HomeMy WebLinkAbout20062087 RESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE
CHAIR TO SIGN - YOUTH EMANCIPATION AND SERVICES, INC.
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
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 Youth
Emancipation and Services, Inc.,commencing June 1,2006,and ending May 31,2007,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 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 Youth
Emancipation and Services, Inc. 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 2nd day of August, A.D., 2006, nunc pro tunc June 1, 2006.
BOARD OF C NTY COMMISSIONERS
-`;,,. • , WELD COU , COLORADO
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nty Clerk to the �a tiQ si h ��wy
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BY:
Depu Clerk the Board --.1"---= ''' EXCUSED WilJe e APP D AS TO M:
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Date of signature: SHIN-
2006-2087
SS0033
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DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
GREELEY, CO. 80632
Website:www.co.weld.co.us
Administration and Public Assistance(970)352-1551
Child Support(970)352-6933
C.
COLORADO
MEMORANDUM
TO: M.J. Geile, Chair Date: July 26, 2006
Board of County Commissioners
FR: Judy A. Griego, Director, Social Services /�k��`� t C 1lo -ct w
1 ) 1
RE: Child Protection Agreement for Services Between the Weld County Department
of Social Services and Youth Emancipation& Services, Inc.
Enclosed for Board approval is a Child Protection Agreement for Services between the Weld
County Department of Social Services(Department) and Youth Emancipation& Services, Inc.
(Youth Emancipation). This Agreement was reviewed at the Board's Work Session of June 19,
2006.
The major provisions of the Agreement are as follows:
1. The term of the Agreement is from June 1, 2006 through May 31, 2007.
2. Youth Emancipation agrees to provide substance abuse evaluations, treatment and
monitoring of adolescents involved in child welfare cases.
3. The Department agrees to reimburse Youth Emancipation at rates identified in the
Agreement with at total not to exceed $50,000.
4. The source of funding is Core Services funding.
If you have any questions,please telephone me at extension 6510.
•
2006-2087
06-07-CPS 69
CHILD PROTECTION AGREEMENT FOR SERVICES
BETWEEN THE WELD COUNTY DEPARTMENT OF SOCIAL SERVICES
AND YOUTH EMANCIPATION& SERVICES,INC.
This Agreement, made and entered into the 1'day of June 2006,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 Youth Emancipation& Services, Inc.,
hereinafter referred to as"Y.E.S."
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 Service funding to Social
Services for immediate referrals for monitored sobriety services for families,children, and adolescents; and
WHEREAS, Social Services requires the services of a substance abuse treatment provider to assist the
County to deliver services for immediate referrals for monitored sobriety to child welfare clients,and Y.E.S. is
willing and able to provide such services; and
WHEREAS, Social Services requires the services of a substance abuse treatment provider to assist
Social Services in delivering substance abuse treatment services to child welfare clients upon the depletion of
Core funding;and
WHEREAS, Y.E.S. is a Colorado non-profit corporation organized for the purpose of managing and
coordinating high quality,cost efficient, integrated chemical dependency and related behavioral health care
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 1,2006,upon proper execution of this Agreement and
shall expire May 31,2007,unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by Y.E.S. network providers 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,"copies 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.
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Y.E.S., in accordance with federal HIPAA regulations,will be adopting the standard
transaction code set for all treatment services on or before October 16,2003. Even though this
compliance will change the service labels and groupings, the net fees associated with those
services will not change.
b. Y.E.S. 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. Y.E.S. 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 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.
4. Financial Management
At all times from the effective date of this Contract until completion of this Contract,Y.E.S. 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 Service 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. Y.E.S.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 Y.E.S. has failed to comply with the Financial
Management Requirements,program objectives,contractual terms, or reporting requirements.
In the event of a forfeiture of reimbursements, Y.E.S.may appeal such circumstance to the
Director of Social Services. The decision of the Director of Social Services shall be final.
6. Assurances
Y.E.S.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,Y.E.S. 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. Y.E.S.acknowledges that the following laws are
included:
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Title VI of the Civil Rights Act of 1964,42 U.S.C. Sections 2000d—1 et. seq.and its implementing
regulation,45 C.F.R. Part 80 a seq.;and
Section 504 of the Rehabilitation Act of 1973,29 U.S.C.Section 794,and 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,Y.E.S. and Social Services will resist in judicial 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
Y.E.S.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
Y.E.S.and Social Services agree that monitoring and evaluation of the performance of this Agreement
shall be conducted by Y.E.S. and Social Services. The results of the monitoring and evaluation shall be
provided to the Board of Weld County Commissioners and Y.E.S..
Y.E.S. shall permit Social Services, and any other duly authorized agent or governmental agency, to
monitor all activities conducted by Y.E.S.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.
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11. Remedies
The Director of Social Services or designee may exercise the following remedial actions should s/he
find Y.E.S. 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 Y.E.S.. These remedial actions are as follows:
a. Withhold payment to Y.E.S.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 Y.E.S. cannot be performed or if
performed would be of no value to 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 Y.E.S.due to omission,error,fraud,and/or defalcation shall be recovered
from Y.E.S.by deduction from subsequent payments under this Agreement or other agreements
between Social Services and Y.E.S.,or by Social Services as a debt due to Social Services or
otherwise as provided by law.
