'Ig &Lc
By: f /: Il . :. fk7
Deputy Clerk � n� � , hair ougla Rademacher
APP' a AS TO ! ! : CONTRACTOR:
BY
Co r A orney Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J d A.Grieg , irecto
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PY-10-11-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
from Child Welfare Administration funding,not to exceed$35,000.00.
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, if Child Welfare Administration funds,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
$970.00/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)
$48.50/Hour(Cancelled home study after 4 hours of service)
$50.00/Episode(Mileage,Home Studies outside Weld County)
$65.00/Hour(Relinquishment Counseling,one(1)hour minimum)
$15.00/Episode(Mileage,Relinquishment Counseling outside Weld County)
$75.00/Hour(Court testimony,one(1)hour minimum)
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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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 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 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 2010,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 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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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 Se 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.
or/c)--,9/g7
PY-10-11-CORE-0191
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.
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 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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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.Grieco,Director Keith P.Wawrzvniak,Jr.
P.O.Box A 36376 Mason View Road
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 13 herein.
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PY-10-11-CORE-0191
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: �`_►
WELD CO Q °t-t L' OF COUNTY
CLERK TO u E ISSIONERS WELD
Ib61 i�,� 1 Y,COLORADO
By: i.?�r� .+.' 043 ffi atk'!
Deputy Clerk ud i Chair/ Doug s Rademacher
S P 2 0 20
APP OVF AS TO-FORM: CONTRACTOR
BY -41
Contractor
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
Ju .Griego vector
7
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PY-10-11-CORE-0191
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Foster Parent/Foster Child Compatibility(FPFC)Evaluation services for
foster and foster-adopt families referred by the Department.
2. The FPFC Evaluation will asses for the appropriateness of placement of a foster/foster-adopt child(ren)
who needs to move from a foster home to a foster-adopt home. CONTRACTOR will:
a. Acquire information specific to the foster/foster-adopt child being considered for adoption from
the caseworker.
b. Acquire and review previously completed home studies.
c. Conduct approximately 1-1/2 to 2 hour visit foster/foster-adopt parents at their residence which
will include a safety inspection.
d. Utilize a Compatibility Inventory checklist similar to the one used in the SAFE Home Study to
determine if prospective foster/foster-adopt parents have the skills to manage the identified special
needs and challenging behaviors unique to the child being considered for placement.
e. Provide a two to three page evaluation within 30 days of receipt of a referral from the Department.
The evaluation will include reasons that support placement or non-placement of the child being
considered for placement.
3. CONTRACTOR also will provide transitional services, if referred by the Department,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.
4. 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.
5. CONTRACTOR will participate in reviews of ongoing referrals as necessary.
6. CONTRACTOR will submit monthly reports of ongoing services with monthly billing. Reports will be
submitted through the on-line system unless otherwise directed by the Department.
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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 Core Services funding,not to exceed$3,000.00.
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, if Core Services funds,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
$300.00/Episode(Foster Parent/Foster Child Compatibility Evaluation)
$75.00/Hour(Hourly Rate of Service-Cancellation)
$75.00/Hour(Hourly Rate of Service-Transitional Services)
$15.00/Episode(Flat Rate per Referral Outside Weld County)
$75.00/Hour(Court Testimony, I-Hour Minimum)
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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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 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 JONATHAN W.GARSON,LCSW
This Agreement,made and entered into the day of 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 the"Department,"and Jonathan W. Garson,LCSW,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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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-10-1 l-CORE-0138
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 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.
IS. 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-10-11-CORE-0138
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:
Jonathan W.Garson,LCSW Private Practice
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 Jonathan W.Garson,LCSW
P.O.Box A 229 Terry Street
Greeley,CO 80632 Longmont,CO 80501
(970)352-1551 (303)494-1634
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-10-11-CORE-0138
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: jL��•iliIJ,•
WELD C i �' A1: - ARD OF COUNTY
CLERK I` T :�':';.� �MMISSIONERS WELD
UNT COLORADO
rrgt
By: i / �T.%!�.L?�i / � :
Deputy Clerk ltJ R A t4 C air ougla RademachLYgp 2 0 2010
:; :; -
CONT- C ntrac r
WELD COUNTY DEPARTMENT
OF HUMAN ERVICE
By:
J d A.Gri o,Directo
7
PY-10-I 1-CORE-0138
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide offense-specific mental health treatment services to youth referred by the
Department.
2. Treatment services will be provided utilizing group sessions,individual sessions and family sessions.
3. Services will only be provided under the terms of this contract by Jonathan W. Garson,LCSW.
4. CONTRACTOR is sensitive to multicultural issues and will utilize interpretive services as necessary.
5. CONTRACTOR will bill the Department on a monthly basis per the terms of this contract.
6. CONTRACTOR will submit a report on a monthly basis for each active referral. 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.
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PY-10-1 l-CORE-0138
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 Core Services funding,not to exceed$20,000.00.
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,if Core Services funds,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 Therapy)
$95.00/Hour(Family Therapy)
$50.00/Hour(Group 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 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. Billings must be submitted with the attached required forms, Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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-10-11-CORE-0138
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-10-11-CORE-0138
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 hinds 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-10-11-CORE-0138
• 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-10-11-CPS-0116 2,00 „eP
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES //:
AND GRIFFITH CENTERS FOR CHILDREN-CHINS UP CENTER
IS_f �'' II N 2010,by and between the Board of
This Agreement,made and entered into the day of V G
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 Griffith Centers for Children-Chins Up Center,
hereinafter referre Ito 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 Anger Managers uJGomcst:c Violence,and
NOW THEREFORE, in consideration of the premises,the parties h..rem co"enant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2010.upon proper execution of this Agreement and shall
expire May 31,2011,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 arc 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-10-11-CPS-0116
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-10-11-CPS-0116
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 ser,ices 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).
