HomeMy WebLinkAbout20091871.tiffMEMORANDUM
0
COLORADO FROM
RE
DATE: July 30, 2009
TO: William F. Garcia, Chair, Weld County Board of
Commissioners
i t (H/V(
Judy Gnego, Director, Department of Hum n Service
Child Protection Agreements for Services for Respite Care
between the Weld County Department of Human Services -
and Various Contractors to be Placed on the Consent
Agenda
li•
Enclosed for Board approval are Child Protection Agreements for Services for Respite Care between the
Weld County Department of Human Services and Contractors listed below. Please place on the Consent
Agenda.
Below are the major provisions of the attached Agreements:
No.
Contractor
Term
Rate
1
Bradshaw, Freddericka
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
2
Brilla, Deb
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
3
Brown, Scott
July I, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
4
Corliss, Loni
July I, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
5
Cowper, Alecia
July I, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
6
Cowper, Zach
July 1, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
7
Dodge, Trena
July 1, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
8
Falk, Florence
July I. 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
y
Foster, Tracy
July 1, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
10
Henkels, Pam
July 1, 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
11
Jerke, Jessica
July 1. 2009 - June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
12
Lewis, Connie
July 1.2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
13
Mellman, Letha
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
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14
Middleton, Deborah
July I. 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
15
Miller, Pam
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
16
Moore, Pat
July I, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.0() per month for 16 hours
17
Maronek, Pat
i July I, 2009 — June 30, 2010 1
$16.75 per each four hours
Max. $67.00 per month for 16 hours
18
Ramos, Julian
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
19
Redding, Sonja
July 1.2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
20
Ripka, Carol
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
21
Ripka, Jennifer
July 1, 2009 — June 30, 2010 $16.75 per each four hours
Max. $67.00 per month for 16 hours
22
Roderick, Chelsi
July 1, 2009 — June 30, 2010 I $16.75 per each four hours
i Max. $67.00 per month for 16 hours
23
Rodriguez, Mary
July 1, 2009 — June 30, 2010 $16.75 per each four hours
Max. $67.00 per month for 16 hours
24
Rodriguez, Michael
July I, 2009 — June 30, 2010 $16.75 per each four hours
Max. $67.00 per month for 16 hours
25
Schwabe, Barb
July 1, 2009 — June 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
26
Steitz, Andy
; July 1, 2009 — Junc 30, 2010
$16.75 per each four hours
Max. $67.00 per month for 16 hours
27
Willert, Melody & } July 1, 2009 — June 30, 2010
Lee, Kimberly 1
$16.75 per each four hours
Max. $67.00 per month for 16 hours
If you have any questions, give me a call at extension 65 10.
09 -10 -RESPITE CARE
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
1.1
This Agreement, made and entered into the day of , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Freddericka Bradshaw, hereinafter referred to as
"Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
N
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreemend shall
expire June 30, 2010, unless sooner terminated as provided herein.
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2. Scope of Services
N
Services shall be provided by Provider to any person(s) eligible for child protection services in Eompliance
with Exhibit A "Scope of Services," a copy of which is attached by reference. DD
3. Payment .c
W
a) Payment shall be made on the basis of Exhibit B, "Payment Schedule," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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 ra 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, PROVIDER and Human Services 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 in 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.
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09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Freddericka Bradshaw
Name
Human Services Administrator
Title
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Respite Care Provider
Title
09 -10 -RESPITE CARE
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Freddericka Bradshaw
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
14. Litigation
217 Chestnut St. Apt.Bl
Windsor, CO 80550
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: /br/ruzu9 it v"w^`s"t p
WELD COUNTY ! ,!� BOARD OF COUNTY rc
COMMISSIONERS N(,r'LD
CLERK TO THE BOARD
COUNTY, CO
1 ti
By:
Chair
AUG G 5 7_999
C.
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09 -10 -RESPITE CARE
APLROV-ED AS TO F
County Auey " Freddericka Bradshaw
WELD COUNTY DEPARTMENT
OF HUMAt SERVIC
By:
C
ud,,A. Griego, Director
Page 5 of 10
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09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES /�
1. PROVIDER agrees it is an independent contractor and that its officers and employees do not becom€
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.
