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Home My WebLink About20253408 EXHIBIT A SCOPE OF SERVICE I. SERVICES The Contractor will not commence services under this Agreement until services have been approved in the individual's Service Plan. Services to be provided are detailed in the Individual's State Supported Living Services (SLS) or OBRA Service Plan which dictates the type of service as well as timing and frequency of service to be performed. Specific work performance expectations that are deemed appropriate and necessary in order to receive compensation for the work must meet specified State Regulations. The Contractor affirms the following requirements are met, as defined by the State of Colorado: The service to be delivered shall meet all applicable state licensing requirements for the performance of the support or service being provided. Certificate: The service to be delivered shall meet all applicable state certification requirements for the performance of the support or service being provided and program approval. II. TERMS a. CREDENTIALING CRITERIA: Contractor and its employee(s) and sub-contractor(s) shall remain in good standing with the Colorado Department of Regulatory Affairs (DORA) and may not, at any time during the term of this contract, be listed as excluded or debarred in the System for Award Management (SAM). Contractor shall ensure that all employees/subcontractors who provide services to clients under this contract meet the credentials/qualifications specific to the County's identified credentialing standards and C.R.S Title 12, Article 43 and in the Social Services Manual Volume 7.000.6(M) (12 CCR 2509-4). The County has the right to approve Contractor's employees/subcontractors who will be performing services under this contract prior to the commencement of the work and shall have the right to review the employee(s)'/subcontractor(s)' employment files prior to granting approval. Contractor must retain copies of employee credentialing qualifications and background checks in personnel files and make such records available to the County Representative upon request. Contractor shall obtain reference and background checks, including fingerprint-based police (CBI and/or FBI) checks (if required by statute or regulation or if there will be unsupervised contact with children), checks of County records, and Sexual Offender Registry checks and receive, at minimum, preliminary results before assigning/hiring employees/subcontractors to perform under this contract. If the County becomes dissatisfied with Contractor's employee(s)/subcontractor(s), the County will notify Contractor of its concerns about the employee(s)/subcontractor(s). Disciplinary measures, if any, will be the sole responsibility of Contractor. However, if the concerns/issues cannot resolve to the County's satisfaction, Contractor's 15 employee(s)/subcontractor(s) may not be allowed to provide services under this contract. The County reserves the right to review all Contractor's or Sub-Contractors background checks. It is the responsibility of the Contractor to notify the County of results of background checks. b. RECORDS: The Contractor shall maintain a complete file of all records, communications, documents, and other written materials that pertain to the operation of programs or the delivery of services under this agreement and shall maintain such records for a period of six (6) years after the date of termination of this agreement as per State requirements, or for such further period as may be necessary to resolve any matters which may be pending. All files shall be kept at the Contractor's place of business, and the Contractor shall furnish copies of such files, or portions thereof, as requested by the County or its designee. c. INSPECTIONS AND PERFORMANCE MONITORING: The Contractor shall permit the County, the State of Colorado, the Colorado Department of Health Care Policy and Financing, the U.S. Department of Health and Human Services, and any other duly authorized agent or governmental agency (including the Medicaid Fraud Control Unit) to monitor all activities authorized under this agreement. Such monitoring may consist of internal evaluation procedures, examination of data, formal audit, on-site checking, or any other reasonable procedure. Any amounts which have been paid by the County, and which are found to be improper in accordance with the terms of this agreement shall be immediately returned to the County or may be withheld from future payments. Services rendered through State SLS are subject to inspection and recovery by the Department pursuant to 10 C.C.R. 2505-10 Section 8.076. 