The URL can be used to link to this page

Browse Search

Home My WebLink About20082129.tiff RESOLUTION RE: APPROVE STANDARD FORM FOR ADDENDUM TO INDIVIDUAL PROVIDER CONTRACT FOR PURPOSE OF FOSTER CARE SERVICES AND FOSTER CARE FACILITY AGREEMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND VARIOUS PROVIDERS WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board, sitting as the Weld County Board of Social Services, has been presented with the form of an Addendum to the Individual Provider Contract for Purpose of Foster Care Services and Foster Care Facility Agreement between the Weld County Department of Human Services and various providers, and WHEREAS, after review, the Board deems it advisable to approve the form of said addendum to said contract and agreement, a copy of which is attached hereto and incorporated herein by reference, and to delegate standing authority to the Chair of the Board of County Commissioners to execute individual agreements between the Department of Human Services and various providers. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, sitting as the Weld County Board of Social Services, that the form of the Addendum to the Individual Provider Contract for Purpose of Foster Care Services and Foster Care Facility Agreement between the Weld County Department of Human Services and various providers be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign any agreements consistent with the form of said addendum to said contract and agreement. 2008-2129 HR0079 of/a0rot. RE: STANDARD FORM FOR ADDENDUM TO INDIVIDUAL PROVIDER CONTRACT FOR PURPOSE OF FOSTER CARE SERVICES AND FOSTER CARE FACILITY AGREEMENT PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 6th day of August, A.D., 2008. BOARD OF COUNTY COMMISSIONERS �� f \ kLas ELD COUNTY, COLORADO bl ATTEST: i �L - t 1861 F .. ' �!` 'am H. Jerke, Chair Weld County Clerk to the Bird =J � (� �, -I �. if Aobert D. Marsden, Pro-Tem BY: "�l44L- ,4 / Deputy Clerk tthhe Board (, `, c W F. Garcia PRO D AST M: David E. Long ounnty ney ��a%� ougla ademac er Date of signature: 2008-2129 HR0079 a DEPARTMENT OF HUMAN SERVICES P.O. BOX A 1 GREELEY, CO. 80632 �1 Website:www.co.weld.co.us Administration and Public Assistance(970)352-1551 Child Support(970)352-6933 • COLORADO MEMORANDUM TO: Judy Griego- Director FROM: Lesley Cobb -Child Welfare Contract Negotiator DATE: August 28, 2008 SUBJECT: Out-of-home providers to be submitted to the Board of County Commissioner for Consent. Attached please find a list of out-of-home providers that I am requesting to be submitted to the Board of County Commissioner for their consent. Directory: Attachment I—RCCF/TRCCF Providers Rates are based on the State Standard rates(also known as base anchor rates).The provider received a 1.5%COLA,as set forth in the 08-09 Longbill and approved by the Board of Weld County Commissioners. Attachment II—County Certified Foster Care Providers Rates are Based the Needs Based Care Assessment and rate table as approved by the Board of Weld County Commissioners. Attachment III—Child Placement Agency Providers Rates are Based the Needs Based Care Assessment and rate table as approved by the Board of Weld County Commissioners. Attachment IV—RCCF/CHRP Providers Rates are based on a negotiated rate per agency due to highly specialized care for children who are not eligible or who are awaiting approval for CHAP. Attachment V—Specialized Group Homes Rates are based on the approved rate structure as outlined in DHS policy/procedures manual section 2.308.5. **To be submitted for approval as contracts arrive: Group Centers/CPA—Due to varied rates based on negotiation with each agency/center. 2008-2129 RCCF only providers—Due to varied rates based on negotiation with each facility,this includes out of State providers. 2008-2009 CONTRACTED COUNTY FOSTER CARE PROVIDERS NAME I PROVIDER ID I MAILING ADDRESS CITY STATE ZIP Aguilar,Riley and Melissa 1510493 2081 40th Ave Greeley,CO 80634 Alaniz,Tony and Donna 1539400 2919 42nd Ave Greeley,CO 80634 Armfield,Pamela 1549727 340 W Shafer Pierce,CO 80650 Beasley,Travis and Sarah 1552607 840 Grandview Meadows Dr.