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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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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11. This Contract shall be binding upon the parties hereto, their successors, heirs, legaldpresentatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations4reunder without
the prior written consent of both parties. //.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the/ 5tday of 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Deb Brilla, hereinafter referred to as "Provider".
W ITNESSETH
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
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09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER acknowledges that the following laws are included:
-Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 a seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.• and
-Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Deb, Brilla
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Deb, Brilla
Judy A. Griego, Director 2018 20th St. Rd.
P.O. Box A Greeley, CO 80631
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
RD OF COUNTY
ISSIONERS WEL
TY, COLORA
1
Deputy Clerk v 4 E. 1 Chair
AUG 0 5 %009
Page 4 of 10
.CO 9 —/f 2,
09 -10 -RESPITE CARE
APP_R9ED AS TO FO
County AttJmey
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Provider
BY
Deb Brilla
Page 5 of 10
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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.
IS. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 5day of ')1/4., t �_ , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of�Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Scott Brown, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
(.2e.32 -/F7/
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Scott, Brown
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Scott, Brown
Judy A. Griego, Director 301 Hickory Avenue
P.O. Box A Eaton, CO 80615
Greeley, CO 80632
14. Lititation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
eputy Clerk
ARD OF COUNTY
MISSIONERS WELD
NTY, COLORA
AUG 0 5 2009
Page 4 of 10
09 -10 -RESPITE CARE
ED AS TO . ' RM:
County ; ttorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Provider
BY ,:,yV K6 f -y ---
Scott Brown
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 51 -day of _ 2009, by and between the Board of
Weld County Commissioners, sifting as the Board oi Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Loni Corliss, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July I, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER acknowledges that the following laws are included:
-Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 a seq. and its implementing
regulation, 45 C.F.R. Part 80 a seq.; and
-Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Loni, Corliss
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Loni, Corliss
Judy A. Grieco, Director 26649 CR 60 1/2
P.O. Box A Greeley, CO 80631
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Clerk
BOARD OF COUNTY
MMISSIONERS WE D
NTY,OLOA
Chair
AUG 052009
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09 -10 -RESPITE CARE
APP ED AS TO F
County Att4mey Loni Corliss
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
Provider
BY
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the LeLl day of TT.i_, , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of4luman on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Alecia Cowper, hereinafter referred to as "Provider".
WITNESSETH
ESSETH
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER acknowledges that the following laws are included:
-Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d -1 a seq. and its implementing
regulation, 45 C.F.R. Part 80 a seq.• and
-Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROWDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Alecia, Cowper
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Alecia, Cowper
Judy A. Griego, Director 509 N. Sholdt Dr.
P.O. Box A Platteville, CO 80651
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
id)
D OF COUNTY
SSIONERS WE
Deputy Clerk / '% d = �� �/ Chair
AUG 0 5 2009
Page 4 of 10
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APPROVED AS TO FO
County Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Provider
BY
Alecia Cowper
Page 5 of 10
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the ' day of S , , Li. , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Zach, Cowper, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July I, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
oICY i-i 7/
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or govemmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Zach, Cowper
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Zach, Cowper
Judy A. Griego, Director 509 N Sholdt Dr.
P.O. Box A Platteville, CO 80651
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
NTY, COLOI2,AD
4 - _BOARD OF COUNTY
,� 1k Jet,J1 MMISSIONERS WELD
By: By:
Deputy Clerk Chair
AUG 0 5 2009
Page 4 of 10
C�% /17/
09 -10 -RESPITE CARE:
APPROVED AS TO
County A tomey
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Provider
BY
Z
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
I . Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 I 1(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the / 1 day of t 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Trena Dodge, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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 a seq.; and
- Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Trena, Dodge
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Trena, Dodge
Judy A. Griego, Director 10595 East Empire Drive
P.O. Box A Franktown, CO 801 16
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Clerk
OARD OF COUNTY
MMISSIONERS WELD
TY, COLORADO
Chair
AUG G 5 2009
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09 -10 -RESPITE CARE
APPR ED AS TO P
orney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Provider
BY
Trena Dodge
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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09 -10 -RESPITE CARE
11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing
appearance ofa conflict of interest situation, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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?m„
nr,r
O
ii
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 4' day of �; t q , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Florence, Falk, hereinafter referred to as "Provider".