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-10-11-CPS-0116
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. 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 tt.e
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-10-11-CPS-0116
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:
Nicole Politis,M.A. Program Manager
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 Nicole Politis,M.A.,Program Manager
P.O.Box A 14142 Denver West Parkway,Suite 225
Greeley,CO 80632 Lakewood,CO 80401
(970)352-1551 (303)906-4909
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-10-11-CPS-0116
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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P"-10-11-CPS-0116
IN WITNESS WHEREOF.the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD CO ARD OF COUNTY
CLERK TI� 1 �'`„ `jt ISSIONERS WELD
C T ,COLORADO
By: '
Deputy Clerk ' % J $> / air Dougl s Rademacher SEP 2 0 2010
APP AS TO F CONT TOR: •
fj1,►�p,�-{Q
BY v 1! t✓si+i 1 ��
Co ey Contractor
WELD COUNTY DEPARTMENT
OF HUMANS RVICES
By:
Ju .Gri g Director
7
a7C/r- a'/•�'%
PY-10-11-CPS-0116
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Anger Management and Domestic Violence evaluation and treatment services
for latency aged youth,adolescents and adults in Weld County(primarily South Weld County)as referred
by the Department.
2. CONTRACTOR will provide the following services under this contract:
• Anger Management
i. Six-week Curriculum(Closed/Time-Limited).
ii. Goals for Referred Clients:
1. Attend all six sessions to complete program.
2. Complete comprehensive anger relapse prevention plan.
3. Eighty-percent of group participants will show an improvement in anger
management as a result of pre/post-test assessments.
• Domestic Violence
i. Based on Restitution Model,which is guided by the following principles:
1. Treatment is driven by the needs of the victim.
2. Offenders participate in treatment in order to repair damage they have done with
their abuse.
3. Part of restitution is prevention of further abuse.
4. Prevention requires taking responsibility and a change in thinking.
ii. Referred client must successfully complete four phases of treatment. The treatment
phases include:
1. Thinking Errors and Cycle of Offending
2. Abuse Histories
3. Clarification
4. Relapse Prevention
3. The average length of treatment is 4-6 months. Groups are open.
4. CONTRACTOR will participate in reviews of ongoing services as requested.
5. CONTRACTOR will submit monthly reports for each active referral. Reports will be submitted with
monthly billing to the Core and Service Contract Coordinator.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from Child Welfare Administration funding,not to exceed$15,000.00.
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,if Child Welfare Administration funds,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
$375.00/Episode(Anger/Domestic Violence Evaluation)
$30.00/Hour/Per Person (Anger Management Group)
$30.00/Episode/Per Person(Anger Management Group, 1.5 Hours, Six Member Minimum)
$30.00/Hour/Per Person(Domestic Violence Group)
$45.00/EpisodePer Person(Domestic Violence Group, 1.5 Hours, Six Member Minimum)
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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services.Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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 part; 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'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 concems 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 concems 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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`rrP
CHILD PROTECTION AGREEMENT FOR SERVICES /3
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Oa.
AND GRIFFITH CENTERS FOR CHILDREN-CHINS 2f
NE,
UP CENTER
This Agreement,made and entered into the rN)V I v day o V 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 the"Department."and Griffith Centers for Children-Chins Up Center,
hereinafter referred to as"Contractor-.
W ITNE`ISETIT
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 Hone-Lased Intensive So'vices(Family Preservation S.rvicec);a.td
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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 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-10-11-CORE-0183
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 Requiremems, 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 stove 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
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-10-11-CORE-0183
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(sl:
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Nicole Politis,M.A. Program Manager
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.Gtiego,Director Nicole Politis.M.A..Program Manager
P.O.Box A 14142 Denver West Parkway,Suite 225
Greeley.CO 80632 Lakewood,CO 80401
(970)352-1551 (303)906-4909
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.
75
ATTEST: WELD CO ARD OF COUNTY
CLERK �� I. "' - �MMISSIONERSWELD
lit • �SIJI iF� ,COLORAD
By. ,.4%/4.'� .i '' O.7
Deputy Clerk Chair Dougl Rademacher
SEP202010
AP V AST CONTRACT R: •
► l) //}
BY "`' cPV
Co ttorn y Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju .Giiego Director
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Home-Based Intensive Services(Family Preservation Services)for high-risk
families designed to prevent out-of-home placements or prepare families for reunification,as referred by the
Department. Target populations include:
• Families who are in crisis or experiencing major struggles in functioning.
• Families with you in the home who are acting out behaviorally or sexually.
• Families with children and youth ages 0-17 years.
• Children who are at risk for out-of-home placement,or transitioning back into the home from
foster care,residential treatment, Department of Youtl;Connections or other out-of-home
placement.
• Foster families with children or youth who meet the above criteria.
2. family Preservation Services are modeled after the National Family Preservation Network's definition of
Intensive Family Preservation Services(IFPS). IFPS is defined as:
• "IFPS services are designed to support families in crisis in which children are either at imminent
risk of placement or have been placed out of the home. The services are for birth and adoptive
families and are effective as reunification services as well as for placement prevention."