16 EXHIBIT B RATE SCHEDULE I. Payment Services: a. The Contractor shall invoice the County within four (4)working days of the end of the month in which the services were performed, except at the end of the fiscal year when invoices are due two (2) working days from the end of the fiscal year. Invoices received within this time frame will be paid Net 30 unless otherwise noted on the invoice. Invoices may be sent via email to wccmabilling(c�weld.gov b. Contractor must include the following detail on invoices in order to be paid for services: i. Name of individual receiving services ii. Dates of Service iii. For services paid in 15-minute increments, invoice must show the amount of time services were provided in hours or 15-minute increment iv. Rate per 15-minute increment or Rate per hour (per State General Fund fee schedule) v. Total Amount Due vi. "No shows" are not billable to Medicaid and will not be reimbursed. Do not include "No shows" in your billing ("No shows" include family cancelling or provider cancelling) c. Rates paid for State SLS, State General Funds and OBRA services can be found on the State Health Care Policy and Financing Website https://hcpf.colorado.qov/provider-rates- fee-schedule. Supplies and Equipment: a. The Contractor shall invoice the County within sixty (60) days of the end of the month in which the client received the supplies and equipment, except at the end of the fiscal year when invoices are due two (2) working days from the end of the fiscal year for all State General Fund invoices. Invoices received within this time frame will be paid Net 30 unless otherwise noted on the invoice. Invoices may be sent via email to wccmabilling(cr�weld.gov b. Contractor must include the following detail on invoices in order to be paid for services: i. Name of individual in services ii. Dates of Supply delivery/pickup iii. Total Amount Due c. Reimbursement for all supplies and equipment will be provided based on the actual purchase price of the item. d. Rates paid for State SLS and OBRA services can be found on the State Health Care Policy and Financing Website https://hcpf.colorado.gov/provider-rates-fee-schedule. II. TERMS In order to comply with HCPF State General Funds reporting requirements, no invoices received from the Contractor after July 3, 2026,for Fiscal Year July 1, 2025 thru June 30, 17 2026 will be accepted or paid by the County, the date of July 3, 2026 is subject to change pending Fiscal Year 25-26 holiday schedule. Services may be increased or decreased during the term of this agreement by either party due to increased or decreased State funding levels or adjustments to service levels, with the agreement by both parties. In the event that overpayments are made by the County due to the Contractor's omission, error, fraud, or defalcation; or in the event that the State or Federal government seeks to recover from the County any sums of money based upon a claim on behalf of the Contractor after said funds have been paid to the Contractor, the Contractor shall immediately reimburse such funds to The County as allowed by law. The parties understand and agree that the County shall have the right to offset against payments due to the Contractor hereunder, or by other legal means recover any debts owed by the Contractor to the County or to the State. Electronic Visit Verification (EVV) is not a requirement for billing State SLS/OBRA services. More information can be found on the HCPF website https://hcpf.colorado.gov/electronic- visit-verification-program-manual#coEVVX 18 EXHIBIT C HIPAA BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("BAA") is entered into by and between the County and the Contractor, referred to as "Business Associate", to set forth the terms and conditions under which protected health information ("PHI"), as defined by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, Regulations enacted hereunder (HIPAA) , created or received by Business Associate on behalf of County may be used or disclosed. This BAA shall commence on the effective date outlined in Paragraph 3 of the Professional Services Agreement and the obligations herein shall continue in effect so long as Business Associate uses, discloses, creates or otherwise possesses or maintains any PHI created, or received, maintained or transmitted on behalf of County and until all PHI created, received, maintained or transmitted by Business Associate on behalf of County is destroyed or returned to County pursuant to Paragraph 16 herein. 1. The following terms, if and when used in this BAA, shall have the same meaning as those terms in the HIPAA Rules: Breach, Data Aggregation, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required by Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use. a. Business Associate. "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103. b. Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered entity" at 45 CFR 160.103. c. HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement rules at 45 CFR Part 160 and Part 164. 2. County and Business Associate hereby agree that Business Associate shall be permitted to use and/or disclose PHI created, received, maintained or transmitted on behalf of County in accordance with this BAA. The permitted uses and disclosures, as may be outlined in a contract or Memorandum of Understanding, must be within the scope of, and necessary to achieve, the obligations and responsibilities of the Business Associate in performing on behalf of, or providing services to, County, or as Required by Law. Business Associate may not use or disclose PHI in a manner that would violate Subpart E of 45 CFR Part 164 if done by County except for the specific uses and disclosures set forth herein. 