WITNESSETH
ESSETH
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July I, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER acknowledges that the following laws are included:
-Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d -I a 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Florence, Falk
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Florence, Falk
Judy A. Griego, Director 1401 32nd Avenue
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
IS. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
eputy Clerk
BOARD OF COUNTY
OMMISSIONERS WE
UNTY, cOL,
Chair
AUG 0 5 %009
Page 4 of 10
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APPROED AS TO
Provider
BY
County t%torney orence Falk
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Page 5of10
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
1 1. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDEIY00 J 1- -2 P 4: 31
This Agreement, made and entered into thy, S1day of 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf f the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Tracy Foster, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER acknowledges that the following laws are included:
-Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 a seq. and its implementing
regulation, 45 C.F.R. Part 80 et seq.: and
-Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Tracy, Foster
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Tracy, Foster
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
14. Litigation
532 Adams Avenue
Louisville, CO 80027
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Clerk v
RD OF COUNTY
ISSIONERS WEL
TY,
Chair
AUG 0 5 2009
Page 4 of 10
WC -2-4f 7/
WELD COUNTY DEPARTMENT
OF HUMAN RVICES
p
Ju. Griego,, Director
/
Provider
BY
�r
(i/ CLiTracy Foster
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accord ingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the ) day of Mtc,/ / , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Pam, Henkels, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
Il. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Pam, Henkels
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Pam, Henkels
Judy A. Griego, Director 5617 Ute Lane
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
BOARD OF COUNTY
COMMISSIONERS WELD
UNTY, COLO
Deputy Clerk i i i ` �� Chair
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09 -10 -RESPITE CARE
`APROVED AS TO 'IRM: Provider
County A omey
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
BY
Pam Henkels
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I . PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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RECEIVED MAY 12100
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 1- day of LLJ 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf o the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Jessica Jerke, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on May I, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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 a seq.; and
-Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
08 -09 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Jessica Jerke
13. Notice
Human Services Administrator
Title
Respite Care Provider
Name Title
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08 -09 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
To: Jessica D. Jerke
22911 WCR 39,
LaSalle, CO 80645
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
IS. 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, PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
Page 4 of 10
08 -09 -RESPITE CARE
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
eputy Clerk
VED AS TO FOR
County Att.mey
W LD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Judy/. Griego, director
BOARD OF COUNTY
COMMISSIONERS WLILD;
COUNTY, CfJLO,
Chair
Provider
BY
AUG 0 5 yo y
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08 -09 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours and not to exceed $802.56 per fiscal year
for 192 hours (16 per month per child)
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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08 -09 -RESPITE CARE
EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
08 -09 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 1 I (b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
08 -09 -RESPITE CARE
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
conceming the other party obtained as a result of this Contract. Any proprietary information removed from
the State's site by PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the(' 1day of iy L/ , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Connie Lewis, hereinafter referred to as "Provider".
W ITNESSETH
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
Il. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Connie, Lewis
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Connie, Lewis
Judy A. Griego, Director 2904 42nd Ave.
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
IS. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
IS. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
BOARD OF COUNTY
COMMISSIONERS WELD
COUNTY, COLAD
By:
Chair
AUG 0 5 2009
Page 4 of 10
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APPROVED AS TO F
Provider
ey - Connie Lewis
WELD COUNTY DEPARTMENT
OF HUMAN S I RVIC S
By:
Ju
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 I I (b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 'day of .1-5.-c.„t i , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board o Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Letha Mellman, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Letha, Melman
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Letha, Melman
Judy A. Griego, Director 352 Laurel Avenue
P.O. Box A Eaton, CO 80615
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST: ��1//�1(
WELD COUNTY
CLERK TO THE BOARD
By:
BOARD OF COUNTY
COMMISSIONERS WELD
UNTY, COLDO
Deputy Clerk „ ',> 1 chair
AUG 0 5 2009
Page 4 of 10
GD%-/f7/
09 -10 -RESPITE CARE
APPRO\cED AS TO F9WM:
Provider
BY
&ski 1tl ( i ox
County gftomey Letha Melman
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Page 5 of 10
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I . Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8of10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the J 'day of 'S, a( , 2009, by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Deborah Middleton, hereinafter referred to as
"Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Deborah, Middleton
Name
Human Services Administrator
Title
Title
Respite Care Provider
Page 3 of 10
09 -10 -RESPITE CARE
13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Deborah, Middleton
Judy A. Griego, Director 2418 W. 24th St. Rd.
