HomeMy WebLinkAbout20253330 EXHIBIT A to the CWS-7A
Additional Provisions for the Agreement to Purchase
Foster/Kinship Care Services and Foster/Kinship Care
Facility Agreement CWS-7A
The following additional provisions in this Exhibit A and Addendum 1 apply to the agreement entitled,
"Individual Provider Contract for Purpose of Foster/Kinship Care Services and Foster/Kinship Care
Facility Agreement," by and between the Weld County Department of Human Services, hereinafter
referred to as, "County," and Shamyra Screen, Provider ID# 1794166, hereinafter referred to as,
"Provider."
GENERAL PROVISIONS
1. Each party shall have the right to terminate this Agreement by giving the other party written
notice received at least thirty (30) days prior to the intended date of termination. If notice is so
given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible
child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties
hereunder for further performance of the terms of this Agreement shall thereupon cease;
however, the parties shall not be released from the duty to perform their obligations up to the
date of termination. This provision does not affect removal of a child in an emergency
situation.
2. Provider agrees that Provider is an independent contractor and that neither Provider nor
Provider's agents or employees are, or shall be deemed to be, agents or employees of the
County for any purpose. Provider shall have no authorization, express or implied, to bind the
County to any agreement, liability, or understanding. The parties agree that Provider will not
become an employee of County. Provider shall be solely and entirely responsible for its acts or
of any agent, employee, servants and sub-Providers during the performance of this
Agreement. Provider is not entitled to unemployment insurance or workers'
compensation benefits through Weld County and Weld County shall not pay for or
otherwise provide such coverage for Provider. Unemployment insurance benefits will
not be available to Provider for services provided under this Agreement. Provider shall
pay when due any/all applicable employment taxes and income taxes and local head
taxes (if applicable) incurred as a result of the services provided under this Agreement.
3. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether
in whole or in part, is subject to and contingent upon the continuing availability of State of
Colorado, county, and federal funds for the purpose thereof.
4. This Exhibit A is intended to be applied in conjunction with the attached Agreement as the
complete integration of all understandings between the parties. No prior or contemporaneous
addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless
embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other
amendment hereto shall have any force or effect unless embodied as a part of this written
Agreement. This section shall not be construed as prohibiting the periodic amending of this
Agreement in writing, if agreed to by both parties. The Agreement, this Exhibit A and the rate
Addendums are intended to be in lieu of and supersede all prior agreements between the
parties hereto and relating to the care and services herein described.
5. The State of Colorado Department of Human Services and the County shall be and hereby is
permitted to monitor the service program, fiscal and other records sufficiently to assure the
Exhibit A to the CWS-7A 5 Revised 05/2025
purchase of services in this Agreement are carried out for the benefit of the aforementioned
child or youth. Monitoring may occur through review of program reports, on-site visits where
applicable and other Agreements as deemed necessary. Provider understands that the State
Department and the County may provide consultation to Provider to assure satisfactory
performance in the provision of purchased services under this Agreement.
6. County shall have access to Provider's service program, financial and other records, which will
sufficiently and properly reflect all direct and indirect costs of any nature incurred in the
performance of this Agreement for purposes of audit. Such records shall be complete and
available for audit 90 days after final payment hereunder and shall be retained and available
for audit purposes for at least five years after final payment hereunder.
7. Time is of the essence in each and all of the provisions of this Agreement.
8. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to
deliver or otherwise to perform any obligation under this Agreement, where such failure is due
to any cause beyond its reasonable control, including but not limited to Acts of God, fires,
strikes, war, flood, earthquakes or Governmental actions.
9. Any notice required to be given under this Agreement shall be in writing and shall be mailed or
delivered to the other party at that party's address as stated in this Agreement.
10.This Agreement is nonexclusive, and County may engage or use other Providers or persons to
perform services of the same or similar nature.
11.Provider assures and certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or
voluntarily excluded from covered transactions by a federal department or agency.
b. Have not, within a three-year period of preceding this Agreement, been convicted of or had
a civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (federal, state, or
local) transaction or contract under a public transaction; violation of federal or state
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
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 (B)above.
d. Have not within a three-year period preceding this Agreement, had one or more public
transactions (federal, state, and local) terminated for cause ordefault.
12.In addition to terminating this Agreement in accordance with the provisions herein, County may
exercise the following remedial actions if the County finds and determines that the Provider
has substantially failed to satisfy the duties found in this Agreement and Exhibit A Substantial
failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or
inaction by the Provider. These remedial actions include, but are not limited to, any one or
more of the following:
Exhibit A to the CWS-7A 6 Revised 05/2025
a. Withhold payment to Provider 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 Provider cannot be performed
or if performed would be of no value to County. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to County.
c. Recover from Provider any incorrect payment to Provider due to omission, error, fraud,
and/or defalcation by deducting from subsequent payments under this Agreement, or other
agreements between County and Provider, or as a debt to County, or otherwise as
provided by law.