3. Business Associate acknowledges Business Associate is required by law to comply with the HIPAA Security Rule (45 CFR 164.302 through 164.318), the use and disclosure provisions of the HIPAA Privacy Rule and the Health Information Technology for Economic and Clinical Health Act (HITECH). To the extent Business Associate is to carry out one or more of County's obligations under Subpart E of 45 CFR Part 164, Business Associate hereby agrees to comply with the requirements of Subpart E that apply to County in the performance of such obligations. 19 4. Business Associate may use and disclose PHI created or received by Business Associate on behalf of County if necessary for the proper management and administration of Business Associate or to carry out Business Associate's legal responsibilities, provided that: a. Any disclosure is required by law; or b. Business Associate obtains reasonable assurances from the person to whom the PHI is disclosed that (i) the PHI will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person; and (ii) the Business Associate will be notified of any instances of which the person is aware in which the confidentiality of the information is breached. 5. Business Associate hereby agrees to maintain the security and privacy of all PHI in a manner consistent with state and federal laws and regulations, including HIPAA, HITECH, 42 CFR Pt. 2 if applicable, and all other applicable laws. 6. Business Associate shall ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information. Business Associate shall not disclose PHI created or received by Business Associate on behalf of County to a person, including any agent or subcontractor of Business Associate but not including a member of Business Associate's own workforce, until such person agrees in writing to be bound by provisions not less restrictive than this BAA and applicable state or federal law. 7. Business Associate shall not disclose PHI to any member of its workforce unless Business Associate has advised such person of Business Associate's privacy and security obligations under this Agreement, including the consequences for violation of such obligations. Business Associate shall take appropriate disciplinary action against any member of its workforce who uses or discloses PHI in violations of this Agreement and applicable law, in addition to meeting its reporting obligations owed to County hereunder. 8. Business Associate represents and warrants that it will use and disclose PHI in accordance with the Privacy Rule's "minimum necessary" standards by taking reasonable steps to limit uses and disclosures to the minimum amount of PHI required in accomplishing the intended purpose and consistent with the County's minimum necessary policies and procedures. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of PHI not permitted by this Agreement or applicable law. 9. Business Associate agrees to maintain a record of its disclosures of PHI, including disclosures not made for the purposes of this Agreement. Such record shall include the date of the disclosure, the name and, if known, the address of the recipient of the PHI, the name of the individual who is the subject of the PHI, a brief description of the PHI disclosed, and the purpose of the disclosure consistent with enabling County to meet its accounting of disclosure obligations under the HIPAA Rules. Business Associate shall make such record available to County within thirty (30) days of a request and shall 20 include disclosures made on or after the date which is six (6) years prior to the request. Business Associate shall not be required to maintain a record of disclosures of PHI made for the following purposes, unless such disclosures become mandatory for accounting of disclosure purposes under HIPAA: a. For the purpose of treatment, payment or health care operations (as those terms are defined under HIPAA); b. To an individual who is the subject of the PHI; and c. Pursuant to an Authorization which is valid under HIPAA. 10.Business Associate agrees to report to County any unauthorized use or disclosure of PHI by Business Associate or its workforce or subcontractors within ten (10) days and the remedial/mitigating action taken or proposed to be taken with respect to such use or disclosure and account for such disclosure. 11.In the event of a or Security Incident involving the County's PHI, Business Associate shall provide County a report including patient name, contact information, nature/cause of the breach, PHI breached and the date or period of time during which the breach occurred. Business Associate understands that such a report must be provided to County within ten (10) days from the date of the breach or the date the breach should have been known to have occurred, or as soon as possible upon discovery (not to exceed 10 days from the date of the breach/breach discovery). Business Associate is responsible for any actual and direct costs related to notification of individuals or next of kin (if the individual is deceased) of any successful Security Incident or Breach reported or caused by Business Associate to County. 12.Business Associates agrees to make its internal practices, books, and records relating to the use and disclosure of PHI received from County or created or received by Business Associate on behalf of County, available to the Secretary of the United States Department of Health and Human Services, for purposes of determining the County's and/or Business Associate's compliance with HIPAA. 