HomeMy WebLinkAbout20072085.tiff RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR ANGER MANAGEMENT
SERVICES AND AUTHORIZE CHAIR TO SIGN-NELSON,WOLF,AND ASSOCIATES,
P.C.
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 Anger
Management Services 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
Nelson, Wolf, and Associates, P.C., 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 Anger
Management Services 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
Nelson, Wolf, and Associates, P.C., 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.
BOARD OF COUNTY COMMISSIONERS
�II / �WELD COUNTY, COLORADO
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ATTEST: gutkil /� -iii Apr '\ USED
' 161 I 'e D.�id E. Long, Chair
Weld County Clerk to the Bird
�r ;►* :_ USED
BY. illiam H. Jykey)ro-Tem
De ty C1 the Bo.r.,
Willi F. Garcia
AP O DAST its
Robert D. Masdcn, Acting Chair Pro-Tem
ounty t rney
Dougla ademacher
Date of signature:
g
2007-2085
SS0034
a) ' SS 08'-a7-o 7
("...... t a DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
VIIChild Support(970)352-6933
Dc
COLORADO
MEMORANDUM
TO: David E. Long, Chair Date: July 23, 2007
Board of County Commissioners
{
FR: Judy A. Griego, Director, Social Services (Llt, C C ( it,(II
RE: Child Protection Agreement for Services between the Weld County
Department of Social Services and Nelson, Wolf&Associates, P.C.
Enclosed for Board approval is a Child Protection Agreement for Services between the Weld
County Department of Social Services(Department) and Nelson, Wolf& Associates. This
Agreement was reviewed at the Board's Work Session held on June 6, 2007.
The major provisions of the contract are as follows:
1. The term of the contract is June 1,2007 through May 31, 2008.
2. The source of funding is Child Welfare Administration funding.
3. Nelson, Wolf&Associates will provide anger management services with adolescents in
individual, group, and family treatment.
4. The Department will reimburse Nelson, Wolf& Associates an amount not to exceed
$2,500 according to the fee schedule and as provided in the Agreement.
If you have any questions, please telephone me at extension 6510.
2007-2085
Contract No.: PY 07-08-CPS-79
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND NELSON,WOLF&ASSOCIATES,P.C.
This Agreement,made and entered into the 1 s`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 Nelson,Wolf&Associates,P.C.,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 to Social Services for anger management and family conflict management services for
families,children,and adolescents;and
WHEREAS, Social Services requires the services of a therapeutic provider to assist the County to deliver
anger management and family conflict resolution services to youth in the child welfare system,and PROVIDER, is
willing and able to provide such services; and
WHEREAS, PROVIDER, is a Colorado non-profit corporation organized for the purpose of managing and
coordinating high quality,cost efficient,therapeutic services in the State of Colorado.
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 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,"a copy of which is attached
hereto and incorporated herein by reference.
"Payment Schedule"shall establish the maximum reimbursement,which will be paid from Child
Welfare Regular Administration funds during the duration of this Agreement.
b. 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. 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 cost was incurred.
c. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the
availability of Child Welfare Regular Administration funds to Social Services.
Contract No.: PY 07-08-CPS-79
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.
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
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. Social 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 Social Services. The decision of the Director of Social Services shall be final.
6. Assurances
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,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
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,PROVIDER,and Social Services will resist in judicial
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Contract No.: PY 07-08-CPS-79
proceedings any efforts to obtain access to client records except as permitted by 42 CFR Part 2.
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
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
PROVIDER,and Social Services agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by PROVIDER,and Social Services. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners and PROVIDER,
PROVIDER,shall permit Social 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 Social 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 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 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 Social Services and PROVIDER„or by Social Services as a debt due to Social Services or
otherwise as provided by law.
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Contract No.:PY 07-08-CPS-79
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 PROVIDER:
James P.Nelson Executive Director
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: Provider,
Judy A. Griego,Director James P.Nelson
P.O.Box A 1920 Chestnut
Greeley,CO 80632 Greeley,CO 80631
14. Litigation
PROVIDER, shall promptly notify Social 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 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 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.
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Contract No.: PY 07-08-CPS-79
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
• _%
ATTEST:
WELD COUNTY '4 � .� OF COUNTY
CLERK O THE BOARD s i wrt— SSIONERS WELD
t �.
ii Y, LORADO
By:
D JCler �, � Robert D. tMMasden, Acting Chair Pro-Tern
07/23/2007
APPj OV AS TO FO • PROVIDER:
ty Attorney Jgrhes P.Nelson,Executive Director
WELD COUNTY DEPARTMENT
OF SOCIAL ERVICES
By: `, 6
J A.Grie o,Directb
5
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Contract No.: PY 07-08-CPS-79
EXHIBIT A
SCOPE OF SERVICES
Overall Project Description
PROVIDER,shall provide services to Social Services clients,specifically adolescents,having issues with
anger management.These services will include individual,group,and family treatment.