12. Representatives
For the purpose of this Agreement,the individuals identified below are hereby designated
representatives of the respective parties. Either party may from time to time designate in writing a new
or substitute representative(s):
For Social Services:
Gloria Romansik Social Services Administrator
Name Title
For Y.E.S.:
James P.Nelson Executive Director,Youth Emancipation&Services,Inc..
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: Youth Emancipation&Services,Inc.
Judy A.Griego,Director James P.Nelson,Executive Director
P.O.Box A 1600 31st Avenue
Greeley,CO 80632 Greeley,CO 80631
14. Litigation
Y.E.S.hall promptly notify Social Services in the event that Y.E.S. learns of any actual litigation in
which it is a party defendant in a case that involves services provided under this Agreement. Y.E.S.,
within five(5)calendar days after being served with a summons, complaint, or other pleading,which
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06-07-CPS 69
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 maybe terminated at any time by either party given thirty(30)days written notice and is
subject to the availability of funding. Y.E.S.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.
IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first
above written.
3 ,1 , \
ATTEST: ��..,. % L✓ a
WELD COUNTY s� OF COUNTY
CLERK TO THE BOARD ISM t i" .SIONERS WEL
%-1 Vgg,� I C ,COLORAD
S. .
By: 1,t .�1 i "Art P/G
De Clerk t, • , J. eile, hair
AUG 0 2 2006
APPRO AS TO FO YOUTH EMANCIPATION &SERVICES, INC.
BY
o my omey e P. elson,Executive Director
WELD COUNTY DEPARTMENT
OF SOCIAL SERVICES
By:
Jud A.Grieg , irect
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06-07-CPS 69
EXHIBIT A
SCOPE OF SERVICES
1. Overall Project Description
Y.E.S. shall provide services including client evaluations, substance abuse treatment,sobriety
monitoring,case consultation and testimony in court for adolescents referred by Social Services. Each
client's treatment needs will be assessed on an individual basis,and the level or modality of treatment
provided by Y.E.S. will be based on the client's needs,in accordance with the American Society of
Addiction Medicine's(ASAM)patient placement criteria.
2. Eligible Population for Services
Social Services will refer to Y.E.S. youth ages twelve to nineteen and who have an open child welfare
case or at imminent risk of out of home placement due to their substance abuse.
3. Types of Services To Be Provided
A. Adolescent Substance Abuse Assessment
Y.E.S.will evaluate and assess alcohol/drug involvement as well as mental health status,
sexual history,legal history and administer certain standard tests(ASAP, SASI,ASAM,
Walmyr Scales). Y.E.S. will provide a summary of assessment including recommendations to
the Social Services' case manager. Y.E.S.'s substance abuse evaluator will complete the
assessment within 10 working days of the face-to-face interview.
Y.E.S. agrees to include a Baseline Urinalysis Testing(7-Panel)as part of the assessment.
B. Treatment Options
Y.E.S.'s treatment options will be dependent upon the American Society of Addiction
Medicine(ASAM)level of care that is formulated at the completion of the substance abuse
assessment.Through group, family,and individual counseling,the methods used to create
change are generated through cognitive and behavioral therapy, Gestalt,problem solving
techniques, motivation enhancement,and solution focused therapy. These will be used in
conjunction with or alone depending upon the client's needs. Y.E.S. agrees to provide the
ASAM level of care as follows:
Level of Care Descriptio
.5 = 10 Groups Client meets once a week for,9erunutes,family
therapy for one hour a week,and one individual
counseling session per month. �/
1.0=20 Groups Client meets once a week for minutes; family
therapy one hour a week,and two individual sessions
per month.
Over 1.0=30 groups Client meets once a week for nutes; mily
therapy one hour a week,and up to four individual
sessions per month.
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06-07-CPS 69
C. Reporting
Y.E.S.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
Y.E.S. will be substantive, clearly written,and signed by the clinician,therapist,or evaluator.
Y.E.S. will utilize the monthly progress report form created by Social Services. Y.E.S.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.
4. Fee Schedule for Services
Y.E.S.'s fee schedule for services is as follows:
Description of Services Fee/Cost
Drug and Alcohol Assessments,which $35.00 Per Hour (Maximum of 6 Hours)
includes SASI,ASAP,ASAM&Walmyr
Scales
UA with Assessment including random UAs 3 Panel UA -$10.00
for 2-3 times per week 3 Panel Confirmation-$10.00
5 Panel UA- $15.00
5 Panel Confirmation-$15.00
7 Panel UA-$20.00
7 Panel Confirmation-$20.00
Swab Test-$18.00
Drug/Alcohol Treatment Counseling Groups $45.00 Per Person Per Group
Individual Counseling $35.00/hr BA Level
$45.00/hr LPC/LCSW
Family Therapy $45.00/hr LPC/LMFT
5. Measurable Outcomes and Objectives
Y.E.S. 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.