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK 1O THE BOARD
By:
411/%11-
DeputyClerk
La/a
1
BOARD OF COUNTY
COMMISSIONERS WELD
OUNTY, COLORAD
rp
ti —Page 4 of 10
c9CCY- /i2//
09 -10 -RESPITE CARE
WELD COUNTY DEPARTMENT
OF HUMAN /
��SERVICES( \
By: d,� ,j, 3
A. Griegb, Director
Provider
BY
DeTiorah Middleton
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
09 -10 -RESPITE CARE
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
09 -10 -RESPITE CARE
EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 1 1(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the! 'day of 7 c; c , 2009, by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Pam, Miller, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
4
/,.
Page 1 of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Pam, Miller
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Pam, Miller
Judy A. Griego, Director P. O. Box 2193
P.O. Box A Greeley, CO 80632
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if finding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
OARD OF COUNTY
MISSIONERS WELD
NTY, COLORADO
tr
UG 0 5 2009
Page 4 of 10
:. ?cc1-/()l/
Provider
BY
ounty Auu' ey Pam Miller
WELD COUNTY DEPARTMENT
OF HUMAN S RVIC S 7, /`
1
By: /AAA
,
Judy( . Griego
A
Page 5of10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
09 -10 -RESPITE CARE
EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the / ay of 't ,L L / , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Pat Moore, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or govemmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Pat, Moore
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Pat, Moore
Judy A. Griego, Director 135 Poplar Street
P.O. Box A Lochbuie, CO 80603
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16, Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Cler
OARD OF COUNTY
MMISSIONERS WELD
UNTY,CQLQRADO
Page 4 of 10
,7?CYf-/Y7i
09-I0-REESPITE CARE
AP-PRQ C'ED AS TO
Provider
BY
County orney 7 rtr at Moore
WELD COUNTY DEPARTMENT
OF HUMANICES (
By:
Jud
. Griego, D ector
✓L 4 M
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
09 -10 -RESPITE CARE
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the/57day of , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of fhe Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Pat Maronek, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Pat, Maronek
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Pat, Maronek
Judy A. Griego, Director 4860 Eagle Crest Blvd.
P.O. Box A Firestone, CO 80504
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
RD OF COUNTY
ISSIONERS WELD
TY, cOAD,
Deputy Clerk % Ctfair
AUG 0 5 2009
Page 4 of 10
o?Cx%9.-/S'7/
09 -10 -RESPITE CARE
APP: !. ED AS TO
Provider
BY
County Att mey Pat Maronek
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations goveming certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
09 -10 -RESPITE CARE
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
09 -10 -RESPITE CARE
EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon teaming of an existing
appearance of a conflict of interest situation, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into theP1 day of 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf o the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Julian Ramos, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page I of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Julian, Ramos
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Julian, Ramos
Judy A. Griego, Director 2604 49th Avenue Ct.
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
D OF COUNTY
ISSIONERS WELD
TY, CO
Deputy Clerk Chair
AUG 0 5 2009
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WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
I . Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the/ 51 -day of ; i x/ , 2009, by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Sonja Redding, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Sonja, Redding
Name
13. Notice
Iluman Services Administrator
Title
Respite Care Provider
Title
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Sonja, Redding
Judy A. Griego, Director 2305 42nd Avenue
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
IS. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Cler
BOARD OF COUNTY
COMMISSIONERS WELD
UNTY, COLO
Chair
AUG 0 5 2009
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a9eX)2-/c59/,
09 -I0 -R SPITE CARE
A'• : VED AS TO FOR Provider
County " ey
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
BY
Page 5 of 10
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
I . Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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- 9 ,, 3: 30
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the Slay of ,, z ( / , 2009, by and bef tten the Board of
Weld County Commissioners, sitting as the Board o Human on behalf of the Weld County Departmti4Vofh�jj uman
Services, hereinafter referred to as "Human Services," and Carol, Ripka, hereinafter referred to as "Providtr"at,
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
29
Page 1 of 10
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
1I. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Carol, Ripka
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Carol, Ripka
Judy A. Griego, Director 1138 35th Avenue
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.,[/� ,
ATTEST: gel -A/11 G'.""'vz!