3. The goal of the program is to keep children safe and avoid both unnecessary removal and long separations
from family in out-of-home care. Aspects of the program include. �w
• Services are flexible and individualized to each family.
• The home-based model offers service delivery that overcomes barriers to service access and
services are provided in the environment in which issues most likely arise.
• Services are utilized to stabilize family functioning and address safety risks. This is done through
teaching families to work with community agencies,appropriate parenting skills,stress reduction,
problem-solving and increased communication skills.
• Services are available 24 hours per day,7 days per week.
• Services include 3-6 hours per week in the referred families' home. Services can be increased as
needed.
• Appointment times are flexible and include evenings and weekends.
4. Average length of services is 2 to 6 months.
5. CONTRACTOR will coordinate and advocate with school systems,court and the Department.
6. Follow up services are available for one year after discharge to aide in long-term success with pre-approval
from the Department.
7. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs.
8. CONTRACTOR will participate in reviews of ongoing services as requested.
9. CONTRACTOR will submit monthly reports and billing for each active referral to the Core and Service
Contract Coordinator. Reports will be submitted via the Department's online system unless otherwise
directed by the Department.
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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 Core Services funding,not to exceed$5,000.00.
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.if Core Services funds,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 Set vices
$48.00,'Hour(Family Preservation 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. x'
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. Billings must be submitted with the following required forms: Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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, non 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: tt
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 c jminal
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 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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2110
CHILD PROTECTION AGREEMENT FOR SERVICES Sep /3
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES QM a
AND GRIFFITH CENTERS FOR CHILDREN-CHINS UP CENTER
This Agreement,made and entered into the (S7 day ofjU N�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 the"Department,"and Griffith Centers for Children-Chins Up Center,
hereinafter referred to as"Contractor".
WITNEf SEI11
WHEREAS,required approval, clearance,and coordination have been accomplished from and witl,
a;-propdate agencies:and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
7.partment for Jfeskills tParenting Skills, isita.ion;. and
NOW TIIEREFURE. in consideration of the premises,the panics hereto covenant and agree as follows:
. Term
This Agreement shall become effective on June 1,2010, upon proper execution of this Agruement and shad
expire May 31,2011.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 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 othe,wise 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 decisicn of the Director of Human Sir:ices
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 arc 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 Fan-ily Services Reviews(CFSR)examines child welfare service outcomes .n 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 enhanry
services to families.
CONTRACTORS providing services to the Department's families and children must continuell: 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 require°trainings.
12. Subpoenas
The CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testi.nony
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 arc 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:
Nicole Politis,M.A. Program Manager
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 Nicole Politis.M.A.,Program Manager
P.O.Box A 14142 Denver West Parkway,Suite 225
Greeley,CO 80632 Lakewood,CO 80401
(970)352-1551 (303)906-4909
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:
WEL� � " Aj �� BOARD OF COUNTY
CLE' r O. e�:.' � . COMMISSIONERS WELD
COUNTY,COLORADO
lIMayrri
Deputy Cler
5i4� ai Dorigla Rademacher
�•�..�� SEP 2 0 2010
APPRO D ASTOO .-' •
SCONTRA TOR:
BY l./
Co Atto.ney Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
t. #.Griego Director
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PY-10-11-CORE-0184
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide Lifeskills(Parenting Services/Skills.Visitation)to families referred by the
Department. Target populations include:
• Parents or primary caregivers who need in-home parenting instruction and assistance with
household management and accessing community resources.
• Parents with children ages 0-17 years who are at risk of out-of-home placement.
• Parents with children ages 0-17 years who are placed out of the home with relatives or in foster
care.
• Children who are transitioning back home from out-of-home placement.
2. Services include an intensive home-based model with an emphasis on the child's developmental needs,and
a Parenting Skills Group
3. The goal of the intensive home-based program is to improve parenting skills,and increase safety and
stability in the home. Aspects of the program include:
• Services are flexible and individualized to each family,and are based on assessment of parent and
child strengths and needs.
• Each referred family is assigned a LSP specialist who is trained in and specializes in parenting,
child development,and life skills. The LSP assists parents/caregivers with basic parenting skills,
household management,budgeting,organizational skills,and other day-to-day issues thatfmpede
the care and development of children in the home.
• All safety risks are addressed immediately by the LSP.
• The home-based model offers service delivery that overcomes barriers to service access and
services are provided in the environment in which issues most likely arise.
• Services are utilized to stabilize family functioning and address safety risks. This is done through
teaching families to work with community agencies,appropriate parenting skills,stress reduction,
problem-solving and increased communication skills.
• Services are available 24 hours per day,7 days per week.
• Services include 3-6 hours per week in the referred families' home. Services can be increased as
needed.
• Appointment times are flexible and include evenings and weekends.
• Average length of services is 2 to 6 months.
• CONTRACTOR will coordinate and advocate with school systems,court and the Department.
• Follow up services are available for one year after discharge to aide in long-term success with pre-
approval from the Department.
4. The Parenting Skills Group is based on the Nurturing Parenting Program,and is an evidenced-based
program that focuses on non-violent parenting.
• The program emphasizes the development of empathy,self-worth,self-awareness,empowerment,
and discipline with dignity,as well as appropriate family roles and age-appropriate expectations
for children.
• The program is 10 weeks in duration and participants must attend 8 out of 10 weeks to successfully
complete the program.
• The group is open.
