HomeMy WebLinkAbout20072080.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES FOR OPTION B
HOME BASED INTENSIVE FAMILY INTERVENTIONS AND AUTHORIZE CHAIR TO
SIGN - LUTHERAN FAMILY SERVICES
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a Child Protection Agreement for Services
for Option B Home Based Intensive Family Interventions between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Social Services, and Lutheran Family Services, commencing June 1, 2007, and
ending May 31, 2008, with further terms and conditions being as stated in said agreement, and
WHEREAS,after review,the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the Child Protection Agreement for
Services for Option B Home Based Intensive Family Interventions between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf
of the Department of Social Services, and Lutheran Family Services be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 23rd day of July, A.D., 2007, nunc pro tunc June 1, 2007.
"\I• WELD COUNTY,OF COUNTY COMMISSIONERS
COLORADO
ATTEST: I �� �..� XCUSED
a avid E. Long, Chair
Weld County Clerk to thee, �'� �►
EXCUSEDWilli
BY: PYo-Tem
BY: Jan
De ty CI to the Boa . L' -
Will 12 -&
. Garccia
Ap�D AS
Robert D. Masden, Acting Chair Pro-Tem
u rney tie car „—
b Douglas`Rademac r
Date of signature:
2007-2080
SS0034
e0 S5 oS-o7-o7
itc Le3/4.4%)%s\ DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Webslte:www.co.weld.co.us
I
WliDe
Administration and Public Assistance(970)352-1551
Child Support(970)3524933
COLORADO
MEMORANDUM
TO: David E. Long, Chair Date: July 17, 2007
Board of County Commissioners q
FR: Judy A. Griego, Director, Social Services. (4 LtV1.)
RE: Child Protection Agreement for Services b een Weld County Department of
Social Services and Lutheran Family Services of Colorado—Option B-Home
Based Intensive Family Interventions
Enclosed for Board approval is a Child Protection Agreements for Services between the Weld
County Department of Social Services and Lutheran Family Services of Colorado. This
Agreement was reviewed at the Board's Work Session of June 6, 2007.
1. The term of the Agreement is June 1, 2007 through May 31, 2008.
2. The Department will agree to reimburse Lutheran Family Services at a rate of$95.00 for
the treatment package for the Home Based Intensive Family Interventions Program.
Court testimony will be at an hourly rate of$60.00.
3. The Home Based Intensive Family Interventions Program under Lutheran Family
Services will be funded with Core Services resources.
4. The Home Based Intensive Family Interventions Program improves both individual and
family functioning in a time-limited, solution-focused manner. The program builds upon
primary family connections, help parents improve their parenting abilities, identify
parental strengths, identify and link families to community resources and sources of
support, and support parental efforts to provide care for their children.
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2007-2080
PY-07-08 CORE-97
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES `ry, /6
AND LUTHRAN FAMILY SERVICES OF COLORADO A/*
22
This Agreement,made and entered into the 1 day of June,2007,by and between the Board of Weld County
Commissioners,sitting as the Board of Social Services,on behalf of the Weld County Department of Social
Services,hereinafter referred to as"Social Services,"and Lutheran Family Services of Colorado, hereinafter
referred to as the"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 Core Services funding to Social
Services for Option B-Home Based Intensive Family Intervention;and
NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on June 1,2007,upon proper execution of this Agreement and shall
expire May 31,2008,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the 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,"of which are attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from Core
Service funds during the duration of this Agreement.
b. The Provider shall submit an itemized monthly bill to Social Services for all costs incurred and
services provided pursuant to Exhibit A of this Agreement in accordance with criteria established
by Social Services. The Provider shall submit all itemized monthly billings to Social Services no •
later than the twenty-fifth(25)day of the month following the month the service was completed.
c. Payments of costs incurred pursuant to this Agreement is expressly contingent upon the availability
of Core Service funds to Social Services.
d. Social 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.