WELD COUNTY
CLERK TO THE BOARD
By:
;; t
Deputy Clerk •
BOARD OF COUNTY
COMMISSIONERS WELD
COUNTY, COL
Chair
AUG 0 5 2009
Page 4 of 10
09 -10 -RESPITE CARE
APPROVED AS TO F%�: . Provider
BY
County A erney Carol Ripk
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES �:
By:
Jud
Cott Of
Griego+Director
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
11. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the/2day of -Iiz c/ , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Jennifer Ripka, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
,209-4F2/
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or govemmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Jennifer, Ripka
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Jennifer, Ripka
Judy A. Griego, Director 2113 74th Avenue
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Clerk
BOARD OF COUNTY
MMISSIONERS WELD
UNTY, CQL
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09 -10 -RESPITE CARE
APPRAS TO FORM:
County Attorn
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Provider
BY \ Z. --E-
JennifekRipka
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09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
1. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
RECEIVED MAY 08 2009
08 -09 -RESPITE CARE
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the 1 day of , 2009, by and between the Board of
Weld County Commissioners, sifting as the Board of Human on behalf the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Chelsi Roderick, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July I, 2008, upon proper execution of this Agreement and shall
expire June 30, 2009, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C. "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
:5e0%-47/
08 -09 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
08 -09 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Chelsi Roderick
13. Notice
Human Services Administrator
Title
Respite Care Provider
Name Title
Page 3 of 10
08 -09 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services
Judy A. Griego, Director
P.O. Box A
Greeley, CO 80632
To: Chelsi N. Roderick
3110 57th Avenue,
Greeley, CO 80634
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
Page 4 of 10
08 -09 -RESPITE CARE
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
"7i/et_
Deputy Clerk
Provider
APPROV IS AS TO FORMc y
County Attoy
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Jud�A� Griegoi Director
•
D OF COUNTY
ISSIONERS WELD
Y, COLORA
Chair
BY
Chelsi Roderick
AUG U 5 ZUU9
Page 5 of 10
08 -09 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
08 -09 -RESPITE CARE
EXHIBIT
PAYMENT SCHEDULE
I . Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours and not to exceed $802.56 per fiscal year
for 192 hours (16 per month per child)
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
08 -09 -RESPITE CARE
EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
08 -09 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 I I(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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08 -09 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the/ " day of 5 t , < <_ ; , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Mary, Rodriguez, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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,_27ere)—/F7,
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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 a seq.; and
- Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Mary, Rodriguez
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
Page 3 of 10
09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Mary, Rodriguez
Judy A. Griego, Director 1800 Delwood Avenue
P.O. Box A Greeley, CO 80631
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
Deputy Clerk
ARD OF COUNTY
MISSIONERS WELD
TY, COLORADO
AUG 0 5 2009
Page 4 of 10
Z2- 427W
09 -10 -RESPITE CARE
APP � AS TO FOR
County Att f ey
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Ju
Provider
BY V//a/ 1 MrZtt-L/7W
Mary Ro uez ,4
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
09 -10 -RESPITE CARE
EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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09 -10 -RESPITE CARE
EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 1 I (b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the/isrday of t , / t ,' , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of tie Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Michael, Rodriguez, hereinafter referred to as
"Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Page 1 of 10
9r?—icY7/
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Michael, Rodriguez
Name
Human Services Administrator
Title
Title
Respite Care Provider
Page 3 of 10
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13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Michael, Rodriguez
Judy A. Griego, Director 224 48th Avenue
P.O. Box A Greeley, CO 80634
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
eputy Clerk
ARD OF COUNTY
MISSIONERS WELD
NTY OL(IRA
AUG 0 5 2009
Page 4 of 10
09 -10 -RESPITE CARE
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
Judy A.Griego,
Provider
BY
Michael Rodriguez
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, and certify that the services authorized were provided on the
date indicated and the charges made were pursuant to the terms and conditions of Exhibit A.