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• Levels of prevention within the program include:
i. Prevention Programs(Primary Prevention). This level includes pre-parent stage and
prenatal stage.
ii. Intervention Programs(Secondary Prevention). This level includes programs designed to
intervene to prevent further escalation of the early stages of maltreatment or for families
considered to be"at-risk".
iii. Treatment Programs(Tertiary Prevention). This level includes programs designed to
treat families identified by the Department for child abuse and/or neglect.
5. Therapeutic/Supervised Visitation services are available in a home-based model with the option of
providing visits in a community setting or other location designated by the Department. Visitation services
will focus on assessing the parent/caregiver's parenting ability and work with individuals to meet the needs
of the children during visits.
• Objectives of Visitation:
i. Ensure child safety during visits.
ii. Closely monitor parent/child interactions to ensure appropriateness.
iii. Improve parenting skills(effectively meeting the developmental needs of the child(ren)).
6. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs.
7. CONTRACTOR will participate in reviews of ongoing services as requested.
8. CONTRACTOR will submit monthly reports and billing for each active referral to the Core and Service
Contract Coordinator. Reports will be submitted via the Department's online system unless otherwise
directed by the Department.
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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 Core Services funding,not to exceed$20,000.00.
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,if Core Services funds,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
$36.00/Hour(Parenting Services,Therapeutic/Supervised Visitation)
$30.00/Hour/Family(Parenting Skills Group)
$45.001Episode/Family(Parenting Skills Group, 1.5 Hours. Six Family Minimum)
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. Billings must be submitted with the following required forms: Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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.voluiteers,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. Isle 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 he used under this Contract is Core Services funds.
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 certifi._s it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring cftninal
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 arc 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 Outc 'me 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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UP9//.31
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p
CHILD PROTECTION AGREEMENT FOR SERVICES I)
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES 44'
AND GRIFFITH CENTERS FOR�! CHILDREN-CHINS UP CENTER ?9
This Agreement, made and entered into the Jday o(')tz 1 N .& 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 the"Department,"and Griffith Centers for Children-Chins Up Center,
hereinafter referred to as"Contractor".
WrINESSLI 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
Oepa:tr ent;or Mental Health S. vices; ant
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective ou Jwr_ 1,20'0, upon proper.xecution of this Agreement and shall
expire May 31,2011,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 arc 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 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.
(27r/Z) .-07/S)7
PY-10-11-CORE-0185
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
shalt he 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 arc 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.Pan 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).
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-10-11-CORE-0185
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 ill 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:
Nicole Politis,MA. Program Manager
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 Nicole Politis,M.A.,Program Manager
P.O.Box A 14142 Denver West Parkway,Suite 225
Greeley,CO 80632 Lakewood,CO 80401
(970)352-1551 (303)906-4909
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 CO(Sa ►'""-,. •�:.ARD OF COUNTY
CLERK TI' ' 'b %IvfMISSIONERS WELD
�y` �����'• . T ',COLORADO
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Deputy Clerk ®(`j`'Q IC Chair Dougl s Rademacher
APP D AS TO F � CONT TOR: lie/A(4'
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Co ;Anon y Contractor
WELD COUNTY DEPARTMENT
OF HUMA SERVICE
By:
d -A.Grie o,Director ,
7
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PY-10-11-CORE-0185
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Mental Health Services to individuals and families(all ages)referred by the
Department.
2. Services include individual therapy,family therapy,Eye Movement Desensitization and Reprocessing
(EMDR)Therapy, and mental health assessment.
• Individual/Family Therapy:
i. Therapy can occur in ;he office or a client's home/community.
ii. Can be utilized in conjunction with or as a follow up to in-home services.
iii. Therapy conducted by Master's level mental health professionals.
iv. Sessions are weekly, unless otherwise directed by the Department.
v. Pager access 24 hours a day 7 days a week.
• Eye Movement Desensitization and Reprocessing(EMDR):
i. Short term therapy for post-traumatic stress, trauma,panic attacks,complicated grief,
dissociative disorder, phobias.anxiety,anger/violence issues,addictions,stress reduction
and other issues.
ii. Can be utilized alone or in conjunction with other therapies.
iii. Length of treatment varies dependent upon severity of issue. Ten to twelve sessions is
recommended, hoe ever services can be completed in as little as 3-4 sessions. ...
• Mental Health Needs Assessment:
i. Pre-treatment assessment used to determine the mental health functioning of the referred
individual.
H. Assessment is conducted by a licensed mental health professional in the office or at the
client's home.
iii. CONTRACTOR will provide a written report that details recommendations for immediate
interventions and/or goals.
iv. Assessment is completed in 1-2 one-hour sessions.
3. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs.
4. CONTRACTOR will participate in reviews of ongoing services as requested.
5. CONTRACTOR will submit monthly reports(with the exception of the Mental Health Needs Assessment)
and billing for each active referral to the Core and Service Contract Coordinator. Reports will be submitted
via the Department's online system unless otherwise directed by the Department.
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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 Core Services funding.not to exceed$10,000.00.
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, if Core Services funds,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 Depa-tment,the Department may
immediately terminate this Contract or amend it accordingly.
2. Fees for Services
$150.00/Episode(Mental Health Assessment)
$52.00/Hour(Individual Therapy)
$56.00/Hour(Family Therapy)
$75.00/Hour(Eye Movement Desensitization and Reprocessing(EMDR)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 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. Billings must be submitted with the following required forms: Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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 ally 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 pricy written consent of botl,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 makinc 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, ;oan, grant,or cooperative agrecm^nt.
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 der eloped 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 f;om 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.