13.Within ten (10) days of a written request by County, Business Associate shall allow a person who is the subject of PHI, such person's legal representative, or County to have access to and to copy such person's PHI maintained by Business Associate. Business Associate shall provide PHI in the format requested by such person, legal representative, or County unless it is not readily producible in such format, in which case it shall be produced in standard hard copy format. Business Associate shall forward any request for access to PHI by an individual to County promptly upon receipt thereof. 14.Business Associate agrees to amend, pursuant to a request by County, PHI maintained and created or received by Business Associate on behalf of County. Business Associate further agrees to complete such amendment within ten (10) days of a written request by County, and to make such amendment as directed by County. Business Associate shall forward any request for amendment by an individual to County promptly upon receipt thereof. 21 15.County shall notify Business Associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her PHI, to the extent that such changes may affect Business Associate's use or disclosure of PHI. 16.In the event Business Associate fails to perform its obligations under this Agreement, County may, at its option: a. Require Business Associate to submit to a plan of compliance, including monitoring by County and reporting by Business Associate, as County, in its sole discretion, determines necessary to maintain compliance with this Agreement and applicable law. Such plan shall be incorporated into this Agreement by amendment hereto; b. Require Business Associate to mitigate any loss occasioned by the unauthorized disclosure or use of PHI; and c. Immediately discontinuing providing PHI to Business Associate with or without written notice to Business Associate. 17.County may immediately terminate this and related agreements if County determines that Business Associate has breached a material term of this Agreement. Alternatively, County may choose to: (i) provide Business Associate with ten (10) days written notice of the existence of an alleged material breach and (ii) afford Business Associate an opportunity to cure said alleged material breach to the satisfaction of County within ten (10) days of receipt of notice. Business Associate's failure to cure shall be grounds for immediate termination of this BAA. County's remedies under this BAA are cumulative and the exercise of any remedy shall not preclude the exercise of any other. 18.After termination or expiration of the Underlying Agreement for any reason, Business Associate with respect to PHI received created or maintained from or on behalf County, shall: (i) retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; (ii) destroy (subject to the Underlying Agreement) the remaining PHI that the Business Associate still maintains in any form; and (iii) not use or disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions set out in this BAA which applied before termination. If the destruction of the PHI is not feasible, in Business Associate's discretion, Business Associate shall notify County of the reasons destruction is not feasible and Business Associate shall continue to for as long as Business Associate retains the PHI. This section shall survive termination of this BAA. 19.Upon termination of this BAA for any reason, Business Associate, with respect to PHI received from County, or created, maintained, transmitted, or received by Business Associate on behalf of County, shall: a. Retain only that PHI which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities. b. Return to County the remaining PHI that the Business Associate still maintains in any form or destroy said PHI. c. Continue to use appropriate safeguards and comply with Subpart C of 45 CFR part 164 with respect to electronic protected health information to prevent use 22 or disclosure of the PHI, other than as provided for in this Section, for as long as Business Associate retains the PHI. d. Not use or disclose the PHI retained by Business Associate other than for the purposes for which such PHI was retained and subject to the same conditions which applied prior to termination. e. Return to County or destroy the PHI retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities. The provisions of this section shall survive the BAA's termination. 20. The parties agree to amend this Agreement in order to maintain compliance with State or Federal law. County shall provide ten (10) days prior written notice to Business Associate of a need to amend the BAA and propose such amendments for Business Associate's consideration. Upon written agreement between the parties, such amendment shall be binding upon the parties. Either party may elect to terminate the BAA and any underlying service agreement(s) if an amendment is not able to be agreed upon within a reasonable timeframe from an amendment's commencement. All duties hereunder to maintain the security and privacy of PHI shall survive such termination. County and Business Associate may otherwise amend this Agreement by mutual written consent. 