HomeMy WebLinkAbout20101991.tiff RESOLUTION
RE: APPROVE SEVEN CHILD PROTECTION AGREEMENTS FOR SERVICES
WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with seven 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 seven 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 30th day of August, A.D., 2010, nunc pro tunc June 1, 2010.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
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Weld County Clerk to t `tl "1. 1._)::
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� A arbara Kirkmeyer, ro-Tem
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Deputy Cler o the Board
Sean P. Conway C.
ptccVED AS TWil m F. cia
County Attorney ckAAA \ ci`�
David E. Long V
Date of signature: / 4 /C
2010-1991
HR0081
MEMORANDUM i EXHIBIT 6411 DATE: August 26, 2010
TO: Douglas Rademacher, Chair, Board of Commis 'one
W� C FROM Judy A. Grie o Director, HumarlS res Tye Rrr{t
g , 1
COLORADO J
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 Area/Funding
Provider Source PY10-11 Proposed Rate(s)
Compliance Monitored Sobriety $13.00/Episode (Instant UA)
Administrative Services $25.00/Episode (Instant UA Confirmation)
(CAS) CW Admin $16.00/Episode (Standard Lab Test)
$48.50/Episode (Club Drug Panel)
06/01/10-05/31/11 $90.00/Episode (Hair Test)
$40.00/Episode (Ethyl Glucuronide Test-
EtG)
$2.00/Episode (BA)
$2.00/Episode (BA Confirmation)
$37.50/Episode (Swab/Saliva Test)
$75.00/Hr(Court Testimony)
Max. $85,000.00
Collaborative Services Mental Health Services $75.00/Episode (Individual, Couples and
for Change (Marci Family Therapy,Staffings)
Brewer) Core $50.00/tvtth (Case Management)
Max.$4,000.00
06/01/10-0531/11
Collaborative Services Sex Abuse Treatment $50.00/Hr (Offense-specific Evaluation)
for Change (Marci $75.00/Episode (Intake, 50-min Session)
Brewer) Core $75.00/Episode (Individual or Family
Therapy, 50-min Session)
06/01/10 -0531/11 $50.00/Episode (Group Therapy, 90-min
Session)
$75.00/Episode (Specialty Services for
Disabled Youth, 50-min Session)
$100.00/Episode (Field/Off-site Therapy,
50-min Session)
$75.00/Episode (Informed Supervision, 1
Person)
2010-1991
$100.00/Episode(2-3 People)
$200.00/Episode (4-6 People)
$300.00/Episode (7-9 People)
$50.00/Mth (Case Management)
Max.$2,500.00
Jubilee Retreat Center Foster Parent Training $3,995.00/Training
$58.00/PP (Foster Parent Education
06/01/10-0531/11 CW Admin Group)
Max. $65,000.00
Perklen Center for Anger/DV $575.00 (Anger or DV Eval.-In office)
Psychotherapy $625.00 (Anger or DV Eval.-Out of office)
(fka Individual Group& CW Admin $200.00 (MMPI-II w/written report)
Therapy Services) $65.00/Hr(Ind./Cpl./Fam. Therapy)
$35.00 (Group)
06/01/10-0531/11 $100.00/Hr(Court Facilitation/Staffing/
Testimony)
Max. $10,000.00
Perklen Center for Mental Health Services $575.00 (MHA- In office)
Psychotherapy $625.00 (MHA-Out of office)
(fka Individual Group& Core $200.00(MMPI-II w/written report)
Therapy Services) $65.00/Hr(Ind./Cpl./Fam. Therapy)
$100.00/Hr(Court
06/01/10-0531/11 Facilitation/StaffingfTestimony)
Max. $2,000.00
Perklen Center for Sex Abuse Treatment $900.00 (Eval w/PPG - In office)
Psychotherapy $1,150.00 (Eval w/PPG -Out of office)
(fka Individual Group& Core $700.00 (Eval w/o PPG)
Therapy Services) $250.00(PPG)
$250.00 (Polygraph -Sex History)
06/01/10-0531/11 $225.00 (Polygraph -Maintenance)
$65.00(Arousal Management)
$65.00 (Intake)
$65.00/Hr(Ind./Fam./Cpl Therapy)
$35.00 (Phase I, 3 or 4 Adult Group)
$40.00 (Phase 2 Adult Group)
$35.00(Chaperone Group-2 people)
$52.50(Informed Supervision -JSO ONLY
-3 hr)
$65.00/Hr (Family Reunification)
$100.00/Hr(Court Testimony,
Facilitation/Staffing)
Max. $6,625.00
If you have any questions, give me a call at extension 6510.
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PY-10-11-CPS-0098
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COMPLIANCE ADMINISTRATIVE SERVICES, LLC
This Agreement,made and entered into the day of 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 Compliance Administrative Services, LLC,
hereinafter referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Child Welfare Administration
funding to the Department for Monitored Sobriety Services;and
NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows:
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 Th day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
I33.
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 l luman Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards, regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
- Title VI of the Civil Rights Act of 1964.42 U.S.C.Sections 2000d—I et.seq.and its implementing
regulation,45 C.F.R. Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R. Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
- the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex, religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized. when possible, as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure, either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County, its
employees and agents, shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL& PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that, at the time of entering into this Contract, it has currently in effect all
necessary licenses,approvals, insurance, etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
1 I. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
12. Subpoenas
The Provider will,on behalf of its employees and/or officers,accept any subpoena for testimony from the
Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215.x6503,and advise that the
subpoena must be personally served.
13. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
14. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables, which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
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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.
15. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Marc Pham Controller
Name Title
16. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s)or address to whom such notices shall be sent:
To: The Department To: CONTRACTOR
Judy A.Griego, Director Marc Pham,Controller
P.O. Box A 7100 N.Broadway,Suite 5-N
Greeley,CO 80632 Denver,CO 80221
(970)352-1551 (303)428-3849
17. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement. CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation" includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
18. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. CONTRACTOR reserves the right to suspend services to clients if
funding is no longer available.