Page 7 of 10
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
Page 8 of 10
09 -10 -RESPITE CARE
This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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.
IS. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
Page 9 of 10
09 -10 -RESPITE CARE
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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
Page 10 of 10
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the / 'day of -II a e J" , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Barb, Schwabe, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July I, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
ti
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in aokities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall pot be
reimbursed or considered part of this Agreement. tr
0
4. Financial Management
13
At all times from the effective date of this Contract until completion of this Contract, PROVIDERsall
comply with the administrative requirements, cost principles and other requirements set forth in they
Page 1 of 10
,;f)tr/ -497/
09 -10 -RESPITE CARE
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER acknowledges that the following laws are included:
-Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 a seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.- and
-Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and
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 O
-the Age Discrimination in Employment Act of 1967; and
- the Equal Pay Act of 1963; and
- the Education Amendments of 1972; and .c-
-Immigration Reform and Control Act of 1986, P.L. 99-603; tU
-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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
Page 2 of 10
09 -10 -RESPITE CARE
8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Barb, Schwabe
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
C
0
O
D
C
NJ
Page 3 of 10
09 -10 -RESPITE CARE
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Barb, Schwabe
Judy A. Griego, Director P. O. Box 337004
P.O. Box A Greeley, CO 80632
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By: / 1,'' 9!/C
RD OF COUNTY
MISSIONERS WELD
TY, COLOP+ADO
Deputy Clerk, % \y '. q tC j5! Chair
AUG 0 5 2009 ff
tV
Page 4 of 10
2( 2-��
09- I 0 -RESPITE CARE
APPROVES TO FORM •
G
County Attorne
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
{
By: 'li�
Jud; . Griego
Provider
BY
arb Schwabe
C-
c
0
D
C
IV
Page 5 of 10
09 -10 -RESPITE CARE
EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I . Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
N
Page 6 of 10
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EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
0T
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/099
EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 govemment has
begun but is not completed at the end of the four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian less
in accordance with PROVIDER written policies governing access to, duplication and dissemination all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that tb eey are
subject to these confidentiality requirements. PROVIDER shall provide its employees, agents, at4W
subcontractors, if any, with a copy or written explanation of these confidentiality requirementsgbfore
access to confidential data is permitted.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
I8. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
tz :h d o 114ff hoot
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15
CHILD PROTECTION AGREEMENT FOR SERVICES ' in
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES PP
AND PROVIDER
et —
This Agreement, made and entered into the/ )day of ( z L f, 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of t e Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Andy, Steitz, hereinafter referred to as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
I. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
11. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Andy, Steitz
Name
13. Notice
Human Services Administrator
Title
Respite Care Provider
Title
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All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Andy, Steitz
Judy A. Griego, Director 1701 Elder Avenue
P.O. Box A Greeley, CO 80631
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
BOARD OF COUNTY
COMMISSIONERS WELD
OUNTY,CQLO
Chair
AUG 0 5 2009
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APPROVED AS TO FORN/7 Provider
BY
County Attome
WELD COUNTY DEPARTMENT
OF HUMAN SFRVICES
By:
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations goveming certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
I. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
I. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER shall not enter any third
party relationship that gives the appearance of creating a conflict of interest. Upon teaming of an existing
appearance of a conflict of interest situation, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND PROVIDER
This Agreement, made and entered into the /'Clay of 'i (cc , 2009, by and between the Board of
Weld County Commissioners, sitting as the Board of Human on behalf of the Weld County Department of Human
Services, hereinafter referred to as "Human Services," and Melody Willed & Kimberly Lee, hereinafter referred to
as "Provider".
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 Regular
Administration funding for respite care for county foster care PROVIDERS and
WHEREAS, Provider is a for-profit Sole -Proprietor.