#A101 Longmont,CO 80503 Brilla,Debbie 30451 2018 20th St Rd Greeley,CO 80631 Brock,Tony and Holly 1546456 4541 W 1st St Rd Greeley,CO 80634 Brown,Scott and Robin 1524302 301 Hickory Ave Eaton,CO 80615 Caldwell,Cynthia 1550399 936 Eichhorn DRn nWESTMINSTER Erie, CO 80516 Charbonneau,David and Loretta 1534505 6256 W 3rd St Rd Greeley,CO 80634 Combs,Colin and Hubert, Rebecca 1545310 5937 W 28th ST Greeley,CO 80634 Cook,Glen and Doleshall,Todd 1532458 29720 CR 78 Eaton,CO 80615 Corliss,Wade and Loni 1547483 26649 CR 60 1/2 Greeley,CO 80631 Cowper,Michael and Alecia 1526756 509 N Sholdt Dr Platteville, CO 80651 Crownover,Ernie and Jennifer 1512351 421 Ventana Way Windsor,CO 80550 Dietz,Bill and Wilma 8635 21257 Hwy14 Ault,CO 80610 Erbacher,Dan and Nellie 1546381 3850 Cheyenne Dr Greeley,CO 80634 Fisher,Matthew and Claire 1532312 5022 W 2nd St Rd Greeley,CO 80634 Fisher,Steve and Joletta 1515472 1416 16th Ave Greeley,CO 80631 Flores, Isaiah and Annette 1534649 302 Maple Ave Eaton,CO 80615 Frank,Jerry and Diana 1530545 7950 Colombine Ave Frederick,CO 80530 Funk-Breay, Edward and Elizabeth 1537105 2047 Kaplan Court Windsor,CO 80550 Garnet,Steven and Cindy 1525231 1324 10th St Greeley,CO 80634 Geesaman,Sterling and Joyce 17920 1275 42 Ave Ct Greeley, CO 80634 Gerardy,Jerry and Priscilla 1530549 3408 Cody Ave Evans,CO 80620 Gilstrap,William and Lynnette 1525054 6363 St Vrain Ranch Blvd Firestone,CO 80504 Hamilton,Kerry and Kate 1547784 3121 39th Ave Evans,CO 80620 Hebbeler,Troy and Christina 1522988 3610 Cactus Ave Evans,CO 80620 Heimer,Sara 1547292 3000 W 19th St Greeley,CO 80634 Hernandez,Roberto and Margarita 1520297 912 Elm Ct Fort Lupton,CO 80621 Hickey,Laurie 1518754 1125 Walnut St Windsor,CO 80550 Holmgren, David and Dawn 1522699 864 Amber Court Windsor,CO 80550 Housden,Richard and Rhonda 1550415 1671 S Troy St Aurora, CO 80012 Humphries,Jason and Rebecca 1545857 1631 Brentford Ln Fort Collins, CO 80525 Hunt,Olen J and Nina 1503154 224 48th Ave Greeley,CO 80634 Hymel,Chad and Tiffany 1540875 1257 Red Mountain Dr Longmont,CO 80501 Jackson,Scott and Andrea 1536689 425 Hickory Ln Johnstown,CO 80534 Keaton,Roger(R.C.)and Eva 1545954 25565 CR 47 Greeley,CO 80631 Kennedy,Joleta 1515472 1416 16th Ave Greeley,CO 80631-4535 Kilgore,Julius and Pamela 1538189 1740 7th Ave Greeley,CO 80631 Kniss, Kevin and Kelly 1524303 1545 71st Ave Greeley,CO 80634 Knutson,Troy and Stacy 1522516 6250 Stagecoach Ave Firestone,CO 80504 Laube, Keith and Julie 1514494 14497 WCR 76 Eaton,CO 80615 Lee,Steve and Brenda 1512263 30932 WCR 50 Kersey,CO 80644 Leonard, Daniel and Julie 1547609 5517 Morgan Way Frederick,CO 80504-4423 Lewis,David and Connie 1523277 2904 42nd Ave Greeley,CO 80634 Loschen,Todd and Alicia 1528352 1747 68th Ave Greeley, CO 80634 Louvado-Gaige, Frank and Virginia 1551566 3041 Promontory Loop Broomfield,CO 80023 Maronek, Dennis and Patricia 1520627 4860 Eagle Crest Blvd Firestone,CO 80504 Martinez,Joseph and Patricia 1548845 9659 W 75th Ave Arvada,CO 80005 McCreery,James and Tammy 40215 120 Maple Ave Eaton,CO 80615 McGee,Donna 1539853 1649 31st Ave Greeley,CO 80634 Mellmen,Jeffrey and Letha 1547484 352 Laurel Ave Eaton,CO 80615 Mena,David and Marie 1510691 2905 41st Ave Greeley,CO 80634 Middleton,Brian and Deborah 1537851 2418 W.24th St Rd Greeley,CO 80634 Miller,Matt and Kyle 1546600 1829 31st St Greeley,CO 80631 Moore,Earl and Patricia 1517579 135 Poplar St Lochbuie, CO 80603 Munnelly,John and Heidi 1523563 291 Columbus St Windsor,CO 80550 Murrell,Nicholas and Terri 1547183 812 Scotch Pine Dr Windsor, CO 80550 Newbold,Scott and Monica 1549222 4324 Silverview Court For Collins,CO 80526 Oster, Kelly and Stacey 1512982 3717 Dry Gulch Rd Evans,CO 80620 Parker, Brian and Beryldell 1538709 3001 50th Ave Greeley,CO 80634 Parmer,Charles and Michelle 1538773 3407 W 24th St Greeley,CO 80634 Perry, Percy and Carmon 1543000 10619 Bald Eagle Circle Firstone,CO 80504 Plums, Mike and Annette 35126 PO Box 34 Kersey,CO 80644 Preston,Daniel and Lisa 1548050 611 Cornerstone Dr Windsor,CO 80550 Purcella,Denise 1551571 10656 Bald Eagle Circle Firestone,CO 80504 Reel,Charles and Carmen 1526232 4319 W 15th St Ln Greeley,CO Ramos,Julian 37631 2604 49th Ave Greeley,CO 