PY-10-1 I-CORE-0185
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 c}-ilel en 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 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-10-11-CORE-0186 ?.,'0 fCp
CHILD PROTECTION AGREEMENT FOR SERVICES e I)
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES Affif/,,
AND GRIFFITH CENTERS FOR CHILDREN-CHINS UP CENTER 29
This Agreement,made and entered into the 1ST day ofj N& 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 the"Department."and Griffith Centers for Children-Chins Up Center,
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,Offense-Specific and Informed Supervision);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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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 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.
o7CR7— ° We/
PY-10-11-CORE-0186
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-10-11-CORE-0186
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).
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-10-1 l-CORE-0186
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. The
Contractor maybe 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,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-10-11-CORE-0186
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:
Nicole Politis,M.A. Program Manager
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 Nicole Politis.M.A.,Program Manager
P.O.Box A 14142 Denver West Parkway,Suite 225
Greeley.CO 80632 Lakewood,CO 80401
(970)352-1551 (303)906-4909
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-10-11-CORE-0186
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD �� :•ARD OF COUNTY
CLERWELD COC u 1. ' " 't ��tMMISSIONERS WELD
ISO ' �: Y,COLORADO
By 6/1/161-
Deputy Clerk' �� /�� ,� air Dougl s Rademacher
�'•* _ I SEP 2 0 2010
APP: : AS T CONTRAF OR: WC,
BY \`` a 'l �T ��1.ddDL J_
C. Atto ey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
7 A. rieg ,Director
7
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PY-10-11-CORE-0186
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Sexual Abuse Treatment services to youth, ages 3-17,and their families as
referred by the Department.
2. Services include Sexual Abuse Intervention(SAD and Informed Supervision Training.
• Sexual Abuse Intervention(SAI):
i. A comprehensive in-home and community intervention designed to ensure protection of
the victim,family,community,and alleged sexually acting out youth.
ii. Target populations include:
1. Families with youth who are demonstrating inappropriate sexual behavior.
2. Families with children ages 3-17.
3. Youth who may be at risk of out-of-home placement,or transitioning back home
from foster care,residential treatment,youth corrections or other placement.
4. Parents/caregivers who are willing to participate in the service and are
committed to monitoring the youth.
iii. SAT provides the following offense-specific services to the youth and family:
1. Sex Offender Risk Assessment
2. Intensive Home-Based Services and Safety Planning
3. Offensive Sexual Abuse Treatment with Polygraphs
4. Individual and Family Therapy
5. Informed Supervision
iv. Program is supervised by a licensed Sex Offender Management Board(SOMB)Juvenile
Full Operating Level Provider.
v. All in-home services are provided by SOMB Juvenile Associate Level Providers.
vi. Program staff serve as members of the multi-disciplinary team (MDT).
vii. The J-Soap II,a standardized community risk assessment tool, is utilized throughout the
intervention.
viii. Aspects of the program include:
1. Services are flexible and individualized to each family.
2. The home-based model offers service delivery that overcomes barriers to service
access and services are provided in the environment in which issues most likely
arise.
3. Services can be utilized at the initial onset of concerns or allegations of
inappropriate behavior.
4. Services are available 24 hours per day,7 days per week.
5. Services include 5-15 hours per week in the referred families' home. Services
can be increased as needed.
6. Average length of services is 5-7 months.
7. Appointment times are flexible and include evenings and weekends.
8. CONTRACTOR will coordinate and advocate with school systems,court and
the Department.
• Informed Supervision Training:
i. Includes 2-3 hour of group or individual training for those responsible for supervising a
juvenile sex offender.
ii. Training covers the following topics:
1. Colorado State Standards for Juveniles Who Commit Sexual Offenses
2. Rationale of Informed Supervision
3. Role of the Multidisciplinary Team(MDT)
4. Cycles of Abuse
5. Patterns of Behavior
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6. Line-of-sight Supervision
7. Arranging for alternate supervision when primary caregiver is not available.
8. Safety Planning
3. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs.
4. CONTRACTOR will participate in reviews of ongoing services as requested.
5. CONTRACTOR will submit monthly reports and billing for each active referral to the Core and Service
Contract Coordinator. Reports will be submitted via the Department's online system unless otherwise
directed by the Department.
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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 Core Services funding,not to exceed$500.00.
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,if Core Services funds,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
$50.00/Hour/Person(Sexual Abuse Intervention(SAI))
$30.00/Hour/Person(Sex Offender Treatment Group)
$45.00/Episode/Person(Sex Offender Treatment Group. Six Member Minimum)
$30.00/Hour/Family(Informed Supervision Training-Group Format)
$60.00/Episode/Family(Informed Supervision Training-Group Format, Six Family Minimum)
$50.00/Hour/Person(Informed Supervision Training-Individual Format)
$100.00/Episode(Informed Supervision Training-Individual Format,Completed in One 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°i 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. Billings must be submitted with the following required forms: Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
c. For monitored sobriety,proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
10
•
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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 staking of any federal gram,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 agreemer:. ,
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 cot rifles that it and its principals: F`
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-10-11-CORE-0186
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 patty 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. An) proprietary information removed frcta the States 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 '. ill abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring crifi rinal
oackground 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.
•
PY-10-1 I-CORE-0186
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 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Wel!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
alsu document what barriers may be impeding progress. 4
• 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 THE KEMPE CENTER OF THE UNIVERSITY OF COLORADO DENVER
SCHOOL OF MEDICINE,AMC CAMPUS
This Agreement,made and entered into the day of 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 the"Department,"and The Kempe Center of the University of Colorado
Denver School of Medicine.AMC Campus, 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.Home Based Services. Lifeskills,and Therapeutic Visitation;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,2010,upon proper execution of this Agreement and shall
expire May 31.201 I.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 ofthe 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 OMR 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 he 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 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.