19. Entire Agreement
This Agreement,together with all attachments hereto,constitutes the entire understanding between the
parties with respect to the subject matter hereof,and may not be changed or modified except as stated in
Paragraph 13 herein.
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IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD COUNT, * 4. fl BOARD OF COUNTY
CLERKTOTH .:Q .a x C iMmMI SIONERS WELD
tIt.I ) CotN f,COLOR
By. r,�� �y ds i � Chair Dougl s Rademacher
Deputy Clerk AUG 3 0 2010
AP E AS T • CONTRACTOR:
Cou Attorney Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
d A.Grieg', irector
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EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide timely and quality random monitored sobriety services to clients referred
by the Department as follows:
a. CONTRACTOR will provide monitored sobriety services to Department clients at the
Department(315 A North 11th Avenue), in Greeley.
b. CONTRACTOR will provide a qualified monitored sobriety collector on site Monday
through Friday at the Department,2-7 p.m., and will conduct random weekend monitoring
two(2)Saturdays and one(I)Sunday per month, 10 a.m.to I p.m.,or as modified by the
Department.
c. CONTRACTOR will only accept referrals when a client has been assigned a color and clients
will be required to call in seven(7)days per week.
d. CONTRACTOR will only provide monitoring services to referred clients who provide picture
identification. A caseworker may provide a client photo in lieu of a formal identification if
formal identification cannot be obtained.
e. CONTRACTOR will have male and female staff available on a regular basis.
CONTRACTOR will attempt to assign male clients on days when male staff members are
available. If a male staff member is not available the CONTRACTOR may opt to have the
client complete a urinalysis and an oral swab for validation purposes.
f CONTRACTOR may have a client complete a urinalysis and an oral swab if they suspect the
test may be compromised.
g. CONTRACTOR will not allow clients to make up missed monitoring unless prior approval
from the caseworker or supervisor is obtained.
h. CONTRACTOR will confirm any positive,negative or missed monitored sobriety within 24
hours through a phone call,test result,e-mail and/or fax to the referring caseworker.
i. CONTRACTOR will provide a report of the client's prior months monitoring within the first
week of the month following service.
j. CONTRACTOR will submit a copy of the valid Authorization for Service form,result and
client sign-in sheet(if applicable)with each monthly billing.
k. Results will be available online 24 hours per day,seven(7)days per week through the
Norchem website(www.norchemlab.com).
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse CONTRACTOR in consideration for the work and services performed
from Child Welfare Administration funding,not to exceed $85,000.00.
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
$13.00/Episode(Instant 5 Panel Drug Screen -Tests for THC,COC, AMP,OPI, PCP)
$25.00/Episode(Instant 5 Panel-Confirmation)
$16.00/Episode(Standard Laboratory Test-Tests for ALC,AMP/METH,BENZ,COC,OPI,PCP,THC)
$48.50/Episode(Club Drug Panel -Ecstasy,GHB,Ketamine,Oxycodone)
$90.00/Episode(Hair Test-Tests for THC,COC,OPI,PCP,AMP up to 90 days or more after use)
$40.00/Episode(EtG/Ethylglucuronide-Tests for alcohol up to 80 hours past consumption)
$2.00/Episode(Breathlyzer Screening)
$2.00/Episode(Breathalyzer Confirmation)
$37.50/Episode(Swab/Saliva Test)
$75.00/Hour(Court Testimony)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 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,unless otherwise agreed upon. The forms 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)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
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EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being, followed by specific considerations
and tasks which must be addressed by the Department contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety I Children are,first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive, social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency 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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dui �9
CHILD PROTECTION AGREEMENT FOR SERVICES AM lb 22
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND COLLABORATIVE SERVICES FOR CHANGE,PC
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 Collaborative Services for Change,PC,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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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 a seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 a seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary,CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
Contractor shall attend a Court Testimony and Ethics Training to be paid for by the Department. 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 return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
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PY-10-1 l-CORE-0135
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:
Marci Brewer,LCSW Clinical Director/Co-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 Marci Brewer,LCSW
P.O.Box A 2480 W.26'"Avenue,#130-B
Greeley,CO 80632 Denver,CO 80211
(970)352-1551 (303)433-0188
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 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 C NTNisier ARD OF COUNTY
CLERK 01*Bryezy MMISSIONERS WELD
I r ,COLORADO
Via `:`_.
By: itze y: ASO C.6-Ar
Deputy Clerk <- Chair Dougla Rademacher
AUG 3 O 2090
APPD AS :N ::or
TR
l _ _
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
d. A.Gri-g. Direct / I
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PY-10-11-CORE-0135
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide mental health services to clients referred by the Department,in the Denver area.
Services include individual,couples and family therapy to address specific problematic issues that may include,
but are not limited to,abuse recovery,anger management,trauma recovery,behavior disorders,mood disorders
and social skills interventions.
2. All services will be provided by Marci Brewer,LCSW. 1/or -$'c_cc �L-05 c-\ LL-S�.J Lam)
3. 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.
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.
6. CONTRACTOR will participate in team reviews of ongoing services as requested.
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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$4,000.00.
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
$75.00/Episode(Individual/Couples/Family Counseling,Face-to-Face Contact)
$50.00/Month(Case Management)
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)(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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PY-10-11-CORE-0158 2/1,?✓(�
CHILD PROTECTION AGREEMENT FOR SERVICES 2;
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES ,
AND COLLABORATIVE SERVICES FOR CHANGE,PC 2?
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 Collaborative Services for Change,PC,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific Treatment);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.