80634 Ransome,Christopher and Mary 1552605 1903 24th Ave Greeley,CO 80634 Rasmussen,Dennis and Diane 104555 345 Gypsum Lane Johnstown,CO 80534 Redding,Christopher and Sonja 1524128 2305 42nd Ave Greeley,CO 80634 Reed,Matthew and Brooke 1537242 6129 W 6th St Greeley,CO 80634 Reedy, Gerald and Crystal 1547166 165 50th Ave Place Greeley,CO 80634 Reyna,Ali and Jessica 1502220 3304 Syrah St Greeley,CO 80634 Ripka,Gary and Jennifer 1538429 2113 74th Ave Greeley,CO 80634 Rogers,Jeffrey and Tami 1550689 5221 Bowersox Parkway Firestone,CO 80504 Rutz, HV(Vernon)and Audrey 1544080 10936 Co Rd 70 Windsor,CO 80550 Salazar,Samuel and Nichole 1547394 1504 27th St Greeley,CO 80631 Sears,Alan and Diane 1551278 61 Westward Way Eaton,CO 80615 Sevestre,Lewis and Maureen 1551169 1717 69th Ave Greeley,CO 80634 Shindle,Danny and Andrea 1550177 1606 Fairacres Rd. Greeley,CO 80631 Skeldum,William 16666 5113 Saguaro Ct Johnstown,CO 80534 Slaughenhaupt,Gary and Grace 1544611 30633 CR 78 Eaton,CO 80615 Slipka,Darrel and Ruby 1525217 515 Shirley Ct Platteville,CO 80651 Steitz,Daniel and Natalie 1546930 1701 Elder Ave Greeley,CO 80631 Sugden,Stanley and Lena 1537224 1251 51st Ave Greeley,CO 80634 Trevino-Rivera, Irene 1506181 4227 W 31st ST Greeley,CO 80634 Van Den Elzen,Dawn 44282 7219 W 20th St Ln Greeley,CO 80634 Varela, Helen 11418 1718 12th Ave Greeley,CO 80631 Walker,Kurt and Jennifer 1546248 1901 15th St Greeley,CO 80631 White, Richard and Melissa 1545830 3109 W 13th St Greeley,CO 80634 Willert, Melody D and Lee, Kimberly 1540372 219 N 4th St LaSalle,CO 80645 WELD COUNTY ADDENDUM To that certain Individual Provider Contract for Purpose of Foster Care Services and Foster Care Facility Agreement(the "Agreement") between «NAME» and the Weld County Department of Human Services for the period from July 1, 2008 through June 30,2009. The following provisions, made this day of , 2008, are added to the referenced Agreement. Except as modified hereby, all terms of the Agreement remain unchanged. GENERAL PROVISIONS 1. County and Provider agree that a child specific Needs Based Care Assessment, designated as Attachment B, shall be used to determine levels of care for each child placed with Provider unless the child is placed in a County certified kinship foster care home or if the child is placed in a County foster/adoption home as a pre-adoptive placement. Kinship foster care homes and pre-adoptive placements will be reimbursed at the County Basic Maintenance level on the Needs Based Care Rate Table, designated as Attachment C, regardless of the child's level of need. 2. County agrees to purchase and Provider agrees to provide the care and services, which are listed in this Agreement,based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Attachment C, for children placed within the Weld County Certified Foster Care Home identified as Provider ID#«PROVIDER ID». These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to Provider. 4. Any additional costs for specialized services, which may include but are not limited to; Co-pays, deductibles, or services not covered by Medicaid, will need to be authorized, in writing by the Department Administrator, prior to the service being performed. Any payment for specialized services not authorized in writing may be denied. 5. All reimbursement requests shall be submitted to and approved by the appropriate County staff as set forth in the Foster Parent Handbook. Reimbursement for placement services shall be paid from the date of placement up to, but not including the day of discharge. All billings by the Provider must be in a format approved by the County and may be returned unpaid if submitted in an unapproved format or inadequate documentation is provided. All billings are to be submitted by the 4th of each month following the month of service. If the billing is not submitted within twenty-five (25) calendar days of the month following service, it may result in forfeiture of payment. ] Weld County Addendum to the CWS-7A 6. The Director of Human Services or designee may exercise the following remedial actions should s/he find that the 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 the Provider