2. Eligible Population for Services
Social Services will refer to PROVIDER,youth ages twelve to nineteen and who have an open child welfare
case or are at imminent risk of out of home placement due to their anger issues.
3. Types of Services to be Provided
A. Treatment Options
Group Therapy/Support Groups:
1. Anger Management and Conflict Resolution Groups will concentrate on discovering the
underlying feelings antecedent to anger outbursts,the irrational thoughts and fears that
contribute to the intensity of anger,and will retain individuals and families in the
understanding and diffusing of their personal anger cycles.
2. A licensed master's level therapist who has experience in group therapy with this
challenging yet rewarding population will facilitate groups.
Family Conflict Management:
1. Family Conflict Management will teach dispute resolution skills to reduce stress and
foster an atmosphere of cooperation rather than contention when internal conflicts arise
that reduces the family's ability to work together to achieve common goals and interests.
The degree of conflict within the family will be measured using an assessment devise at
the initiation of services and at the termination of services.
B. Reporting
PROVIDER,will provide monthly reports to Social Services concerning the status of each
participant including both monthly aggregate and client progress reports. All client progress
reports submitted by PROVIDER,will be substantive,clearly written,and signed by the clinician,
therapist,or evaluator. PROVIDER,will utilize the monthly progress report form created by
Social Services. PROVIDER,will incorporate into each youth treatment plan the child welfare
objective as identified by the Social Services caseworker. These objectives are derived from the
Social Services' caseworker's assessment and state what must be done to undertake behavioral
changes, to mitigate safety concerns,to resolve risks and to result in family continuity and/or
permanency. These reports will be provided to Social Services by the twenty-fifth day of each
month.
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Contract No.:PY 07-08-CPS-79
4. Fee Schedule for Services
PROVIDER,fee schedule for services is as follows:
Anger Assessment(up to 4 hours) $35.00 per hour
Individual,Group,and Family Therapy $45.00 per hour
5. Measurable Outcomes and Objectives
PROVIDER,shall abide by Social Services outcome indicators of Safety,Permanency and Child and
Family Well-Being,which are provided under Adoption and Safe Families Act (ASFA), 1997;Colorado
Child and Family Services Plan 2000-2004;and ACF Reviews(Reference: Federal Register,Volume 65,
Number 16: 45 CRF Parts 1355, 1356,and 1357),March 25,2000.
a. Client Objectives
The Social Services caseworker will identify three child welfare objectives to be addressed within
each client's treatment plan. PROVIDER,shall develop action steps to reach the identified child
welfare objectives. PROVIDER, shall report monthly on each client's progress in meeting the
three identified objectives. Each objective will be measured via a percentage Liken Scale to
determine progress.
b. Overall Program Objectives
PROVIDER,and Social Services agree to monitor the ability of the substance abuse program
offered by PROVIDER, to achieve objectives as follows:
1) Increase level of functioning currently impaired by anger issues.
2) Decrease in aggressive behaviors at home and/or school and in the community.
3) Develop the capacity to ask for help and assistance with out resorting back to aggressive
behavior.
4) Youth will demonstrate increased verbal skills,empathy and accountability
5) Youth will develop problem-solving skills when confronted with a relapse trigger
6) Youth will address past/current victimization issues that interfere with their ability to
manage their anger.
7) Improve Parent-child functioning to lower the risk of out of home placement
8) Family member will identify and implement opportunities to support the youth in their
recovery.
6. Workload Standards
PROVIDER,will meet the following workload standards:
a. Serve up to eight youth per month in anger management treatment;
b. Should there not be enough clients to begin a group,PROVIDER,will work with the youth on an
individual basis until they can be transitioned to a group.
7. Staff Qualifications
PROVIDER,staff members who will provide services to Social Services will have credentials and/or
certifications as required by the Colorado Department of Human Services,Alcohol and Drug Abuse
Division.
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Contract No.: PY 07-08-CPS-79
a. CACII; A CACII level counselor will be utilized when it appears that the primary issue is
substance abuse with underlying home/social factors.
b. LPC/LCSW;A LPC/LCSW will be utilized when the clients' substance abuse issues are a direct
result of home/social factors.
c. Case Manager; A PROVIDER case manager will be assigned to every Social Services client that
is referred for substance abuse services.
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Contract No.: PY 07-08-CPS-79
EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Social Services agrees to reimburse PROVIDER, in consideration for the work and services performed,a
total amount not to exceed Two Thousand Five Hundred Dollars($2,500)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 Social Services expenditures and shall not be reimbursed by Social 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 Social Services, Social Services may immediately terminate this Contract or amend it
accordingly.