C5kr://)-/(7'9/
PY-10-11-CORE-0158
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. 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 return a waiver of service within 72 business hours. If
the Provider receives a subpoena via facsimile but will only accept personal service,the Provider will
contact the Weld County Attorney's Office immediately at 970-353-5215,x6503,and advise that the
subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
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PY-10-11-CORE-0158
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:
Marci Brewer,LCSW Clinical Director/Co-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 Marci Brewer,LCSW
P.O.Box A 2480 W.26th Avenue,#130-B
Greeley,CO 80632 Denver,CO 80211
(970)352-1551 (303)433-0188
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-0158
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-0158
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: .•" GQ%
WELD CO c BOARD OF COUNTY
CLERK TIiwtioARD COMMISSIONERS WELD
CO COL
By: ./ � /lit=: ��_,�„t�! -r+:` �p A �IW
Deputy Clerk s ( 1 N \�J Chuai Doug s Rademacher
O .'a AS CONTRACTOR: c AUG ^ n na+)
�/! -_/ice _. •Y _ f —l��
C. A •mey ontractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
J A.Griego rector
7
o?E/L4)- lJ9/
PY-10-11-CORE-0158
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide offense specific services to clients referred by the Department,in the Denver
area. Services include intake assessments,offense specific evaluations,individual,family and group therapy,
specialty services for special needs and developmentally disabled youth,field(in-home)therapy in the
community,healthy sexuality curriculum and informed supervision training.
2. All services will be provided by Marci Brewer,LCSW. /CY �4.�C \C- sC�c:� S� `
3 (PS)
3. CONTRACTOR will identify in detail areas of continued concem and make recommendations to the
Department regarding continuation of services and/or the need for additional 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.
6. CONTRACTOR will participate in team reviews of ongoing services as requested.
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PY-10-11-CORE-0158
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$2,500.00.
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(Offense Specific Evaluation,Max=$950.00)
$75.00/Episode(Intake,50-minute session)
$75.00/Episode(Individual or Family Therapy,50-minute Session)
$50.00/Episode(Group Therapy,90-minute Session)
$75.00/Episode(Specialty Services for Disabled Youth,50-minute Session)
$100.00/Episode(Field/Off-site Therapy,50-minute Session)
$75.00/Episode(Info ed Super,/ ' 1 Perso
$100.00/Epi nformed ervision, eople) prenc,p . .Qc ctn > no \ory,
$200. pisode(Inf ed Supervis ,4-6 People) // p, CVust> `0.,1 oc , i w���A�u
.00/Episode formed Sup ision,7-9 People) cilv
$50.00/Month/Case(Case Management) (SS (-tat— c.G. SL-n-5 ,pc
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-0158
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.
11
PY-10-11-CORE-0158
16. CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Contract. Except for purposes directly connected with the
administration of Child Protection,no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR written policies governing access to,
duplication and dissemination of,all such information. CONTRACTOR shall advise its employees,agents,
and subcontractor,if any,that they are subject to these confidentiality requirements. CONTRACTOR shall
provide its employees,agents,and subcontractors,if any,with a copy or written explanation of these
confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall have its
employees,agents,and subcontractors,if any,sign a written confidentiality agreement and shall provide a
copy of such agreement to the Department,if requested.
17. Proprietary information for the purposes of this contract is information relating to a party's research,
development,trade secrets,business affairs,internal operations and management procedures and those of its
customers,clients or affiliates,but does not include information(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes(C.R.S.) 8-17.5-
101,et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
12
PY-10-1 t-CORE-0158
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.
13
PY-10-11-CORE-0158
• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made,in the providers' opinion.
• Providers should continually assess family relationships(parent/child,sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
14
•
F27p� N1IflJIv1
PY-10-11-C l'S-0095 ("/7//,
CHILD PROTECTION AGREEMENT FOR SERVICES °+
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND JUBILEE RETREAT CENTER �I�y
[his Agreement,made and entered into the 49 day of 2010,by and between the Hoard of
Weld County Commissioners, sitting as the Hoard of Human Services, in behalf of the Weld County Department of
limas'Services.hereinafter referred to as the"Department."and Jubilee Retreat Center,hereinafter referred to as
"Contractor".
WITNESS]FFl I
WHEREAS,required approval,clearance.and coordination have been accomplished from and with
appropriate agencies:and
WI II Rl AS.the Colorado Department of I Inman Services has provided Child Welfare Administration
funding to the Department for Foster Parent Training:and
NOW fl i}il2f?ht)I21;. in consideration of the premises,the parties hereto covenant and agree as fiollotys:
1. 'Fenn
This Agreement shall become effective on June I,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 he 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 N%hick 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 hill 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 7h day of the month following the month the cost was incurred. if the
billing is not submitted within titeuty-live(23)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 he billed for,and reimbursement shall not he made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not he reimbursed or considered parr of this Agreement.
ace -/99/
1'Y-1 0-l 1-CI'S-t)t)95
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 OM13 Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRAC'T'OR shall provide proper monthly invoices and itemization of services performed Ii>r
costs incurred in the pei ormance ol'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!Inman Services. 'The decision of the Director of!Inman 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 incorNrated herein by reference.
7. Compliance with Applicable[saws
At all tunes 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 he established which
relate to the Contract. C()N'TRACTOR acknow ledges that the following laws are included:
Title Vi of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.s o.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.1,. 99-603:
42 C.F.R.Pan 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. 11'necessan, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted be 42 CFR Part 2.
PY-l0-I I-CPS-0095
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 14 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!Inman Services or with the U.S. Department of Health and I luman Services,
Office for Civil Rights.
S. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas:
Safety,Permanency and Well Being of families. For each outcome,data and perlomiunce indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PiP)will he 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 arc required to comply with a standard assessment and
reporting system set forth in Iixhibit I)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 he named as additional named insured on the insurance,where permissible hr
the insurance provider.
a. Standard Worktttan'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.&Pi))(Minimum).
!. Combined single limit-$500,001)written on an occurrence basis.
2. Any aggregate limit will not he less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability-policy.
5. Certificate of insurance to be provided to Weld County and must he attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
3
PY-I0-i I-CPS-0095
c. Automobile Liability (Minimum) for any Contractor transporting children or any party to whum
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 he 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 he paid for by the Department if the
Contractor has not previously attended the training. .1 he Contractor may he 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 hut 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 he personally served.
I 3. Monitoring and I valuation
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
CON I'RAC'I 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 he in writing and signed by both parties.