as outlined in the State Department Staff Manual Volume VII and/or County Department Policy and Procedure Manual. These remedial actions are as follows: A. Withhold payment to the 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 the 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. Recover from the Provider any incorrect payment due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement or other agreements between Human Services and the Provider, or by Human Services as a debt to Human Services or otherwise as provided by law. 7. Provider shall promptly notify Human Services in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Provider, within five(5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the Human Services' Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. PROVIDER AGREES: 1. To attend or participate, if requested by the Department, in staffing a child's placement with the Utilization Review Team. This review team convenes every Monday morning, excluding holidays but may hold emergency staffings as needed. 2. To request a staffing if considering giving notice to remove a child, except in emergency situations. These requests shall be made through the child's caseworker and/or the provider's Foster Home Coordinator. 3. To cooperate with any contractors hired by Weld County Department of Human Services or Weld County Department of Human Services staff to preserve placement in the least restrictive placement appropriate and to comply with the treatment plan of the child. 4. To schedule physical and dental examinations within 48 hours after a child is placed in provider's care. Medical examinations need to be completed within 10 days of the child being placed with Provider and dental examinations need to be completed within 14 days of the child being placed with Provider. All documentation of these examinations will be placed in the Foster Child's Placement Information Management Binder or as indicated in the Foster Parent Handbook. 5. To attend all necessary school meetings and support any plan that is developed regarding the child in order to promote educational success. 2 Weld County Addendum to the CWS-7A 6. To read, be familiar with and agree to the terms and conditions as set forth in the Foster Parent Handbook. 7. To report to the County Department and/or local law enforcement any known or suspected child abuse or neglect as set fourth in Section 19-3-304, C.R.S. 8. To maintain/access information on the Foster Parents Internet Database On-line System (FIDOS) as indicated in the Foster Parent Handbook. 9. To maintain/update information in the Foster Child Placement Information Management binder. The binder may be reviewed on a monthly basis and signed off by child's caseworker and/or the provider's Foster Home Coordinator. 10. To maintain behavior observation notes as required by the level of care assessed for each child as indicted in the Foster Parent Handbook. EXHIBITS: (Please refer to pages 4-7) 3 Weld County Addendum to the CWS-7A WELD COUNTY DSS NEEDS BASED CARE ASSESSMENT (Exhibit B) IDENTIFYING INFORMATION CHILD'S NAME STATE ID# SEX rTRAILS CASE ID DOB M F WORKER COMPLETING ASSESSMENT HH# IDATE OF ASSESSMENT AGENCY NAME PROVIDER NAME PROVIDER TRAILS ID ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below,please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care provider for the following: Therapy;Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc.,as outlined in the treatment plan? ❑Basic Maint.)Less than one round trip a week 01)One round trip a week ❑1%:)2 round trips a week 02)3-4 round trips a week. ❑2'%)5 round trips a week 03)6 round trips a week 03%)7 round trips or more P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions? 0 Basic Maint.)No participation required ❑1)Once a month 011/2)Two times month 02)Three times a month 02%)Once a week 03)Two times a week 03%)Three times a week or more P 3. How much time is the provider required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.)No educational requirements ❑l)Less than a Yz hour per day 011/2) %x hour a day ❑2) 1 hour a day 02 %) 11/2-2 hours per day 03)2%-3 hours per day 03%)More that 3 hours per day P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time and/or activities and/or crisis management? 