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 I luman Services or with the U.S. Department of I lealth 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).
1. Combined single limit-$500.000 written on an occurrence basis.
2. Any aggregate limit will not be less than SI 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 arc being provided.
d. Additional coverage may he 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 [raining to be paid for by the Department if the
Contractor has not previously attended the training. 'fhe 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. lithe 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
CON'IRACI OR.
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 0-I 1-CORE-0200
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed:
h. 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:
Kim Pierpoint Administrator
Name Title
17. Notice
All notices required to be given by the parties hereunder shall he 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 Kim Pierpoint,Administrator
P.O.Box A 13123 E. 16' Avenue, 13390
Greeley,CO 80632 Aurora,CO 80045
(970)352-1551 (303)864-5363
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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 live(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 flings 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-10-I I-CORE-0200
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: .73
WELD COU OF COUNTY
CLERK TO T� G n "`. ;, � y ISSIONERS WELD
wy�
"N.Y.COLO�O
// I,I �\ `�
By: I.i///r r' iA!.11�'. y c. Gk.'
Deputy Cler / �� Chair Dougl�sacher
APP AS TO CONTRACTOR: SEP 2 0 2010
BY
Co ttomey Contractor
WELD COUNTY DEPARTMENT
OF HUMA SERVICES
By: Lt
J ,A.Grie o,Direct
THE REGENTS OF THE UNIVERSITY OF COLORADO, A I3OUY CORPORATE,
F ' AN ON BEHALF OF THE (UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
Ric'and D. Krugman,Cdr Date
Vice Chancellor for Health Affairs
Dean, University of Colorado Seh)ol of Me licinc
S phen Daniels. M.D. Date
Professor and Chair
Department of Pediatrics
University of Colorado School of Medicine
UNIVERSITY PHYSICIANS, INC.
!1_V
Gail Albertson, M.D. Date
Chief Operating Officer
7
0?C/o"- c2/J)7
PY-I 0-11-CORE-0200
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provider Foster Parent Consultation,Home Based Services and/or I.ifeskills (to
include Therapeutic Visitation)for children and youth.as referred by the Department. The goal of these
programs 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. parents,caseworkers,foster care
coordinators and other service providers to identity and address issues, in a solution-focused manner that
could potentially result in out-of-home placement or disrupt placement.
3. Foster Parent Consultation will occur in Weld County foster homes as referred by the Department.
Services will focus on the following components:
a. Impact of culture and trauma on development and attachment.
b. Positive approaches to dealing with challenging behavior.
c. Talking with children about traumatic events.
d. Assisting children with transitions.
e. Advocating for children across multiple systems.
II Self care.
4. Home Based Services will focus on the following components:
a. Reduction in the number of out-of-home placements and failed reunifications.
b. Measurable improvement in the child's well-being,as well as reduction in symptoms and/or
behaviors that could potentially disrupt placement or reunification.
c. Security in attached relationships.
d. Family functioning.
5. I,ifeskills services will occur primarily in the home. Services will focus on the following components:
a. Household Management.
b. Effective access to community resources.
c. Parenting techniques.
d. Family conflict management.
6. Therapeutic Visitation services can occur in home or in office. Services will focus on the following
components:
a. Assessment and provision of clinical interventions that promote healthier parent/child
relationships.
b. Reduction in dysfunctional patterns within the parent/child relationship.
7. CONTRACTOR will follow up with referred foster family within 48 hours of receiving referral and will
document efforts to engage foster family in referred services.
8. 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.
9. 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.
10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of foster parent consultation services and/or the need for additional
services.
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PY-10-1 1-CORE-0200
11. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child
whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are
not limited to.any physical,emotional,educational or behavioral issues. Areas of concern should be
reported immediately AND on the required monthly report.
12. CONTRACTOR will submit reports on a monthly basis for each active referral. Reports will be submitted
per the online format required by the Department unless otherwise directed by the Department.
13. CONTRACTOR will participate in team reviews of ongoing services as requested.
9
I
PY-10-I I-CORE-0200
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 Core Services funding,not to exceed$1,000.00(Foster Parent Consultation),Home Based Services
($3,000.00),Lil'eskills($3,000.00).
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, if Core Services funds.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
$125.00/I lour(Foster Parent Consultation)
$165.00/Hour(Home Based Services)
$121.00/Hour(Lifeskills,Therapeutic Visitation)
$110.00/I lour(Court'testimony)
$100.00/I lour(TDM/Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of clients 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 arc to be submitted by the 7t5 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 pay ment.
b. Billings must be submitted with the attached required forms.Authorization for
Contractual Services, Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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 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 he 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-I0-I I-CORE-0200
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 CONE RACTOR,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
Departments 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.
13
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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 arc considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children arc 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-10-I 1-CORE-0200
• 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-10-11-CORE-0 189 1,
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND MILESTONES COUNSELING SERVICES,LLC
This Agreement,made and entered into the day of 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 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 Foster Parent Consultation;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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. Pa, yment
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-10-11-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 xi_vices performed for
costs incurred in the performance of the agieement.
h. 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.P.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-10-11-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 I Iealth 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(PI,&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-10-11-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 fmd
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:
11
PY-10-11-CORE-0189
a. Withhold payment to CONTRACTOR until the necessary services or corrections in 1x,rformance 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 49ih 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-10-11-CORE-0189
20. Entire Apeement
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-10-11-CORE-0189
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above wntten.