15. Remedies
The Director of I Inman 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 eeork shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
4
l'Y-I0-I I-CI'S-0095
a. Withhold payment to CONTRAC'I'c tR until the necessary services or corrections in performance arc
satisfactorily completed;
h. Den payment or recover reimbursement for those services or deliverables,which have not been
pertionned and which due to circumstances caused 1w CONTRACTOR cannot he performed or if
performed would he 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:
Lori Koehevar,MS,I.PC Owner
Name 'Title
17. Notice
All notices required to be given by the panties 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 he sent:
'To: 'The Department To: CON'TRAC'1'Olt
.ludo A. Griego,Director Lori Kochevar.MS,LPC
P.O. 13ox A 6445 lite I lighwav
Greek .CO 8(1632 Longmont,CC)80503
(970)352-1551 (970)352-887.
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 tenn"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-CPS-0095
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 he changed or modified except as stated in
Paragraph 14 herein.
6
PY-10-1 I-C I'S-0095
TN W I T NI i SS WI I EREOF,the parties hereto have d ulY ezcented the Agreement as of the day.month, and rear first
above mitten
ATTEST:
WELD CO�� I Y OARD OF COON'l Y
CLERK T( i611 ; ti� N` / )MMISSIONERS WELD
t E--!t '`,Th , 3 - Y. COLORAD
Far: J � _� v� f/ � / \. �� —
Deputy Cu, ;7 a='/ Chair Dougl Rademacher
� AUG 302010
AP ' . )AS ;ORM CONTRACTOR:
13Y
CO h A o e)' ' ntracty
WELD COI!MA' DEPARTMENT
OF HUMAN S 'RVICES
13\:
Jo 1. Gricgo Director
7
�r/O—/99/
PY-10-1 I-CPS-(1095
EXHIBIT A
SCOPE OF SERVICES
I. CONTRACTOR will provide training for Department foster families. Training includes Core Foster
Parent Training for Department lister home applicants(as scheduled by the Department)and
individualized training as identified by the Department. The goal of the program is to enhance and
improve the quality of care being provided to the Department's children and youth.
2. Core Foster Parent Training consists of a 27-hour training that includes,but is not limited to.a complete
review of the Weld County Foster Parent I landhook.as well as information on the following:
a. Iiffccts of fostering on the foster family.
h.Foster care resources and references.
e. Balancing needs(team approach to tbster care).
d. Roles and responsibilities of foster parents.
e. Reasons for and determination of placement of children.
!' Appropriate boundaries.
g.Documentation.
h. Structured house procedures.
i. Working with biological family members.
j.Oycryiew of abuse.
k. Effective parenting.
I.Legal issues.
m. Ethnicity and cultural issues.
n. Key concepts of child growth and development.
o. Attachment and bonding issues.
p. Attachment parenting.
q. Consequence-based parenting.
3. CONTRACTOR will obtain prior approval from the Department for any other training other than Core
Foster Parent Training(as scheduled by the Department).
4. CONTRACTOR will provide Core Foster Parent Training per the agreed upon schedule below:
October - 15. 16.29.30
- January - 28,29, Feb. 11, 12
May - 20,21. June 3,4
5. C'ONTRAC'TOR will work collaboratively with Ivslw parents,caseworkers, foster care coordinators and
other service providers to identify and address issues, in a solution-focused manner.
6. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care
for the foster children in their home and report this information to the Department.
7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the
Department regarding the need for additional services in a specific Weld County home.
8. CONTRAC'T'OR 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 he reported immediately per law.
8
l'Y-I D-I 1-CPS-0095
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$65.000.00.
Expenses incurred by CONTRACTOR,in association with said project prior to the term of this agreement,
are not eligible Department expenditures and shall not he 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
$3,995.00/tpisode(Core Foster Parent Training—Regardless of Number of Participants)
$58.00/Person(Foster Parent Education)
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 killing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certil that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Fxhibit A.
a. All billings are t0 he submitted by the 7th day of the month following the month of
ser-yice. If the pilling is not submitted within twenty-live(25)calendar days of the month
following service,it may result in forfeiture of payment.
h_ l3illings must be submitted with the attached required forms,Authorization for
Contractual Services, Request for Reimbursement, Client Verification Fomi and monthly
report. The Authorization for Contractual Services and Client Verification Form must he
submitted with original signatures.
c. For monitored sobriety,proof of services rendered shall he a sign-in sheet with client
signatures or the test result.
9
I'Y-10-11-CPS-(1)95
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 he
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while perlinming 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 pertirrmance 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 ol'this Agreement he 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 he 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 he 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,he excluded from participation in,
he denied the benefits of,or be othcnyise subjected to discrimination under this approved Contract.
g. 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.
tl. 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 he 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 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 hut is not completed at the end of the seven(7)year period,or it'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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10. CONTRACTOR assures that authorized local,federal,and state auditors and representatives shall,during
business hours,have aee,e,5a 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 he binding upon the parties hereto,their successors,heirs.legal representatives, and
assigns. CONTRACTOR or the Department may not assign any of its rights or obligations hereunder
without the prior written consent of both parties.
12. CON'T'RACTOR certifies that federal appropriated funds have not been paid or will he 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 finds 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.
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.forger,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. I lave not,within a three-year period preceding this Contract,had one or more public transactions
(federal,state,and local)terminated for cause or default.
15. The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest,it is not necessary for the contractor
to gain from knowledge of these opposing interests. it is only necessary that the contractor know that the
two relationships 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.
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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 inl miation 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 he accorded at least the
same precautions as arc employed by CONTRACTOR Ibr similar information in the course of its own
business.
IFS. 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 Pro'am administered by
the Social Security Administration and Department of I lomeland Security, and (h) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(h). 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 he 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 linked 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 slate's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will he implemented for the state to enhance services to families.
Additionally,the review will assess statewide,systemic factors to determine it'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 he addressed by the Department contracted providers.
Safety Outcomes
C1:SR Outcome Measures
Safety 1 Children are, first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Departments 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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• 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
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 harrier 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 l Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate serv=ices to meet their educational needs.