0 Basic Maint.)No special involvement needed 01)Less than 5 hours per week ❑1'%)5 to 7 hours per week ❑2) 8 to 10 hours per week ❑2%) 11 to 14 hours per week 0 3)Constant basis during awake hours 03%)Nighttime hours P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feeding, bathing,grooming,physical, and/or occupational therapy? 0 Basic Maint.)0-2 hours per week ❑1)3 to 4 hours per week ❑1%)5 to 7 hours per week ❑2)8 to 10 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week 031/2)21 or more hours per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.)Face-to-face contact one time per month with child and no crisis intervention. (i.e.mutual care placements.) 01)Face-to-face contact one time per month with child and minimal crisis intervention. ❑1'/)Face-to-face contact one time per month with child and occasional crisis intervention. 02)Face-to-face contact two times per month with child and occasional crisis intervention. 02%)Face-to-face contact three times per month with child and occasional crisis intervention. 03)Face-to-face contact weekly with child and occasional crisis intervention. 03%)Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group,or more than one County foster child is with the same provider. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? 00)Not needed or provided by another source(i.e.Medicaid) ❑l)Less than 4 hours per month 02)4-8 hours per month 03)9-12 hours per month 4 Weld County Addendum to the CWS-7A WELD COUNTY DSS NEEDS BASED CARE ASSESSMENT (Exhibit B) BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category) Assessment Areas Nam mud Moderatq $ever@ Comments: 0 1 2 3 Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ Verbal or Physical Threatening ❑ ❑ ❑ ❑ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ Stealing ❑ ❑ ❑ O Self-injurious Behavior ❑ ❑ ❑ ❑ Substance Abuse ❑ ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ Enuresis/Encopresis ❑ ❑ ❑ ❑ Runaway ❑ ❑ ❑ ❑ Sexual Offenses ❑ ❑ ❑ ❑ 5 Weld County Addendum to the CWS-7A S-7A BEHAVIOR ASSESSMENT CONTINUED (Exhibit B) Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category) Assessment Areas None Ind Moderate Severe Comments: 0 1 2 3 Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ Disruptive Behavior ❑ ❑ ❑ ❑ Delinquent Behavior ❑ ❑ ❑ ❑ Depressive-like Behavior ❑ ❑ ❑ ❑ Medical Needs (If condition is rated"severe",please complete ❑ ❑ ❑ ❑ the Medically fragile NBC) Emancipation ❑ ❑ ❑ ❑ Eating Problems ❑ ❑ ❑ ❑ Boundary Issues ❑ ❑ ❑ ❑ Requires Night Care ❑ ❑ ❑ ❑ Education ❑ ❑ ❑ ❑ Involvement with Child's Family ❑ ❑ ❑ ❑ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) n 0 n 1 n 2 n 3 6 Weld County Addendum to the CWS-7A WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE (Exhibit C) LEVEL OF RECOMMENDED SERVICE PROVIDER RATE P1-P5 Level Rate Age 0-10...$16.32/day ($496/month) County Basic Age 11-14...$18.05/day ($549/month) Maint. Age 15-21...$19.27/day ($586/month) +Respite Care$.66/day ($20/month) $19.73 1 +$.66 Respite Care Total Rate= ($20.39 day/$620 month) $23.01 1 1/2 +$.66 Respite Care Total Rate=($23.67 day/$720 month) $26.30 2 +$.66 Respite Care Total Rate=($26.96 day/$820 month) $29.59 2 112 +$.66 Respite Care Total Rate=($30.25 day/$920 month) $32.88 3 4.66 Respite Care Total Rate=($33.54day/$1020 month) $36.16 3 112 +$.66 Respite Care Total Rate=($36.82 day/$1,120 month) 4 $39.45 TRCCF Drop Down +$66 Respite Care Total Rate=($40.11 day/$1220 month) Assessment Rate $30.25 day/$920 month(Includes Respite) (30 day max) Effective 7/1/2008 7 Weld County Addendum to the CWS-7A IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day, month, and year first above written. ATTEST: Weld County Clerk to the Board WELD COUNTY BOARD OF HUMAN SERVICES, ON BEHALF OF THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: By: Deputy Clerk to the Board Chair Signature PROVIDER: «NAME» «MAILING_ADDRESS» «CITY_STATE_ZIP» By: (Signature) WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: (Director Signature) 8 Weld County Addendum to the CWS-7A Hello