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06-07-CPS 69
a. Client Objectives
The Social Services caseworker will identify three child welfare objectives to be addressed
within each client's treatment plan. Y.E.S. shall develop action steps to reach the identified
child welfare objectives. Y.E.S. 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
Y.E.S. and Social Services agree to monitor the ability of the substance abuse program offered
by Y.E.S. to achieve objectives as follows:
1) Increase level of functioning currently impaired by substance abuse.
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
substance abuse.
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
maintain sobriety.
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
Y.E.S. will meet the following workload standards:
a. Complete up to 12 youth substance abuse evaluations per month;
b. Begin group treatment with a minimum of four clients not to exceed 8 clients per group.
Should there not be enough clients to begin a group,Y.E.S. will work with the youth on an
individual basis until they can be transitioned to a group.
7. Staff Qualifications
Y.E.S. 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.
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 Y.E.S. case manager will be assigned to every Social Services client that is
referred for substance abuse services.
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EXHIBIT B
PAYMENT SCHEDULE
Funding and Method of Payment
Social Services agrees to reimburse to Y.E.S. in consideration for the work and services performed,a
total amount not to exceed Fifty Thousand dollars($50,000.00)under Core Service funding.
Expenses incurred by Y.E.S., 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 Service funds,whether in whole or in part, is subject to and
contingent upon the continuing availability of Core Service 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
Fees for services will be based on services and fees as described in Exhibit A.
Social Services referrals will not be sent to collections by Y.E.S. for default of co-pay/fees. Services
will be performed regardless of client's refusal or inability to pay co-pay.
The Sliding Fee Schedule will only be applied to those services as noted on the fee schedule,all other
fees will be charged directly to Social Services.
Y.E.S.will collect any applicable sliding scale co-pays and credit Social Services for any payments
received on the monthly billing statements.
For those clients who have the responsibility to pay for their own treatment and related services as
documented by court order, Y.E.S.will treat such clients as a non-Social Services referral and
according to its rules and regulations afforded to other community clients.
3. Submittal of Vouchers
Y.E.S. 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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EXHIBIT C
ASSURANCES
1. Y.E.S. 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 Y.E.S.-
contracted providers or its employees,volunteers,or agents while performing duties as described in this
Agreement. Y.E.S. shall indemnify,defend,and hold harmless Weld County,the Board of County
Commissioners of Weld County,its employees,volunteers,and agents. Y.E.S. 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, Y.E.S. 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. Y.E.S. 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. Y.E.S. 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 Y.E.S..
9. All such records,documents,communications,and other materials shall be the property of Social
Services and shall be maintained by Y.E.S., 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
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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. Y.E.S. 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. Y.E.S. or Social Services may not assign any of its rights or obligations hereunder without the
prior written consent of both parties.
12. Y.E.S. certifies that federal appropriated funds have not been paid or will be paid,by or on behalf of
Y.E.S.,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. Y.E.S. assures that it will fully comply with all other applicable federal and state laws. Y.E.S.
understands that the source of funds to be used under this Contract is Core Service funds.
14. Y.E.S.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
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know that the two relationships are in opposition. During the term of the Contract,Y.E.S. 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,Y.E.S. 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 Y.E.S..
16. Y.E.S. 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 Y.E.S. shall
be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in
accordance with Y.E.S.written policies governing access to, duplication and dissemination of,all such
information. Y.E.S. shall advise its employees,agents,and subcontractor, if any,that they are subject
to these confidentiality requirements. Y.E.S. 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 Y.E.S. in the course of providing services under this
Contract will be accorded at least the same precautions as are employed by Y.E.S. for similar
information in the course of its own business.
18. The Contractor certifies it will abide by Colorado Revised Statue(C.R.S.)26-6-104,requiring criminal
background record checks for all employees, contractors, and sub-contractors.
Page 3 of 3
06-07-CPS 69
EXHIBIT D
CORE SERVICE FUNDS
Standards of Responsibility:
Y.E.S. agrees to:
1. Provide a written report to the Social Services caseworker within 24 hours of providing services to the
client;
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 Ms.Andrea Shay,Core Services Caseworker,by the 10th
day of the month following service provision. If billing is submitted after the twenty-five(25)calendar
day of the month following service shall result in forfeiture of payment.
5. 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. Work with family to prepare to pay for services beyond established time frame.
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 Core Service Funding.
7. 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;
8. Will meet with Social Services FPP Supervisor and/or Core Services Caseworker quarterly(more if
needed)to review program usage and effectiveness to discuss necessary improvements to better serve
families or increase referrals;
9. Be available to meet with DSS staff to explain program,time lines of response to referrals and answer
questions to enhance program.
10. Be available for the Families,Youth and Children Commission review and attendance at the FYC
meetings.
Page 1 of 1
06-07-CPS 69
WELD COUNTY
AUTHORIZATION FOR CONTRACTUAL SERVICES
Date:
Provider: Billing Contact:
Phone #:
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:
Approvals:
/ /
Core Caseworker Date Director Date
AMOUNT PAYABLE: $
ANY CHANGES LISTED BELOW:
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