Well 13eing 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Departments 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 he 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 providers service continues to be appropriate. Reports should
also document what harriers may he impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
corking. 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 he provided and should he 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 PERKLEN CENTER FOR PSYCHOTHERAPY
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 Perklen Center for Psychotherapy,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 Management/Domestic Violence;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 7'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Child Welfare Administration to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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PY-10-II-CPS-0093
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R. Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
its implementing regulations,45 C.F.R.Part 84;and
- the Age Discrimination Act of 1975,42 U.S.C.Sections 6101 et. seq.and
its implementation regulations,45 C.F.R.Part 91;and
- Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S.Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents,shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
1. As required by state statute including occupational disease,covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
I. Combined single limit-$500,000 written on an occurrence basis.
2. Any aggregate limit will not be less than$1 million.
3. Provider must purchase additional insurance if claims reduce the annual aggregate below
$500,000.
4. State of Colorado to be named as additional insured on each comprehensive general
liability policy.
5. Certificate of insurance to be provided to Weld County and must be attached to the
contract.
6. Insurance shall include provisions preventing cancellation without 60 days prior notice
by certified mail to Weld County.
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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc.required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext.6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
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PY-10-11-CPS-0093
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:
Kim Ruybal,MA,LPC,NCAC II Executive Director/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 Kim Ruybal,MA,LPC,NCAC II
P.O. Box A 1020 8'h Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)353-8171
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-CPS-0093
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST: `�T
WELD CO -Ty(<;=i t•. " V: RD OF COUNTY
CLERK T tblOIDARD "a-- ' MISSIONERS WELD
l ,COL
t� 4 y
By: 1 " - : bu
Deputy Clerk . t /' Ch r Dou as Rademacher
AUG 302010
APP AS T CONTRACTORf
BY b 1 JUL 9Th • j1/49
omey Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju .Griegoi, irector
7
aC/L - i9 ?
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PY-I0-11-CPS-0093
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide Anger Management and Domestic Violence services to male and female
adults and juveniles, including developmentally disabled individuals,in Weld County.
2. CONTRACTOR will provided Anger Management and Domestic Violence services utilizing assessment
tools including the Shipley Institute of Living Scale,Millon Clinical Multiaxial Inventory (MCMI),
Minnesota Multiphasic Personality Inventory-II (MMPI-ll), STAXI-2, SASSI Questionnaire,Jesness
Inventory and the Hare PCL-R.
3. CONTRACTOR will complete an intake on each referred client prior to development of a treatment plan.
4. CONTRACTOR will submit a written document outlining recommendations for treatment, further
assessment,and risk to repeat similar behavior. The evaluation will determine the best placement for the
client in regards to treatment. CONTRACTOR will provide a copy of the evaluation to the caseworker.
5. CONTRACTOR will comply with the Colorado Domestic Violence Offender Management Board's
Standards and Guidelines. Domestic Violence services include a minimum of thirty-six(36)90-minute
sessions. Groups meet weekly.
6. Anger Management services include a minimum of thirty(30)90-minute sessions. Groups meet weekly.
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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
$575.00/Episode(Anger Management/Domestic Violence Evaluation-Office)
$625.00/Episode(Anger Management/Domestic Violence Evaluation -Off Site)
$200.00/Episode(MMPI-II Administration only with written report)
$65.00/Hour(Individual,Couples or Family Counseling)
$65.00/Episode(Intake Sessions)
$35.00/Episode(Group Sessions)
$100.00/Hour(Court Facilitation, Staffing and 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(1)lawfully obtained from third parties,(2)
that which is in the public domain,or(3)that which is developed independently. Neither party shall use or
disclose directly or indirectly without prior written authorization any proprietary information concerning the
other party obtained as a result of this Contract. Any proprietary information removed from the State's site
by CONTRACTOR in the course of providing services under this Contract will be accorded at least the
same precautions as are employed by CONTRACTOR for similar information in the course of its own
business.
18. CONTRACTOR certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor represents, warrants, and agrees that it (a) has verified that it does not employ any
illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(6). Contractor shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et
seq., the Department may terminate this Contract for breach and Contractor shall be liable for actual and
consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if Contractor
receives federal or state funds under this Contract, Contractor must confirm that any individual natural
person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24-
76.5-103(4) if such individual applies for public benefits provided under this Contract. If Contractor
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce
one of the forms of identification required by C.R.S.24-76.5-103 prior to the effective date of this Contract.
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EXHIBIT D
CHILD and FAMILY SERVICES REVIEWS(CFSR)
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review,a Performance
Improvement Program(PIP)will be implemented for the state to enhance services to families.
Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety,permanency and well-being for our youth. In order to insure continued
progress in this area,the Department is requiring providers to comply with a standard assessment and reporting
system which will address these three areas.*
The Department is requesting that provider reports include observations and recommendations regarding clients in a
way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that
will be assessed by the CFSR in the areas of safety,permanency and well-being, followed by specific considerations
and tasks which must be addressed by the Department's contracted providers.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are,first and foremost,protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's providers
• Providers should always consider the following definitions regarding child safety when assessing families.
o Children are considered safe when there are no present dangers or impending danger threats,or the
caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger threats,
and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance,potential,prospect)for parenting behavior that is harmful and
destructive to a child's cognitive,social,emotional and/or physical development,and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the provider to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the provider
believes should be implemented to insure safety of the child(ren).
• Providers must specifically document efforts to engage families in services and to control for safety.
Permanency Outcomes
CFSR Outcome Measures
Permanency I Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's providers:
• Provider reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• Provider reports must indicate progress toward achieving the permanency goal and should make specific
recommendations regarding how the continuation of the service may assist in achieving the goal.
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• Providers should continually provide recommendations about whether any out-of-home placement
continues to be appropriate and should make recommendations regarding when changes in this area should
be made, in the providers'opinion.
• Providers should continually assess family relationships(parent/child, sibling/sibling,extended
family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving
permanency. Providers should document ongoing efforts to resolve those issues and/or make
recommendations regarding additional services that may be required to address relationship issues.