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4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,the Provider shall
comply with the administrative requirements,cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under Core Services 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. The Provider shall provide proper monthly invoices and itemization of services performed for costs
incurred in the performance of the agreement.
b. Social Services may withhold any payment if the 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,the Provider may appeal such circumstance to the
Director of Social Services. The decision of the Director of Social Services shall be final.
6. Assurances
The Provider shall abide by all assurances as set forth in the attached Exhibit C,which is attached hereto and
incorporated herein by reference.
7. Compliance with Applicable Laws
At all times during the performance of this contract,the 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. The 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
its implementing regulations,45 C.F.R.Part 84;and
the Age Discrimination Act of 1975,42 U.S.C. Sections 6101 et.seq.and
its implementation regulations,45 C.F.R.Part 91;and
Title VII of the Civil Rights Act of 1964;and
the Age Discrimination in Employment Act of 1967;and
the Equal Pay Act of 1963;and
the Education Amendments of 1972;and
Immigration Reform and Control Act of 1986,P.L.99-603;
42 C.F.R.Part 2
and all regulations applicable to these laws prohibiting discrimination because of race,color,
National origin,and sex,religion and handicap,including Acquired Immune Deficiency Syndrome(AIDS)
or AIDS related conditions,covered under Section 504 of the Rehabilitation Act of 1973,as amended, cited
above. If necessary,the Provider and Social 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 is 45 C.F.R. Part 74 Appendix G 9,which requires that affirmative steps be taken to assure that
small and minority businesses are utilized,when possible,as sources of supplies,equipment,construction
and services. This assurance is given in consideration of and for the purpose of obtaining any and all
federal and/or state financial assistance.
Any person who feels that s/he has been discriminated against has the right to file a complaint either with
the Colorado Department of Human Services or with the U.S. Department of Health and Human Services,
Office for Civil Rights.
8. Certifications
The 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.
9. Monitoring and Evaluation
The Provider and Social Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Provider and Social Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and the Provider.
The Provider shall permit Social Services,and any other duly authorized agent or governmental agency,to
monitor all activities conducted by the 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 Social Services or designee may exercise the following remedial actions should s/he find
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.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 Social Services. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to Social Services;
c. Incorrect payment to the Provider due to omission,error,fraud,and/or defalcation shall be recovered
from the Provider by deduction from subsequent payments under this Agreement or other agreements
between Social Services and the Provider,or by Social Services as a debt due to Social Services or
otherwise as provided by law.
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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 Social Services:
Gloria Romansik Social Services Administrator
Name Title
For Lutheran Family Services:
James Barclay President/CEO
Name Title
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: Social Services To: Lutheran Family Services of Colorado
Judy A.Griego,Director James Barclay,President/CEO
P.O.Box A 3800 Automation Way,Ste.200
Greeley,CO 80632 Fort Collins,CO 80525
14. Litigation
The Provider shall promptly notify Social Services in the event that the Provider learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this 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 Social 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 patty given thirty(30)days written notice and is
subject to the availability of funding. The 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.
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IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year
first above written.
ATTEST:
WE D CO Y t: 'o-+►�� COUNTY
CLERK TO THE B NERS WELD
1161 bu.'� .►r
11��� �t` ' rLORADO
D4tyCler / � ( Sert D. Masden, Acting Chair Pro-Tem
07/ 3/2007
OV AS TO F LUTHERAN Y SERVIC
.BY
Colttorney s cla , reside O
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By: l
Ju A.Grie o,Direct r
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EXHIBIT A
SCOPE OF SERVICES
PROJECT DESCRIPTION
Lutheran Family Services of Colorado(LFS)is a community-based agency with an experienced staff that
offers a wide range of services to children,families and adults. It is a nonprofit agency that has provided
human services in Colorado since 1948. Although the agency was established as an affiliate of the Lutheran
Church,it is an equal opportunity agency that provides services to all individuals without consideration of
religious beliefs,race,ethnicity,gender or economic status.
The purpose of the Home-Based Intensive Family Intervention Program is to promote the safety and well
being of children and their family members by reducing the risk of child maltreatment in the home,reducing
the risk of imminent placement out of the home and/or assisting with reunifying children with their families.