13.It is expressly understood and agreed that the enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to
the undersigned parties or their assignees, and nothing contained in this Agreement shall give
or allow any claim or right of action whatsoever by any other person not included in this
Agreement. It is the express intention of the undersigned parties that any entity other than the
undersigned parties or their assignees receiving services or benefits under this Agreement
shall be an incidental beneficiary only.
14.No portion of this Agreement shall be deemed to constitute a waiver of any immunity the
parties or their officers or employees may possess, nor shall any portion of this Agreement be
deemed to have created a duty of care that did not previously exist with respect to any person
not a party to this Agreement. The parties hereto acknowledge and agree that no part of this
Agreement is intended to circumvent or replace such immunities.
15.Provider shall promptly notify County in the event in which it is a party defendant or respondent
in a case, which involves services provided under the agreement. The Provider, 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 County Director. The term "litigation" includes an assignment for the
benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure.
16.This Agreement and the provision of services hereunder shall be subject to the laws of
Colorado and be in accordance with the policies, procedures, and practices of County.
Provider shall strictly comply with all applicable federal and State laws, rules and regulations in
effect or hereafter established.
17.Financial obligations of the County payable after the current fiscal year are contingent upon
funds for that purpose being appropriated, budgeted and otherwise made available. Execution
of this Agreement by County does not create an obligation on the part of County to expend
funds not otherwise appropriated in each succeeding year.
18.County agrees to purchase, and Provider agrees to provide the care and services, which are
listed in this Agreement. The State approved rate for Child Maintenance/Respite will be paid
for any child placed with the Provider unless the Medically Fragile Tool has been completed
due to intensive medical/physical needs, or limitations that interfere with daily life functioning.
The Medically Fragile Tool will be completed every six months as long as the child remains in
care with the Provider. The rate will be adjusted if the Medically Fragile Tool indicates a
change in the level of care. The Medically Fragile Tool will determine the reimbursement rate
Exhibit A to the CWS-7A 7 Revised 05/2025
as specified in Addendum 1.
19.AII bed hold authorizations and payments are subject to a 7-day maximum for a child's
temporary absence from a facility; however, if the absence is a result of hospitalization the
maximum bed hold authorization may be up to 14 days. Bed hold requests must have prior
written authorization from the Department Administrator or Designee before payment will be
release to Provider.
20.Any additional costs for specialized services, which may include but are not limited to; Co-
pays, deductibles, or services not covered by Medicaid, will need to be authorized, in writing by
the Department Administrator, prior to the service being performed. Any payment for
specialized services not authorized in writing may be denied.
21.All reimbursement requests shall:
a. Be submitted in a format approved by the County. If submitted in an unapproved format or
inadequate documentation is provided, the County reserves the right to deny payment.
b. Be submitted by the 4th of each month following the month of service. If the
reimbursement request is not submitted within twenty-five (25) calendar days of the month
following service, it may result in forfeiture of payment.
c. Placement service reimbursement shall be paid from the date of placement up to, but not
including the day of discharge.
d. Transportation reimbursement shall be for visitation purposes or transportation to school if
out of county and with prior approval only If medical transportation is needed, Provider will
arrange reimbursement through Medicaid.Any other special requests for transportation
reimbursement shall require prior approval by the Resource Manager or the Department
Administrator.
e. Clothing allowance reimbursement shall be approved and reimbursed as indicated on the
clothing allowance form provided by the Foster/Kinship Care Coordinator.
22.It is agreed that if, after investigation, it is shown that reasonable care was given to guard and
protect personal items brought to Provider by the children, Provider shall be released from
responsibility for loss or damage to such personal items.
PROVIDER SHALL:
1. Conform with and abide by all rules and regulations of the Colorado Department of Human
Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the
State of Colorado and any applicable federal laws and regulations, as such, which may be
amended from time to time, and shall be binding on Provider and control any disputes in this
Agreement.
2. Not charge any fees to children or families of children referred by County for any services
provided under this Agreement.
3. Not assign the obligations under this Agreement nor enter into any sub-Agreement without the
express written approval of the Director of the County Department or his/her appointed
designee.
Exhibit A to the CWS-7A 8 Revised 05/2025
4. Maintain at all times during the term of this Agreement a liability insurance policy of at least
$25,000 for property damage liability, $150,000 for injury and/or damage to any one person,
and $500,000 for total injuries arising from any one accident. Provider shall provide a
certificate of insurance provided by its insurer upon request by County.