• Providers must document specific time frames when recommending ongoing services and/or recommending
changes to services and/or placements.
Child and Family Well-Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PERKLEN CENTER FOR PSYCHOTHERAPY
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 Perklen Center for Psychotherapy,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:
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
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 7t1i day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations, interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
- Section 504 of the Rehabilitation Act of 1973,29 U.S.C. Section 794,and
its implementing regulations,45 C.F.R. Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 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 performanceindicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department's families and children must continually strive for
positive outcomes in the areas of safety,permanency and well being. Contractors providing services in
program areas identified by the Department are required to comply with a standard assessment and
reporting system set forth in Exhibit D which will address the aforementioned three areas.
9. Insurance
CONTRACTOR,shall procure,either personally or through its employer as applicable to the Contractor's
business,at its own expense,and maintain for the duration of the work,the following insurance coverage;
Weld County,Colorado,by and through the Board of County Commissioners of Weld County,its
employees and agents, shall be named as additional named insured on the insurance,where permissible by
the insurance provider.
a. Standard Workman's Compensation and Employer's Liability.
I. As required by state statute including occupational disease, covering all employees at
work site.
b. General Liability(PL&PD)(Minimum).
1. Combined single limit-$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-0140
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:
Kim Ruybal,MA,LPC,NCAC II Executive Director/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 Kim Ruybal,MA,LPC,NCAC II
P.O. Box A 1020 8'"Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 970)353-8171
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-0140
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
ATTEST:
WELD CO OF COUNTY
CLERK TO OR.:�BOAAR11 ';a„ onb ISSIONERS WELD
' "' O Y,COLOR
By: 1.1Cati
Deputy Clerk `- Chair Dougl Rademacher
AP V)r AS TO M: CONTRACTOR: \( un�YAUG3 0 2010
BY l.uk,
Co Attome Contractor
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Judy .Griego, irector
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PY-10-11-CORE-0140
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide mental health services to male and female adults and juveniles,including
developmentally disabled individuals,in Weld County,as referred by the Department. Services include:
a. Evaluation Services-Consisting of two(2)to four(4)hours of face-to-face interview followed by
psychometric assessment. Assessment tools include the Shipley Institute of Living Scale,Millon
Clinical Multiaxial Inventory(MCM1),Minnesota Multiphasic Personality Inventory-11 (MMPI-II),
STAXI-2,SASSI Questionnaire,Jesness Inventory and the Hare PCL-R.
b. Individual,Couples and/or Family Counseling—Face-to-face contact to address specific identified
areas of concern,trauma and/or conflict.
2. CONTRACTOR will complete an intake on each referred client prior to development of a treatment plan.
3. For evaluation services,CONTRACTOR will submit a written document outlining recommendations for
treatment, further assessment,and risk to repeat similar behavior.CONTRACTOR will provide a copy of
the evaluation to the caseworker.
4. For counseling services,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.
5. CONTRACTOR will participate in team reviews of ongoing services as needed.
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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$2,000.00.
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
$575.00/Episode(Mental Health Evaluation-In-office)
$625.00/Episode(Mental Health Evaluation-Off site)
$200.00/Episode(MMPI-ll Administration only with written report)
$65.00/Hour(Individual,Couples or Family Counseling)
$100.00/Hour(Court Facilitation, Staffing and 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 7ih 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
I. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld,State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect, in the approved Agreement or the proceeds thereof
7. CONTRACTOR assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no
person shall,on the grounds of race,creed,color,sex,or national origin,be excluded from participation in,
be denied the benefits of,or be otherwise subjected to discrimination under this approved Contract.
8. CONTRACTOR assures that sufficient,auditable,and otherwise adequate records that will provide
accurate,current,separate,and complete disclosure of the status of the funds received under the Contract
are maintained for three(3)years or the completion and resolution of an audit. Such records shall be
sufficient to allow authorized local,Federal,and State auditors,and representatives to audit and monitor
CONTRACTOR.
9. All such records,documents,communications,and other materials created pursuant or related to this
contract shall be maintained by CONTRACTOR, in a central location and shall be made available to Social
Services upon its request, for a period of seven(7)years from the date of final payment under this Contract,
or for such further period as may be necessary to resolve any matters which may be pending,or until an
audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or
state government has begun but is not completed at the end of the seven(7)year period,or if audit findings
have not been resolved after a seven(7)period,the materials shall be retained until the resolution of the
audit finding.
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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
employess,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'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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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PERKLEN CENTER FOR PSYCHOTHERAPY
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 Perklen Center for Psychotherapy,hereinafter
referred to as"Contractor".
WITNESSETH
WHEREAS,required approval,clearance,and coordination have been accomplished from and with
appropriate agencies;and
WHEREAS,the Colorado Department of Human Services has provided Core Services funding to the
Department for Sex Abuse Treatment(Offense Specific);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'h day of the month following the month the cost was incurred. If the
billing is not submitted within twenty-five(25)calendar days of the month following service, it
may result in forfeiture of payment.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Services to the Department.
d. The Department shall not be billed for,and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A. Work performed prior to the execution of this
Contract shall not be reimbursed or considered part of this Agreement.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, CONTRACTOR shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Service funding must conform to the Single Audit Act of 1984 and OMB Circular A-
133.
5. Payment Method
Unless otherwise provided in the Scope of Services and Payment Schedule:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the
Financial Management Requirements,program objectives,contractual terms,or reporting
requirements. In the event of a forfeiture of reimbursements,CONTRACTOR may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
CONTRACTOR shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto
and incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, CONTRACTOR shall strictly adhere to all applicable
federal and state laws,orders,and all applicable standards,regulations,interpretations or guidelines issued
pursuant thereto. This includes the protection of the confidentiality of all applicant/recipient records,
papers,documents,tapes and any other materials that have been or may hereafter be established which
relate to the Contract. CONTRACTOR acknowledges that the following laws are included:
Title VI of the Civil Rights Act of 1964,42 U.S.C.Sections 2000d—I et.seq.and its implementing
regulation,45 C.F.R.Part 80 et.seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and
- its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
- the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
- 42 C.F.R. Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap, including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended,cited
above. If necessary, CONTRACTOR and the Department will resist in judicial proceedings any efforts to
obtain access to client records except as permitted by 42 CFR Part 2.