La
ATTEST:
WELD CO �f Y , :., B o ' P OF COUNTY
CLERK TO 'i I (� 6 ' C ISSIONERS WELD
I. ,'•, `
y TY,COLORADO)
� : lla 4AC By: y:a// /. i��.. !!/�f%rcv;� �: 4 ]]llaa
Deputy Clerk �`�; Chair Doug s Rademacher
SEP 2
APP AS'T •
ACONTRACTO •
} 2010 BY 06124;CIA__C y Contractor "fie �
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju . Gtiego Director
, (2/(2_ /41)
PY-10-11-00RE-0189
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 follow up with referred foster family within 48 hours of receiving referral and will
document efforts to engage foster family in referred services.
4. 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,barriers 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 imam 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.
5. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appavpi iatcly care
for the foster children in their home and report this information on a monthly basis to the Department.
6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding continuation of foster parent consultation 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-10-11-CORE-0189
8. CONTRACTOR will submit reports on a monthly basis for each active referral. 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 requested.
n
PY-10-11-CORE-0189
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 Core Services funding,not to exceed$1,000.00.
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,if Core Services funds,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
$540.00(Evaluation,Intervention and Feedback-6 hours)
$90.00/Hour(Additional Follow Up after 6 hours)
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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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-10-1l-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 the
audit finding.
11
PY-10-11-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.
I3. 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 arc 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.
,')
P Y-10-1 1-CORE-0189
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.
11
•
PY-10-11-CORE-0189
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 he 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-10-11-CORE-0 189
• 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 bathers 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-10-II-HS-0115 L07r ;;c9
ticto—
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND MILESTONES COUNSELING SERVICES,LLC
//
'6
[his Agreement,made and entered into the day of 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 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 Home Studies/Relinquishment Counseling;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
Term
This Agreement shall become effective on June 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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.
PY-10-11-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 fatal.
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.
PY-10-11-HS-0115
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-10-11-11S-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 he 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:
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PY-10-11-1-IS-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 CONTRAC TOR:
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 49a'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-10-11-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.
A
•
PY-10-ll-HS-0115
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD CO Y ��A� � UARD OF COUNTY
CLERK T• I -7� � yi ISSIONERS WELD
11161 •, n� : ¶1 T COLORADO
Deputy Clerk � , air Dougl s. Rademactyex, 2 0 2010
APP D AS TO CONTRACTOR:
- BY (166C-64;r4- a 4I'74,CC
Co ttomey Contractor o4CA/ -Gi
L .
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J d A. G ,Director
„217/(,)-0247
PY-10-I 1-HS-0115
EXHIBIT A
SCOPE OF SERVICES
I. 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 conduct a minimum of three 2-hour visits at the home study applicant's residence.
Visits will include physical contact and evaluation of each member living in the household.
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,unless otherwise directed
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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PY-10-11-HS-0115
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 Child Welfare Administration funding,not to exceed$10,000.00.
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,if Child Welfare Administration funds,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
$950.00(Full Home Study)
$250.00(Each Additional Adult)
$550.00(Updated Home Study)
$250.00(Cancelled Home Study, 1-4 Hours of Service)
$.30/Mile(Mileage-Referrals Outside Weld County)
$80.00/Hour(Relinquishment Counseling)
$100.00/Hour(Court Testimony- 1 Hour Minimum)
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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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-10-11-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
arc 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-I0-11-I-IS-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.
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. Ilave 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. lIavc 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-10-11-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 m
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 (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.
in
PY-10-11-HS-0115
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 arc 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 arc 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-10-11-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 he 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 sperific 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 harriers 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.
A
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PY-10-11-CORE-0204 Li
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND MILESTONES COUNSELING SERVICES,LLC
This Agreement,made and entered into the day of 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 the"Department,"and Milestones Counseling Services,LI,C,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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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.
&C/ - ,;2
PY-10-11-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.
h. 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.
F,
PY-10-11-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.
PY-10-11-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-10-11-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 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.
c
PY-10-11-CORE-0204
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-10-11-C ORE-0204
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
��!f1
ATTEST:
WELD C OARD OF COUNTY
CLERK [I T L "�` •,'OMMISSIONERS WELD
861 t4j * OUNTY,COLORADO
By: �/ .� ��:�1 -:'•Y s 4'BY: ")/YDh'p4a4�
Deputy Clerk' t Chair ouglas Qademacher
�•.►ice SEP 2 0 2010
AP$ D AS T CONTRACTOR:
�
BY �,2,g ��-ct;.. /r4 CAL
Co y ontractor M , /U r_ia, -0A,n
WELD COUNTY DEPARTMENT ,' 1
OF HUMAN ER VICES
By:
J y A. Griegg ,Directo
PY-10-11-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 follow up with referred client(s)within 48 hours of receiving referral and will
document efforts to engage the client(s)in referred services.
4. 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.
5. CONTRACTOR will submit reports on a monthly basis for each active referral. Reports will be submitted
per the online format required by the Department,unless otherwise directed by the Department.
6. CONTRACTOR will participate in team reviews of ongoing services as requested.
Q
PY-10-11-CORE-0204
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 Core Services funding,not to exceed$5,000.00.
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,if Core Services funds,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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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-10-11-CORE-0204
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-10-1 I-CORE-0204
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.
11
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PY-10-11-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 requirewents. 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 subcontractors.