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on July 1, 2009, upon proper execution of this Agreement and shall
expire June 30, 2010, unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Provider 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," and Exhibit C, "Fee Schedule,"
copies of which are attached hereto and incorporated herein by reference.
b) "Payment Schedule" shall establish the maximum reimbursement, which will be paid from Child Welfare
Regular Administration funds during the duration of this Agreement.
c) PROVIDER shall submit an itemized monthly bill to Human Services for all costs incurred and services
provided pursuant to Exhibit A of this Agreement in accordance with criteria established by Human
Services. PROVIDER shall submit all itemized monthly billings to Human Services no later than the
twenty-fifth (25) day of the month following the month the cost was incurred.
d) Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of
Child Welfare Regular Administration funds to Human Services.
e) Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities
outside of those defined in Exhibit A. Work performed prior to the execution of this Contract shall not be
reimbursed or considered part of this Agreement.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract, PROVIDER shall
comply with the administrative requirements, cost principles and other requirements set forth in the
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Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Child Welfare Regular Administration 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. PROVIDER shall provide proper monthly invoices and itemization of services performed for
costs incurred in the performance of the agreement.
b. Human Services may withhold any payment if PROVIDER has failed to comply with the
Financial Management Requirements, program objectives, contractual terms, or reporting
requirements. In the event of a forfeiture of reimbursements, PROVIDER may appeal such
circumstance to the Director of Human Services. The decision of the Director of Human Services
shall be final.
6. Assurances
PROVIDER shall abide by all assurances as set forth in the attached Exhibit D, which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract, PROVIDER 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. PROVIDER 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
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, PROVIDER and Human Services will resist in judicial
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
Included in 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.
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8. Certifications
PROVIDER 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. A copy of certificate will be provided to Human Services upon completion of this agreement.
Failure to do so will null and void this contract in its entirety.
9. Monitoring and Evaluation
PROVIDER and Human Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER and Human Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER.
PROVIDER shall permit Human Services, and any other duly authorized agent or govemmental agency, to
monitor all activities conducted by PROVIDER 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.
10. Modification of Agreement
All modifications to this agreement shall be in writing and signed by both parties.
II. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
PROVIDER 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
PROVIDER. These remedial actions are as follows:
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 the Human Services. Denial of the amount of payment
shall be reasonably related to the amount of work or deliverables lost to Human Services;
c. Incorrect payment to PROVIDER due to omission, error, fraud, and/or defalcation shall be
recovered from PROVIDER by deduction from subsequent payments under this Agreement or other
agreements between Human Services and PROVIDER, or by Human Services as a debt due to
Human Services or otherwise as provided by law.
12. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For Human Services:
Gloria Romansik
Name
For Provider:
Melody Witten, & Kimberly Lee
Name
Human Services Administrator
Title
Title
Respite Care Provider
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13. Notice
All notices required to be given by the parties hereunder shall be given by certified or registered mail to the
individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent:
To: Human Services To: Melody Willed, & Kimberly Lee
Judy A. Griego, Director 219 N 4th Street
P.O. Box A LaSalle, CO 80645
Greeley, CO 80632
14. Litigation
PROVIDER shall promptly notify Human Services in the event that PROVIDER learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Human Services Director. The term "litigation" includes an assignment for the benefit
of creditors, and filings in bankruptcy, reorganization and/or foreclosure.
15. 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. PROVIDER reserves the right to suspend services to clients if funding is
no longer available.
16. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 10 herein.
17. No Third Party Beneficiary. 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 and nothing 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 receiving services or benefits under
this Agreement shall be an incidental beneficiary only.
18. No portion of this Agreement shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may posses, nor shall any portion of this Agreement be deemed to have created a duty
of care which did not previously exist with respect to any person not a party to this Agreement.
IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year
first above written.