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Included is 45 C.F.R.Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Compliance with Child and Family Services Review
The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;
Safety,Permanency and Well Being of families. For each outcome,data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review,a Program Improvement Plan(PIP)will be implemented for the state to enhance
services to families.
CONTRACTORS providing services to the Department'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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c. Automobile Liability(Minimum)for any Contractor transporting children or any party to whom
Department services are being provided.
d. Additional coverage may be required in specific program areas. For any insurances that are
required by this contract,a completed Standard Certificate of Insurance Form shall be provided to
the Department by the Contractor prior to the start of any contract.
10. Certifications
CONTRACTOR certifies that,at the time of entering into this Contract,it has currently in effect all
necessary licenses,approvals,insurance,etc. required to properly provide the services and/or supplies
covered by this contract. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any contract.
11. Training
CONTRACTOR shall attend a Court Testimony and Ethics Training to be paid for by the Department if the
Contractor has not previously attended the training. The Contractor may be required to attend additional
training at the request of the Department. The cost of such training will be paid for by the Department. The
Department will not compensate the Contractor for the time spent attending the required trainings.
12. Subpoenas
CONTRACTOR will,on behalf of its employees and/or officers,accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service,the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215,ext. 6503,and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by CONTRACTOR and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners,the Department and
CONTRACTOR.
CONTRACTOR shall permit the Department,and any other duly authorized agent or governmental agency,
to monitor all activities conducted by CONTRACTOR pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate,such program data,special
analyses,on-site checking,formal audit examinations,or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with agreement work.
14. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
CONTRACTOR substantially failed to satisfy the scope of work found in this Agreement. Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by
CONTRACTOR. These remedial actions are as follows:
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a. Withhold payment to CONTRACTOR until the necessary services or corrections in performance are
satisfactorily completed;
b. Deny payment or recover reimbursement for those services or deliverables,which have not been
performed and which due to circumstances caused by CONTRACTOR cannot be performed or if
performed would be of no value to the Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department;
c. Incorrect payment to CONTRACTOR due to omission,error,fraud,and/or defalcation shall be
recovered from CONTRACTOR by deduction from subsequent payments under this Agreement or
other agreements between the Department and CONTRACTOR,or by the Department as a debt due
to the Department or otherwise as provided by law.
16. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated representatives of
the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Gloria Romansik Social Services Administrator
Name Title
For CONTRACTOR:
Kim Ruybal,MA,LPC,NCAC II Executive Director/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 Kim Ruybal,MA,LPC,NCAC I I
P.O. Box A 1020 8th Street
Greeley,CO 80632 Greeley,CO 80631
(970)352-1551 (970)353-8171
I8. Litigation
CONTRACTOR shall promptly notify the Department in the event that CONTRACTOR learns of any
actual litigation in which it is a party defendant in a case that involves services provided under this
Agreement.CONTRACTOR,within five(5)calendar days after being served with a summons,complaint,
or other pleading which has been filed in any federal or state court or administrative agency,shall deliver
copies of such document(s)to the Human Services Director. The term"litigation"includes an assignment
for the benefit of creditors,and filings in bankruptcy,reorganization and/or foreclosure.
19. Termination
This Agreement may be terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of 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-10-1 I-CORE-0160
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
:ice,
t n/l
ATTEST:
WELD CO ii,z4 - ' D OF COUNTY
CLERK TO 9R Op \✓1 c, OM ISSIONERS WELD
By. &esEJOaRade vyalr
L r`7---
OVE S TO F CONTRAjCTOnR: Res)r(f
0 2010
Co Attorney Contractor
WELD COUNTY DEPARTMENT
OF HU4Qecth
RVICES
By
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PY-10-11-CORE-0160
EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will provide offense specific evaluation and treatment services to male and female
juveniles and adults,including developmentally disabled individuals, in Weld County,as referred by the
Department. Services include:
a. Evaluation Services-Consisting of two(2)to four(4)hours of face-to-face interview with the referred
juvenile,and/or parents when necessary, followed by psychometric assessment. Assessment tools
include the Shipley Institute of Living Scale,Millon Clinical Multiaxial Inventory(MCMI),Minnesota
Multiphasic Personality Inventory(MMPI),Minnesota Multiphasic Personality Inventory(MMPI)-
Juvenile Version, STAXI-2, SASS1 Questionnaire,Jesness Inventory,Jesness Inventory-Juvenile
Version,Multiphasic Sex Inventory(MSI),Multiphasic Sex Inventory(MSI)-Juvenile Version, Penile
Plethysmograph(PPG),Wilson Sex Fantasy Questionnaire,and the Hare PCL-R,Hare PCL-Youth
Version.
b. Penile Plethysmograph(PPG)—An assessment used to determine sexual arousal patterns and identify
potential treatment needs related to deviant sexual arousal. Services include administration of the PPG
and a written statement of the findings.
c. Arousal Management—An assessment used to help deter deviant arousal patterns and used in
conjunction with the PPG and clinical interpretation of healthy sexual fantasies.
d. Sex Abuse Individual,Couples and Family Treatment—Face-to-face contact with the individual,
couple or family to address specific identified areas of concern,trauma and/or conflict.
e. Sex abuse Group Therapy for Adults—Gender-specific groups with curriculum that addresses,but is
not limited to,cognitive restructuring,anger management,assertive communication,the cycle of
sexually violent behavior,core beliefs,victim impact and empathy,stress management,how children
and families are impacted by personal choices and formulation of a relapse prevention plan.Treatment
is conducted in four phases that meet one to two times per week.