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.
to
PY-10-11-CORE-0204
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 0-l l-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 bathers 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 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 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,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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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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PY-10-11-CORE-0129
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-10-11-CORE-0129
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
(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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PY-I0-1I-CORE-0129
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD CO TY. , 4 RD OF COUNTY
CLERK T1 I j 1 MISSIONERS WELD
r/ ��•' �1 N Y,COLORAT
By: / J%/! � //1�►iiii�FT. jV. `y: � Qdd2��� � p�Q r-
Deputy Clerk / ` � hair Dougla Rademacher
R ED AS T •
RCONTRACTOR: SEP 2 0 2010
BY �"
C A mey Contractor yykatitmu
Contractor
WELD COUNTY DEPARTMENT ontractor
OF HUMAN ERVICES
By: 9/ 00(0
J y .Grieg ,Direct
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PY-10-11-CORE-0129
EXHIBIT A
SCOPE OF SERVICES
1. 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 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. 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 requested.
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PY-10-11-CORE-0129
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 Core Services funding,not to exceed$78,500.00.
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,if Core Services funds,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 or Intensive Home-Based Lifeskills Coaching,Face-to-Face Contact,
without Transportation)
$125.00/Hour(Therapeutic Visitation or Intensive Home-Based Lifeskills Coaching,Face-to-Face Contact,
with Transportation)
$95.00/Hour(Court Facilitation or Staffing)
$150.00/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'"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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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.
1 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 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)(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 S
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND TRANSITIONS PSYCHOLOGY GROUP,LLC
This Agreement,made and entered into the day of 2010,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 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:
1. Term
This Agreement shall become effective on June 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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. moment
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-10-I 1-CORE-0144
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 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).
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. Trainino
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-10-11-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 20th Street,Unit M-2
Greeley,CO 80634
(970)336-1123
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PY-10-I 1-CORE-0144
18. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the 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-10-11-CORE-0144
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD COUN 4u.f4.., A�� OF COUNTY
CLERK TOT 1",l •fId'wjO '�.�M ISSIONERS WELD
,COLORADO
By: '/' / .. �� '7�II �r/t� {�,�► .7< ► �' 511!• / '/Y
Deputy Clerk• hair Douglas Rademacher
AP ED AS T CONTRACTOR: SEP 2 O 2010
BY PA-U�j
Co omey Co ctor
Contractor
WELD COUNTY DEPARTMENT C ntractor
OF HUMAN SERVICES
By:
J A. rieg ,Directs
PY-I0-I l-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. All staffings outside Court staffings/facilitation require pre-approval from the Department's Core and Service
Contract Coordinator.
5. 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.
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.Reports will be submitted per
the online format required by the Department, unless otherwise directed by the Department.
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9. CONTRACTOR will participate in team reviews of ongoing services as requested.
9
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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 Core Services funding,not to exceed$70,000.00.
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, if Core Services funds,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)
$110.00/Hour(Individual/Couples/Family Counseling,Play Therapy,EMDR 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)
$150.00/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 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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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.
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
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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 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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trey)
CHILD PROTECTION AGREEMENT FOR SERVICES /)
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES 4/}r�/
AND STEPHANIE WALKER,MSW //:
This Agreement,made and entered into the day of 2010,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 Stephanie Walker,MSW,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 1,2010,upon proper execution of this Agreement and shall
expire May 31,2011,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's 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-10-11-HS-0050
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).
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-10-Il-HS-0050
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:
Stephanie Walker,MSW Private Practice
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 Stephanie Walker,MSW
P.O.Box A 1389 Swallow Street
Greeley,CO 80632 Loveland,CO 80537
(970)352-1551 (970)581-2435
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-10-11-HS-0050
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-10-1 I-HS-0050
1N WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written. /•Trzt`
ATTEST: ��iFNfa9J
WELD C•1 �w _ .�.ARDOFCOUNTY
CLERK 1 li ik.:I�till*: �`:MMISSIONERS WELD 4404/UNT\ €OJORADOBy: /CW"Wilt, �4 , % ff, By: 1 efl
Deputy Clerk I •
Chair 20ug1a Rademacher
SEP 2 0 2010
APP D AS TO CONTRACTOR: }, pp�
Y C�Iaerit re.e." <
Cou ome Contra for
WELD COUNTY DEPARTMENT
OF HUMA SERVICE
By:
d A.Grie o,Director
7
(/C'-02/cf7
PY-10-11-HS-0050
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide home study and relinquishment counseling services for families within a 45-
mile radius of Loveland,CO.,as referred by the Department.
2. CONTRACTOR utilizes the Structured Analysis Family Evaluation(SAFE)tool developed by the
Consortium of Children. CONTRACTOR is SAFE certified and on the State's approved home study
vendor list. CONTRACTOR also is certified as a SAFE supervisor.
3. Services will be provided by Stephanie Walker,MSW.
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. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any
specific Weld County home. Areas of concem 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 Child Welfare Administration funding,not to exceed$10,000.00.
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, if Child Welfare Administration funds,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
$925.00/Episode(Full Home Study within 45 mile radius of Loveland,CO)
$400.00/Episode(Updated Home Study within 45 mile radius of Loveland,CO)
$ .50/Mile(Per mile charge beyond 45 mile radius of Loveland,CO)
$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 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. Billings must be submitted with the attached required forms,Authorization for
Contractual Services,Request for Reimbursement,Client Verification Form and monthly
report. The Authorization for Contractual Services and Client Verification Form must be
submitted with original signatures.
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(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 (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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• 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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