21.To the fullest extent permitted by law, each party (the "Indemnifying Party") shall indemnify the other party, and its officers, directors, employees and agents (collectively the "Indemnified Parties"), against any and all claims brought by or directly resulting from third parties, including reasonable attorneys' fees (the "Third Party Losses"), to the extent Third Party Losses are proximately caused by a breach of this BAA by the Indemnifying Party, each by the Indemnifying Party or its employees, directors, officers, subcontractors, and agents. The Indemnifying Party shall have the right to control the defense or settlement of such third-party claim, subject to the reasonable participation of, and approval by, the Indemnified Parties of any such settlement or defense strategy. The foregoing indemnification shall not apply to the extent such claims arise out of(i) the Indemnified Party's negligence or willful misconduct, or (ii) the negligence or willful misconduct of any subcontractor or agent other than Business Associate under the Indemnified Party's control. 23 SIGNATURE REQUESTED: Weld/LifeStation , Inc. CMA PSA Final Audit Report 2025-12-08 Created: 2025-12-05 By: Sara Adams(sadams@weld.gov) Status: Signed Transaction ID: CBJCHBCAABAA5PEQjrmLceMjRLJUms-T04hKBnfHVjx6 "SIGNATURE REQUESTED: Weld/LifeStation, Inc. CMA PSA" History t Document created by Sara Adams (sadams@weld.gov) 2025-12-05-9:29:05 PM GMT-IP address:204.133.39.9 P. Document emailed to mark.pezold@lifestation.com for signature 2025-12-05-9:29:59 PM GMT t Email viewed by mark.pezold@lifestation.com 2025-12-05-9:31:59 PM GMT-IP address: 141.150.131.76 bo Signer mark.pezold@lifestation.com entered name at signing as Mark Pezold 2025-12-08-2:45.24 PM GMT-IP address: 198.17.112.250 Li Document e-signed by Mark Pezold (mark.pezold@lifestation.com) Signature Date:2025-12-08-2:45:26 PM GMT-Time Source:server-IP address: 198.17.112.250 0 Agreement completed. 2025-12-08-2:45:26 PM GMT Powered by Wite Adobe Acrobat Sign �... 40 LIFES-1 OP ID; EBL ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/13/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 877-242-9600 CONTACT Central Insurance Agency PRODUCER NAME: Central Insurance Agency,Inc. PHONE 877-242-9600 FAX 877-243-8995 PO Box 1047 (A/C.No,Eat): (A/C,No): - Smithtown,NY 11787 inas ciainsures.com E-MAILD George Gavaris ADDRESS: ginas@ciainsures.com INBURER(SJ AFFORDING COVERAGE NAIC• INSURER A:StarStone Specialty Insurance 44776 INURED. INSURER B:Crum&Forster Speciality Ins 44520 LireStatlon,Inc. Gotham Insurance Co 25569 825 Rahway Avenue INSURER C: Union,NJ 07083 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR WSGL002122 -08/31/2025:08/31/2026 DAMAGEPREMISESTO[EaRENTED occurrence) $- 100,000 - -_ X _ X ,Errors&Omissions WSGL002122 08/31/2025 08/31/2026 MED EXP(Any one person) $ 5,000 X Contractual Liab WSGL002122 08/31/2025 08/31/2026 PERSONAL&ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 _�•LPOLICY X JERCOT [ LOC PRODUCTS-COMP/OP AGG _$ 2,000,000 OTHER Prof Liab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) .$ ANY AUTO j LBODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ ';AURED NN_pp PROPERTY DAMAGE TOS ONLY ;AUUTOS ONLYY I,., (Per acciden .$ $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'000'000 X EXCESS LIAB CLAIMS-MADE, WSGU000497 08/31/2025 08/31/2026 AGGREGATE .$ 5,000,000 ♦DED X RETENTION$ 10,000I $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE. ER ANY PR OPRIE NOR/PARTNER/EXECUTIVE IY/N F 1- EACH ACCIDENT ..$ -. OFFICER/ry in NH)EXCLUDED? N/A L L DISEASE-EA EMPLOYEE $ IIf yes,describe under DESCRIPTION OF OPERATIONS below - I DISEASE-POLICY LIMIT $ B Excess Liability SEO-143976 08/31/2025 08/31/2026 EE/AA 5,000,000 C Excess Liability i EX202500005356 08/31/20251,08/31/2026 EE/AA 5,000,000 DESCRIPTION OF OPERATIONS,LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Board of County Commissioners of Weld County and its Officers/Employees are included as additional insured for work performed while on the premises, by insured subject to terms and conditions of the policy as required by written contract. CERTIFICATE HOLDER CANCELLATION WELDCOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Weld County ACCORDANCE WTHDTHE EPOLICY NOTICE WILL BE DELIVERED IN PROVISIONS. Po Box A Greeley, CO 80632 AUTHORIZED REPRESENTATIVE 1 $A ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Contract Form Entity Information Entity Name* Entity ID* New Entity? LIFESTATION INC @00050509 Contract Name* Contract ID Parent Contract ID LIFESTATION INC CASE MANAGEMENT AGENCY (CMA) 1 01 52 SERVICES AGREEMENT 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) LIFESTATION INC CASE MANAGEMENT AGENCY (CMA) SERVICES AGREEMENT. TERM 1 2/1 /25 TO 6/30/26. Contract Description 2 Contract Type* Department Requested BOCC Agenda Due Date AGREEMENT HUMAN SERVICES Date* 12/06/2025 12/10/2025 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 04/30/2026 Termination Notice Period Expiration Date* Committed Delivery Date 06/30/2026 Contact Information Contact Info Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 12/08 2025 Approval Process Department Head Finance Approver Legal Counsel JAMIE ULRICH CONSENT CONSENT DH Approved Date Finance Approved Date Legal Counsel Approved Date 12/08/2025 12/08/2025 12, 08/2025 Final Approval BOCC Approved Tyler Ref# AG 121025 BOCC Signed Date Originator BOCC Agenda Date SADAMS 12,'102025 Hello