The services provided through this program will build upon primary family connections,help parents
improve their parenting abilities,identify parental strengths,identify and link families to community
resources and sources of support,and support parental efforts to provide care for their children. The
program is directed toward families,focused on family strengths,is protective of children,prevents
placement or reunifies children and their families,is time limited,and solution-focused. Families must be
receptive to the services;however,exceptions are made for families who are ordered by the court to obtain
these services. The program will expedite the return of children to their families and assist in creating a
stable and nurturing family environment in which children can grow and develop. If children are returning
to their permanent home from out-of-home care,we intend to help them reintegrate and stabilize in the
family system as soon as possible. The program goal is to improve both individual and family functioning
in a time-limited,solution-focused manner.
The Home-Based Intensive Family Intervention Program combines all of the elements listed below.
• Short Term(an average of 10 weeks of service duration)
• Intensive(a maximum.of 20 hours of direct service,an average of two hours of direct service weekly)
• Home-Based(service is provided in the family's natural environment)
• Individualized(treatment focuses on the family's specific strengths and needs)
• Solution-Focused(brief counseling provided on areas of greatest risk in the family)
• Strength-Oriented(intervention builds on behavioral strengths of family members)
• Family and clinician as partners(emphasizes relationship between family and clinician;treatment based
on family's expertise)
II. TARGET/ELIGIBILITY POPULATIONS:
Because referrals come to LFS from Weld County Department of Social Services(DSS)caseworkers,the
decision that a child is at imminent risk of out-of-home placement has been made prior to the referral of the
family to LFS for home-based therapy services. However,if during the process of working with a family
unit an LFS staff member feels that a child is in imminent danger,we will immediately contact Weld
County DSS to discuss the conditions that exist in the family to determine whether they meet the criteria as
defined in 26-5.3-103(2),C.R.S.
Families considered as the appropriate target population for these services are those in which family
members are facing problems that have affected their well-being, safety,psychosocial growth and
development,and family stability. Families in the midst of a transition,such as reunification,are also
appropriate for this program. Families mandated or referred by the courts will be considered for the Option
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B program contingent upon their willingness to participate in and ability to profit by participation in such
services. Primary caregivers must demonstrate a desire to maintain family relationships and must possess
the mental stability to utilize home-based services. Children must be at imminent risk of out-of-home
placement or have been removed from the home with imminent return expected. Families appropriate for
this program should be able to benefit from services that are primarily therapeutic in nature(vs. concrete
and collateral services). The provision of services will have a reasonable possibility of diminishing or
ameliorating the problematic behaviors/issues in the home. There must be a manageable level of risk of
harm to the child and/or among family members.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
Social Services agrees to reimburse the Provider in consideration for the work and services performed
under Core Services funding.
Expenses incurred by the Provider,in association with said project prior to the term of this agreement,are
not eligible Social Services expenditures and shall not be reimbursed by Social Services.
Payment pursuant to this Contract,if Core Services funds,whether in whole or in part,is subject to and
contingent upon the continuing availability of Core Services funds for the purposes hereof. In the event
that said funds,or any part thereof,become unavailable as determined by Social Services, Social Services
may immediately terminate this Contract or amend it accordingly.
2. Fees for Services
$95 an hour for face-to-face client contact.
Travel,monthly reports,monthly billing paperwork,telephone consultation with Caseworkers and
attendance at CRT meetings are included in this rate.
Court testimony would be billed separately at the rate of$60 per hour for travel and time spent at the
Courthouse,whether testifying,meeting with DSS staff and attorneys or waiting under instruction from
Social Service attorneys.
3. Submittal of Vouchers
Provider shall prepare and submit monthly the itemized voucher and certify that the services authorized
were provided on the date indicated and the charges made were pursuant to the terms and conditions of
Exhibit A.
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EXHIBIT C
ASSURANCES
1. The Provider agrees it is an independent the Provider 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 the Provider or its
employees,volunteers,or agents while performing duties as described in this Agreement. The Provider
shall indemnify,defend,and hold harmless Weld County,the Board of County Commissioners of Weld
County,its employees,volunteers,and agents. The 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,The Provider shall provide Social 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. The 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. The 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 the Provider.