2. Fees for Services
Anger Assessment(up to 4 hours) $35.00 per hour
Individual,Group,and Family Therapy $45.00 per hour
Social 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.
3. Submittal of Vouchers
PROVIDER,shall prepare and submit monthly the itemized voucher according to the criteria listed under
"Standards of Responsibility"in Exhibit D,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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Contract No.: PY 07-08-CPS-79
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,
PROVIDER,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 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. 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 Social Services
and shall be maintained by PROVIDER„in a central location and custodian, in behalf of Social 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
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Contract No.: PY 07-08-CPS-79
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. PROVIDER,or Social 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 Social 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,NELSON,WOLF&ASSOCIATES,
INC. 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
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,
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Contract No.: PY 07-08-CPS-79
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.
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. The Contractor certifies it will abide by Colorado Revised Statute(C.R.S.)26-6-104,requiring criminal
background record checks for all employees,contractors,and sub-contractors.
19. Contractor certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-
101, et seq. Contractor shall not knowingly employ or contract with an illegal alien to perform work under
this Contract or enter into a contract with a subcontractor that fails to certify to Contractor that the
subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this
Contract. Contractor 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). Contractor 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 Contractor 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 Contractor 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 Contractor
receives federal or state funds under this Contract, Contractor 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 Contractor
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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Contract No.:PY 07-08-CPS-79
EXHIBIT D
STANDARDS OF RESPONSIBILITY
PROVIDER,agrees to:
1. Provide a written report to the Social Services caseworker within 25 calendar days of the month following
service.
2. Report to Social Services a monthly brief report on the status of the program as prescribed by Social
Services.
3. Report expenditures and case disbursement at agreed upon times.
4. Submit monthly-completed billing forms to Core and Service Contract Coordinator,by the 10`h day of the
month following service provision. If the billing is not submitted within twenty-five(25)calendar days of
the month following service,it may result in forfeiture of payment.
5. Submit in the event no service fees are incurred during the service month,an Authorization for Contractual
Services stating no services were provided for that service month shall be submitted within twenty-five(25)
calendar days following the month of service.
6. Submit an original Request for Reimbursement in complete form to re-bill for services previously denied by
Social Services. If in the resolution process,the provider will not re-bill for payment unless the provider
can justify payment by documentation. Social Services will not consider payments that were originally
reviewed as deficient in documentation without new documentation to justify payment. Social Services shall
receive the Request for Reimbursement no later than five business days from receipt of a certified letter
from Social Services documenting such denials of payment.
7. Work with family to prepare to pay for services beyond established time frame.
8. A complete and timely billing form is identified by and must include the following elements.
a. The billing must be an original billing signed by the provider and/or designee.
b. The billing must include all forms designed for Child Welfare Administration funding
reimbursement and approved by the Department of Social Services including Colorado State
Department of Social Services Authorization for Contractual Services form and Weld County
Monthly Request for Reimbursement under Child Welfare Regular Administration Funding.
c. A re-bill must include all forms designed for re-billing of Requests for Reimbursement under
Child Welfare Regular Administration funds,and approved by the Department of Social
Services. This includes a signed original Authorization for Contractual Services and Weld
County Program Re-bill under Child Welfare Regular Administration funds and Additional
Request for Reimbursement form.
1. Authorization for Contractual Services forms must be submitted completely filled in
with an original signature from the provider and/or designee.
2. Request for Reimbursement forms must include the client's full name;Weld County
household number,suffix number,and referral number, if applicable;units provided,
service date,unit rate,and total billed for the service date.
3. Requests for payment must be date stamped by the Department of Social Services by
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Contract No.: PY 07-08-CPS-79
the 25th day of the month following the service month.Requests for payment
received after the 25th of the month following service will not be honored.
4. Re-bills for services must include only those items that can be justified with
documentation and include a signed original Authorization for Contractual Services
form and Additional Request for Reimbursement form. The form must include the
client's name;household number and suffix number,if applicable;month of billed
service,re-bill amount,the approved entry date and exit dates,the actual units re-
billed,the rate per unit,and the re-bill total for the line item.
9. Will develop and utilize evaluation tools(pre and post assessment test instruments)to collect necessary data
in cooperation with Social Services staff to monitor effectiveness of program.
10. Will meet with Social Services FPP Supervisor and/or Core and Service Contract Coordinator quarterly
(more if needed)to review program usage and effectiveness to discuss necessary improvements to better
serve families or increase referrals.
11. Be available to meet with Social Services staff to explain program,time lines of response to referrals and
answer questions to enhance program,and to participate in Core Review Team,if necessary.
12. Be available for the Families,Youth and Children Commission review and attendance at the FYC meetings.
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Contract No.: PY 07-08-CPS-79
EXHIBIT D
BILLING PROCEDURES
1. All billings are to be submitted by the l0i°`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.
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