ATTEST:
WELD COUNTY
CLERK TO THE BOARD
By:
BOARD OF COUNTY
COMMISSIONERS WELD
COUNTY, COLO
AUG 0 5 1009
9a -22-7f7/
09 -10 -RESPITE CARE
APPROVED AS TO FO
7
County
WELD COUNTY DEPARTMENT
OF HUMAN ERVICES
By:
Jud
Provider
BY
Melody Willert &Rimberly Lee
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EXHIBIT A
SCOPE OF SERVICES
Each Provider will:
I. Complete a fingerprint card for a background check at the PROVIDERS expense with the
Colorado Bureau of Investigation. A Federal Bureau of Investigation background check will
be done if the Provider has been a resident of the State of Colorado for less than two years.
Human Services will clear the Provider through CBI and FBI;
2. Complete a course in CPR and first aid, in which a current copy of the certifications must be
provided to Human Services with this agreement. If either certification should expire during
the contracted period, the Provider will send a new current certification copy to Human
Services;
3. Provide transportation for the child to appointments during the hours of service as agreed
upon with the foster parent;
4. Become familiar with State rules and regulations governing certified foster homes;
5. Must be eighteen years of age or older.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Human Services agrees to reimburse PROVIDER in consideration for the work and services performed
under Child Welfare Regular Administration funding.
Expenses incurred by PROVIDER, in association with said project prior to the term of this agreement, are
not eligible Human Services expenditures and shall not be reimbursed by Human Services.
Payment pursuant to this Contract, if Child Welfare Regular Administration funds, whether in whole or in
part, is subject to and contingent upon the continuing availability of Child Welfare Regular Administration
funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable as
determined by Human Services, Human Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Respite care is limited to four hours per week per child. The hours of care may be provided in any
combination throughout a month, but not to exceed 16 hours per month. Payment will be $16.75 per each
four hour period, but not to exceed $67.00 per month for 16 hours.
Human Services referrals will not be sent to collections by PROVIDER for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co -pay.
PROVIDER will collect any applicable sliding scale co -pays and credit Human Services for any payments
received on the monthly billing statements.
3. Submittal of Vouchers
PROVIDER shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility" in Exhibit E, 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.
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EXHIBIT C
ASSURANCES
1. PROVIDER 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 PROVIDER -contracted
PROVIDERS or its employees, volunteers, or agents while performing duties as described in this
Agreement. PROVIDER shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers, and agents. PROVIDER 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, PROVIDER shall provide Human Services
with the acceptable evidence that such coverage is in effect.
3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their
officers or employees may possess, not shall any portion of this Agreement be deemed to have treated a
duty of care with respect to any persons not a party of this Agreement.
4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State
of Colorado, to expend funds not otherwise appropriated in each succeeding year.
5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or
decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The
parties hereto declare that they would have entered into this Contract and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or
invalid.
6. No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
7. PROVIDER 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. PROVIDER 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 PROVIDER.
9. All such records, documents, communications, and other materials shall be the property of Human Services
and shall be maintained by PROVIDER, in a central location and custodian, in behalf of Human Services,
for a period of four (4) 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 four (4) year period, or if audit findings have not been resolved
after a four (4) year period, the materials shall be retained until the resolution of the audit finding.
10. PROVIDER 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.
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This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and
assigns. PROVIDER or Human Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. PROVIDER certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of
PROVIDER, 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. PROVIDER assures that it will fully comply with all other applicable federal and state laws. PROVIDER
understands that the source of funds to be used under this Contract is Child Welfare Regular
Administration funds.
14. PROVIDER 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 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 11(b) 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 Human Services
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, PROVIDER 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, PROVIDER shall submit to Human Services, a full disclosure
statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly
submit a disclosure statement required by this paragraph shall constitute grounds for Human Services'
termination, for cause, of its contract with PROVIDER.
16. PROVIDER 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 PROVIDER
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with PROVIDER written policies governing access to, duplication and dissemination of, all
such information. PROVIDER shall advise its employees, agents, and subcontractor, if any, that they are
subject to these confidentiality requirements. PROVIDER 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.
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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 PROVIDER in the course of providing services under this Contract will be accorded at
least the same precautions as are employed by PROVIDER for similar information in the course of its own
business.
18. PROVIDER certifies that s/he will abide by Colorado Revised Statute (C.R.S.) 26-6-104, requiring
criminal background checks for all employees, contractors, and sub -contractors.
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