5. Indemnify the County against any and loss against all claims and actions based upon or
arising out of damage or injury, including death, to persons or property caused or sustained in
connection with the performance of this Agreement or by conditions created thereby, or based
upon any violations of any statute, ordinance, or regulation and the defense of any such claims
or actions.
6. Attend or participate in Ice Breaker, Family Engagement or Team Decision making meetings,if
requested by the Department. County staff shall notify the Provider of the dates and times
attendance is requested.
7. Request a staffing if considering giving notice to remove a child, except in emergency
situations. These requests shall be made through the child's caseworker and/or the Provider's
Foster/Kinship Care Coordinator.
8. Actively participate in achieving the child's permanency goal, cooperate with any contractors
hired by the Weld County Department of Human Services to preserve placement in the least
restrictive placement appropriate, comply with the treatment plan of the child, and attend court
hearings as requested.
9. Have physical examinations completed within 14 days and dental examinations completed
within 8 weeks of the child being placed with Provider. All documentation of these
examinations will be placed in the foster child's placement binder.
10.Attend all necessary school meetings and support any plan that is developed regarding the
child in order to promote educational success.
11.Immediately report to the County Department and/or local law enforcement any known or
suspected child abuse or neglect as set forth in Section 19-3-304,C.R.S.
12.Maintain, access and review information monthly on Binti.
13.Maintain/update information in the foster/kinship child's binder, either hard copy or in Binti. The
binder will be reviewed on a monthly basis and signed off by child's caseworker and/or the
Provider's Foster/Kinship Care Coordinator.
14.Maintain/update medication logs on a daily basis, if child is taking medications.
15.Comply with all County and State certification requirements as set forth in the State
Department rules, Staff Manual Volume VII and the Weld County Department of Human
Services Policy and Procedure manual.
16.Contractor certifies that, at the time of entering into this Agreement, he/she currently has in effect
all necessary licenses, approvals, insurance, etc., required to properly provide the services
covered by this Agreement. These requirements include, but are not limited to, the following:
a. Valid driver's license indicating Contractor is at least eighteen (18) years of age; and
Exhibit A to the CWS-7A 9 Revised 05/2025
b. Completed background check through the Colorado Bureau of investigation (CBI) and
the Federal Bureau of Investigation (FBI).
c. Procurement of at least the minimum amount of automobile liability insurance required
by the State of Colorado.
Exhibit A to the CWS-7A 10 Revised 05/2025
ADDENDUM 1
Medically Fragile Tool Rates
Child Maintenance
Daily Rate
Medically Fragile
Level 1 $57.73
Level 2 $115.82
Level 3 $174.17
Level 4 Negotiate up to $210 1
Addendum 1 to Exhibit A CWS-7A 11 Revised 07/2023
Contract Form
Entity Information
Entity Name* Entity ID* ❑ New Entity?
SCREEN, SHAMYRA @00050570
Contract Name* Contract ID Parent Contract ID
SCREEN, SHAMYRA (INDIVIDUAL PROVIDER CONTRACT 10149
CWS-7A) Requires Board Approval
Contract Lead* YES
Contract Status SADAMS
CTB REVIEW Department Project#
Contract Lead Email
sadams@weld.gov;cobbx
xlk@weld.gov
Contract Description*
(CONSENT) SCREEN, SHAMYRA (INDIVIDUAL PROVIDER CONTRACT CWS-7A) - NEW PROVISIONAL FOSTER CARE
PROVIDER. TERM: 12/4/25 THROUGH 6/3/26.
Contract Description 2
Contract Type* Department Requested BOCC Agenda Due Date
CONTRACT HUMAN SERVICES Date* 12/04/2025
12/08/2025
Amount* Department Email
$0.00 CM- Will a work session with BOCC be required?*
HumanServices@weld.gov NO
Renewable*
NO Department Head Email Does Contract require Purchasing Dept. to be
CM-HumanServices- included?
Automatic Renewal DeptHead@weld.gov
Grant County Attorney
IGA GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date Review Date* Renewal Date
04/03/2026
Termination Notice Period Expiration Date*
Committed Delivery Date 06/03/2026
Contact Information
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
CONSENT 12/04/2025
Approval Process
Department Head Finance Approver Legal Counsel
)AMIE ULRICH CONSENT CONSENT
DH Approved Date Finance Approved Date Legal Counsel Approved Date
12/04/2025 12/04/2025 12/04/2025
Final Approval
BOCC Approved Tyler Ref#
AG 120825
BOCC Signed Date
Originator
BOCC Agenda Date SADAMS
12/8/2025
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