9. All such records,documents,communications,and other materials shall be the property of Social Services
and shall be maintained by the Provider,in a central location and custodian,in behalf of Social Services, for
a period of four(4)years from the date of fmal 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.
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10. The 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.
11. This Contract shall be binding upon the parties hereto,their successors,heirs,legal representatives,and
assigns. The Provider or Social Services may not assign any of its rights or obligations hereunder without
the prior written consent of both parties.
12. The Provider certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of
the 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. The Provider assures that it will fully comply with all other applicable federal and state laws. The Provider
understands that the source of funds to be used under this Contract is Child Welfare Regular Administration
funds.
14. The 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 The Provider with Social Services
when the Provider 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 Provider to
gain from knowledge of these opposing interests. It is only necessary that the Provider know that the two
relationships are in opposition.During the term of the Contract,the 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,The Provider shall submit to Social 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 Social Services'
termination,for cause,of its contract with the Provider.
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16. The 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 the Provider
shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless
in accordance with the Provider written policies governing access to,duplication and dissemination of,all
such information. The Provider shall advise its employees,agents,and sub the Provider,if any,that they
are subject to these confidentiality requirements. The Provider shall provide its employees,agents,and sub
The Providers,if any,with a copy or written explanation of these confidentiality requirements before access
to confidential data is permitted.
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 the Provider in the course of providing services under this Contract will be accorded at least the same
precautions as are employed by the Provider for similar information in the course of its own business.
18. The Provider certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,the Providers,and sub-Providers.
19. The Provider certifies that it shall comply with the provisions of Colorado Revised Statutes(C.R.S.)8-17.5-
101,et seq. The Provider shall not knowingly employ or contract with an illegal alien to perform work
under this Contract or enter into a contract with a sub-Provider that fails to certify to the Provider that the
sub-Provider shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. The Provider represents,warrants,and agrees that it(a)has verified that it does not employ any
illegal aliens,through participation in the Basic Pilot Employment Verification Program administered by
the Social Security Administration and Department of Homeland Security,and(b)otherwise will comply
with the requirements of C.R.S. 8-17.5-102(2)(b). The Provider shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and
Employment. If the Provider fails to comply with any requirement of this provision or C.R.S. 8-17.5-101,
et seq., Social Services may terminate this Contract for breach and the Provider shall be liable for actual and
consequential damages to Social Services.
Except where exempted by federal law and except as provided in C.R.S.24-76.5-103(3),if the Provider
receives federal or state funds under this Contract,the Provider must confirm that any individual natural
person eighteen(18)years of age or older is lawfully present in the United States pursuant to C.R.S.24-
76.5-103(4)if such individual applies for public benefits provided under this Contract. If the Provider
operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it(a)is a citizen of
the United States or is otherwise lawfully present in the United States pursuant to federal law,(b) shall
produce one of the forms of identification required by C.R.S. 24-76.5-101,et seq.,and(c)shall produce
one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract.
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EXHIBIT D
BILLING PROCEDURES
1. All billings are to be submitted by the 10`he day of the month following the month of
service. If the billing is not submitted within twenty-five(25) calendar days of the month
following service, it may result in forfeiture of payment.
2. Billings must be submitted with the attached required forms, Authorization for
Contractual Services, Request for Reimbursement and Client Verification Form. The
forms must be submitted with original signatures.
3. For monitored sobriety, proof of services rendered shall be a sign-in sheet with client
signatures or the test result.
12
WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
Program Year 2007-08
TO BE COMPLETED BY PROVIDER:
Date:
Provider: Billing Contact:
Phone Number:
Address:
Description of Services:
Service Month / Year: Charges: $
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE
INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE
CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF SOCIAL
SERVICES.
Printed Name of Signer Provider Signature Date
(Original signature REQUIRED—NO FAXES)
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approvals:
Core & Service Contract Coordinator Date
Director Date
Comments:
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