f. Chaperones Group—Educational group for the non-offending parent or caregiver who may supervise
children in the presence of the offending parent. Curriculum includes, but is not limited to,rules and
guidelines,the offense cycle, Rational Emotive Therapy, irrational beliefs,thinking errors,consent and
the SAFE formula,and victim empathy.
g. Juvenile Sex Offense Specific Treatment and Groups—Treatment for youth who have been convicted
of a sexual assault and have been found appropriate for community based treatment. Curriculum
includes,but is not limited to,cognitive restructuring,consent,types of violence,sex education ,victim
empathy,sexual offense cycle, assessing deviant vs. non-deviant thoughts and behaviors,covert
sensitization,prevalence of sexual offending,and power and control dynamics related to sexual
offending.
h. Informed Supervision(Juveniles Only)—Education for the identified parent or caregiver who will
supervise the offending youth. Curriculum includes, but is not limited to,Guiding Principles of the
Colorado Standards for Treatment for Juveniles who Sexually Offend, Ecological Model,goal
orientation,evaluation process,Treatment Outcomes Summary, Informed Supervisors,types of illegal
sexual behavior,defense mechanisms,cycle of sexual offending,universal goals,safety planning,
SOMB supervision protocol,Informed Supervision Initial Caregiver-Juvenile Supervision Plan,and
therapeutic care protocol. Each informed supervision training will occur over(3)hours
i. Family Reunification—Therapy utilized for juveniles who have completed sex offender treatment and
are reintegrating into the family/home. Therapy will involve all family members, including the victim
if the victim resides in the home,and a safety plan will be established to ensure continued safety in the
home.
2. All evaluations will be conducted under the supervision of by Kim Ruybal,MA,LPC,NCAC II. Ms.
Ruybal will also review and sign all evaluations.
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3. The following Perklen staff are approved by the Department to conduct SOMB evaluations:
• Kim Ruybal,MA,LPC,NCACII(SOMB Full Operating Level Supervisor)
• Jodie Goter,MA,LPC(BOMB Full Operating Level Treatment Provider)
• Aaron Henderson,MA(SOMB Associate Level)
• Victoria Cordova,MS(SOMB Associate Level)
4. All services will comply with the Colorado Sex Offender Management Board's Standards and Guidelines for
for juveniles,adults and developmentally delayed offenders.
5. The Department will pay for one(I)polygraph per year per referred client. At this time,CONTRACTOR
utilizes Chuck H. Marshall Polygraph Services,LLC.
6. For evaluation services,CONTRACTOR will submit a written document outlining recommendations for
treatment,further assessment,and risk to repeat similar behavior. CONTRACTOR will provide a copy of
the evaluation to the caseworker.
7. For ongoing services,such as therapy and groups,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.
8. CONTRACTOR will participate in team reviews of ongoing services as needed.
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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 Core Services funding,not to exceed $6,625.00.
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
$900.00/Episode(Evaluation with PPG -In-office)
$1,150.00/Episode(Evalation with PPG -Off-site)
$700.00/Episode(Evaluation without PPG)
$250.00/Episode(Penile Plethysmograph)
$250.00/Polygraph(Sex History)
$225.00/Polygraph(Maintenance)
$65.00/Episode(Arousal Management)
$65.00/Episode(Intake)
$65.00/Hour(Individual,Couples or Family Counseling)
$35.00/Per Person/Group(Phase One,Three or Four-Adult Sex Abuse Group)
$40.00/Per Person/Group(Phase Two-Adult Sex Abuse Group)
$35.00/Per Two People/Group(Chaperones Group)
$35.00/Per Person/Group(Juvenile Sex Offense Specific Treatment Group)
$52.50/Per Person(Informed Supervision-Juveniles Only,3-hour training)
$65.00/Hour(Family Reunification)
$100.00/Hour(Court Facilitation/Staffing)
Department referrals will not be sent to collections by Contractor for default of co-pay/fees. Services will
be performed regardless of client's refusal or inability to pay co-pay.
Contractor will collect any applicable sliding scale co-pays and credit the Department for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly the itemized voucher and certify that the services
authorized were provided on the date indicated and the charges made were pursuant to the terms and
conditions of Exhibit A.
a. All billings are to be submitted by the 7'"day of the month following the month of
service. If the billing is not submitted within twenty-five(25)calendar days of the month
following service, it may result in forfeiture of payment.
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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
I. CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County,nor are they entitled to any employee benefits as Weld County employees,as
the result of the execution of this Agreement.
2. Weld County,the Board of County Commissioners of Weld County,its officers and employees,shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR-contracted
CONTRACTOR or its employees,volunteers,or agents while performing duties as described in this
Agreement.CONTRACTOR shall indemnify,defend,and hold harmless Weld County,the Board of
County Commissioners of Weld County, its employees,volunteers,and agents. CONTRACTOR shall
provide adequate liability and worker's compensation insurance for all its employees,volunteers,and agents
engaged in the performance of the Agreement upon request, CONTRACTOR shall provide the Department
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess,not shall any portion of this Agreement be deemed to have created a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado,to expend funds not otherwise appropriated in each succeeding year.
S. If any section,subsection,paragraph,sentence,clause,or phrase of this Contract is for any reason held or
decided to be unconstitutional,such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection,paragraph,sentence,clause,and phrase thereof irrespective of the fact that any one or more
sections,subsections,paragraphs,sentences,clauses,or phrases might be declared to be unconstitutional or
invalid.
6. No officer,member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest,direct or indirect,in the approved Agreement or the proceeds thereof.
7. 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 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'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
CF SR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's providers:
• Providers must engage in ongoing assessments of the parents' capacity to appropriately care for their
children and whether or not the service being provided continues to be appropriate. This must be clearly
documented in monthly reports.
• Providers should specifically detail areas of continued concern within the family and make
recommendations regarding whether that provider's service continues to be appropriate. Reports should
also document what barriers may be impeding progress.
• Providers should document any and all observed concerns regarding any child with whom the provider is
working. This should include concerns regarding physical,emotional,educational and behavioral well-
being of the child. When appropriate,providers should make recommendations regarding evaluations
and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
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